N Engl J Med. 1999 Mar 4;340(9):669-76.
Comment in: N Engl J Med. 1999 Jul
29;341(5):369-70;
author reply 370. N Engl J Med. 1999 Jul 29;341(5):369;
author reply 370. N Engl J Med. 1999 Jul 29;341(5):369;
author reply 370. N Engl J Med. 1999 Jul 29;341(5):370. N Engl J
Med. 1999 Mar 4;340(9):720-1.
A multicomponent intervention to prevent delirium in
hospitalized older patients.
Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L,
Acampora D, Holford TR, Cooney LM Jr.
Department of Internal Medicine, Yale University School of
Medicine, New Haven, Conn 06504, USA.
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.
Publication Types: Clinical Trial Controlled Clinical Trial
PMID: 10053175 [PubMed - indexed for MEDLINE]
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