Delirium in the elderly: A systematic review of pharmacological and non-pharmacological treatments

Abstract

Delirium is a common disorder associated with poor prognosis, especially in the elderly. The impact of different treatment approaches for delirium on morbimortality and long-term welfare is not completely understood.OBJECTIVE:To determine the efficacy of pharmacological and non-pharmacological treatments in elderly patients with delirium.METHODS:This systematic review compared pharmacological and non-pharmacological treatments in patients over 60 years old with delirium. Databases used were: MEDLINE (PubMed), EMBASE, Cochrane CENTRAL and LILACS from inception to January 6th, 2016.RESULTS:A total of ten articles were selected. The six non-pharmacological intervention studies showed no impact on duration of delirium, mortality or institutionalization, but a decrease in severity of delirium and improvement in medium-term cognitive function were observed. The most commonly used interventions were temporal-spatial orientation, orientation to self and others, early mobilization and sleep hygiene. The four studies with pharmacological interventions found that rivastigmine reduced the duration of delirium, improved cognitive function and reduced caregiver burden; olanzapine and haloperidol decreased the severity of delirium; droperidol reduced length of hospitalization and improved delirium remission rate.CONCLUSION:Although the pharmacological approach has been used in the treatment of delirium among elderly, there have been few studies assessing its efficacy, involving a small number of patients. However, the improvements in delirium duration and severity suggest these drugs are effective in treating the condition. Once delirium has developed, non-pharmacological treatment seems less effective in controlling symptoms, and there is a lack of studies describing different non-pharmacological interventions.

A call to action for delirium research: Meta-analysis and regression of delirium associated mortality

“…This was in contrast to the decline in cardiovascular mortality observed in the past four decades [ 33 ], as well as the steady drop of approximately 1.5% per year in cancer mortality over the past two decades [ 34 ]. While pursuing an explanation for such a phenomenon, it was found that neither antipsychotic pharmacological therapy [ 35 ] nor non-pharmacological [ 36 ] interventions showed any benefit in terms of decreasing mortality. Greater awareness of delirium over the past three decades would have been expected to result in increasing diagnostic rates and lower mortality simply due to greater detection of milder cases.…”

The Management of Psychiatric Emergencies in Situations of Public Calamity

“…It is associated with a rapid reduction in brain function and is caused by physical illnesses, usually of systematic involvement. It has a high impact on morbidity and a high risk of lethality ( 43 , 44 ).…”

“…However, the diagnosis of delirium and the early identification of its causal factors depend on the training of the health team. After discharge, patients who have developed delirium will need continuous monitoring ( 21 , 43 , 44 ).…”

Hospital and nursing home patients’ experiences with delirium assessments: A qualitative content analysis

“…3 The disturbance is not due to pre-existing, established, or evolving dementia. The incidence of delirium is 1–2% in the general population, 4 11–29% in hospitalised medical patients, 11–51% in surgical patients, and as high as 82% among patients in intensive care units (ICUs). 5 In elderly patients, the incidence reaches 50% in hospitalised patients.…”

“…6 Nevertheless, many cases go undiagnosed. 4 In Dutch nursing homes and residential homes, the prevalence of delirium is 8.9% and 8.2%, respectively, 7 and in a study on lengthy stays in Canadian nursing homes, over the course of 32 months, 40.4% of patients experienced delirium. 8 Nurses’ knowledge about delirium in general and risk factors leading to delirium does not increase with graduation, higher levels of education, or years of nursing practice.…”