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Cited by 801Intensive Care Unit Cognitive DisordersPatient Safety and Medication ErrorsAlcoholism and Thiamine Deficiency

Effectiveness of Multicomponent Nonpharmacological Delirium Interventions: A Meta-analysis

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Hshieh, Tammy T., Yue, Jirong, Oh, Esther, Puelle, Margaret, Dowal, Sarah, Travison, Thomas, Inouye, Sharon K.·2015·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2014.7779PMC PMC4388802
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Abstract

IMPORTANCE: Delirium, an acute disorder with high morbidity and mortality, is often preventable through multicomponent nonpharmacological strategies. The efficacy of these strategies for preventing subsequent adverse outcomes has been limited to small studies to date. OBJECTIVE: To evaluate available evidence on multicomponent nonpharmacological delirium interventions in reducing incident delirium and preventing poor outcomes associated with delirium. DATA SOURCES: PubMed, Google Scholar, ScienceDirect, and the Cochrane Database of Systematic Reviews from January 1, 1999, to December 31, 2013. STUDY SELECTION: Studies examining the following outcomes were included: delirium incidence, falls, length of stay, rate of discharge to a long-term care institution (institutionalization), and change in functional or cognitive status. DATA EXTRACTION AND SYNTHESIS: Two experienced physician reviewers independently and blindly abstracted data on outcome measures using a standardized approach. The reviewers conducted quality ratings based on the Cochrane risk-of-bias criteria for each study. MAIN OUTCOMES AND MEASURES: We identified 14 interventional studies. The results for outcomes of delirium incidence, falls, length of stay, and institutionalization were pooled for the meta-analysis, but heterogeneity limited our meta-analysis of the results for change in functional or cognitive status. Overall, 11 studies demonstrated significant reductions in delirium incidence (odds ratio [OR], 0.47; 95% CI, 0.38-0.58). Four randomized or matched trials reduced delirium incidence by 44% (OR, 0.56; 95% CI, 0.42-0.76). The rate of falls decreased significantly among intervention patients in 4 studies (OR, 0.38; 95% CI, 0.25-0.60); in 2 randomized or matched trials, the rate of falls was reduced by 64% (OR, 0.36; 95% CI, 0.22-0.61). Length of stay and institutionalization also trended toward decreases in the intervention groups, with a mean difference of -0.16 (95% CI, -0.97 to 0.64) day shorter and the odds of institutionalization 5% lower (OR, 0.95; 95% CI, 0.71-1.26). Among higher-quality randomized or matched trials, length of stay trended -0.33 (95% CI, -1.38 to 0.72) day shorter, and the odds of institutionalization trended 6% lower (OR, 0.94; 95% CI, 0.69-1.30). CONCLUSIONS AND RELEVANCE: Multicomponent nonpharmacological delirium prevention interventions are effective in reducing delirium incidence and preventing falls, with a trend toward decreasing length of stay and avoiding institutionalization. Given the current focus on prevention of hospital-based complications and improved cost-effectiveness of care, this meta-analysis supports the use of these interventions to advance acute care for older persons.

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  • The Hospital Elder Life Program (HELP) is a multidomain nonpharmacological intervention that has been shown to be effective in mitigating the risk of delirium, falls, and functional status decline in hospitalized older adults.

    “The Hospital Elder Life Program (HELP) is a multidomain nonpharmacological intervention that has been shown to be effective in mitigating the risk of these adverse events. A meta-analysis of 14 interventional studies demonstrated efficacy in reducing incidence of delirium [18], falls [18], and functional status [18].”

    From A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study (2019) · cites this paper as [18]

    The Introduction describes HELP as a multidomain program successful in preventing delirium and functional decline, and the Discussion reports that the 14-study meta-analysis found reductions in delirium and falls among hospitalized older adults. However, the Results (Functional change) say the pooled improvement in functional status was not statistically significant and should be interpreted cautiously. The meta-analysis also assessed multiple interventions, not HELP alone. (LLM, conf=0.90)

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  • HELP is used in more than 200 hospitals worldwide and serves as the gold-standard nonpharmacological intervention for risk mitigation and management of delirium, cognitive and functional decline, falls, and 1:1 observation among older adults.

    “HELP is used in more than 200 hospitals worldwide, and it serves as the gold-standard nonpharmacological intervention for the risk mitigation and management of delirium, cognitive and functional decline, falls, and 1:1 observation among older adults [18-20].”

    From A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study (2019) · cites this paper as [18]

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  1. [27]Wier LM Thomson Reuters Pfuntner A Thomson Reuters Steiner C AHRQ Hospital Utilization among Oldest Adults, 2008 HCUP Statistical Brief #103 Agency for Healthcare Research and Quality 12 2010 Agency for Healthcare Research and Quality Rockville, MD http://www.hcupus.ahrq.gov/reports/statbriefs/sb103.pdf 21413201

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Authors
Hshieh, T. T., Yue, J., Oh, E., Puelle, M., Dowal, S., Travison, T., & Inouye, S. K.
Affiliations
  • Brigham and Women's Hospital (US)
  • Sichuan University (CN)
  • Johns Hopkins University (US)
  • Hebrew SeniorLife (US)
  • Beth Israel Deaconess Medical Center (US)
Corresponding author
Hshieh, Tammy T.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2015-04-01
Volume
175
Issue
4
Pages
512
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2014.7779
PMC
PMC4388802
OpenAlex
W2106268880
Cited by
801
References
38
Citations by year
2026: 77 · 2025: 84 · 2024: 60 · 2023: 75 · 2022: 72 · 2021: 106 · 2020: 82 · 2019: 74 · 2018: 58 · 2017: 59 · 2016: 39 · 2015: 13
FWCI
48.15
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Aging (T32AG000158, AG000158, K07AG041835)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
Keywords
delirium prevention, non-pharmacological treatment, multicomponent intervention, delirium incidence, falls, length of hospital stay, institutionalization, functional status, cognitive status, hospitalized patients, risk of bias, delirium risk factors, delirium severity assessment
MeSH terms
Accidental Falls, Confusion, Delirium, Humans, Institutionalization, Length of Stay, Quality of Life, Research Design, Observer Variation, Incidence, Odds Ratio, Treatment Outcome

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