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Cited by 2,917

The DOI matches its Crossref record; 6 of the 6 references it cites were found in a registry or an index.

A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients

Open access
Inouye, Sharon K., Bogardus, Sidney T., Charpentier, Peter A., Leo-Summers, Linda, Acampora, Denise, Holford, Theodore R., Cooney, Leo M.·1999·New England Journal of Medicine
DOI 10.1056/nejm199903043400901
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Abstract

BACKGROUND: Since in hospitalized older patients delirium is associated with poor outcomes, we evaluated the effectiveness of a multicomponent strategy for the prevention of delirium. METHODS: We studied 852 patients 70 years of age or older who had been admitted to the general-medicine service at a teaching hospital. Patients from one intervention unit and two usual-care units were enrolled by means of a prospective matching strategy. The intervention consisted of standardized protocols for the management of six risk factors for delirium: cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration. Delirium, the primary outcome, was assessed daily until discharge. RESULTS: Delirium developed in 9.9 percent of the intervention group as compared with 15.0 percent of the usual-care group, (matched odds ratio, 0.60; 95 percent confidence interval, 0.39 to 0.92). The total number of days with delirium (105 vs. 161, P=0.02) and the total number of episodes (62 vs. 90, P=0.03) were significantly lower in the intervention group. However, the severity of delirium and recurrence rates were not significantly different. The overall rate of adherence to the intervention was 87 percent, and the total number of targeted risk factors per patient was significantly reduced. Intervention was associated with significant improvement in the degree of cognitive impairment among patients with cognitive impairment at admission and a reduction in the rate of use of sleep medications among all patients. Among the other risk factors per patient there were trends toward improvement in immobility, visual impairment, and hearing impairment. CONCLUSIONS: The risk-factor intervention strategy that we studied resulted in significant reductions in the number and duration of episodes of delirium in hospitalized older patients. The intervention had no significant effect on the severity of delirium or on recurrence rates; this finding suggests that primary prevention of delirium is probably the most effective treatment strategy.

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Metadata

Authors
Inouye, S. K., Bogardus, S. T., Charpentier, P. A., Leo-Summers, L., Acampora, D., Holford, T. R., & Cooney, L. M.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1999-03-04
Volume
340
Issue
9
Pages
669-676
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199903043400901
OpenAlex
W2149938672
Cited by
2,917
References
6
FWCI
46.95
Type
journal article
Language
en
Open access
bronze

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