Melatonin for delirium prevention in hospitalized patients: A systematic review and meta-analysis

SummaryDelirium is the most common acute disorder of cognitive function in older patients. Delirium is life threatening, often under-recognized, serious, and costly. The causes are multifactorial, with old age and neurocognitive disorders as the main risk factors. Etiologies are various and multifactorial, and often related to acute medical illness, adverse drug reactions, or medical complications. To date, diagnosis is clinically based, depending on the presence or absence of certain features. In view of the multifactorial etiology, multicomponent approaches seem most promising for facing patients’ needs. Pharmacological intervention, neither for prevention nor for treatment, has been proven effective unanimously. This article reviews the current clinical practice for delirium in geriatric patients, including etiology, pathophysiology, diagnosis, prognosis, treatment, prevention, and outcomes.

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“…The pathogenetic role of endogenous hormones and neuromodulators is of increasing interest [ 13 , 14 ], offering new therapeutic options.…”

Section: Pathogenesis and Etiologymentioning

confidence: 99%

Delirium in geriatric patients

Iglseder

Frühwald²,

Jagsch

2022

Wien Med Wochenschr

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“…Melatonin, a pineal gland hormone, has been predominantly explored as a preventative pharmacological approach [ 40 ]. There is potential that it may also have preventative benefits in advanced cancer patients but this needs further confirmation in larger trials [ 41 ].…”

Section: Treatmentmentioning

confidence: 99%

The Dilemma of Treating Delirium: the Conundrum of Drug Management

Agar

Amgarth-Duff

2022

Curr. Treat. Options in Oncol.

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Opinion statementDelirium is a common medical complication in people living with cancer, particularly with more advanced disease. Delirium is associated with significant symptom burden which causes distress and impacts quality of life. As recommended by international guidelines, a high degree of suspicion is needed to ensure delirium is detected early. Attention to collateral history can provide clues to changes in cognition and attention. Non-pharmacological approaches that can be considered essential elements of care are effective in reducing the risk of delirium. Delirium screening using a validated measure is recommended as even expert clinicians can underdiagnose or miss delirium. The diagnostic assessment requires consideration of the cancer diagnosis and comorbidities, in the context of potential reversibility, goals of care, and patient preferences. The gold standard approach based on expert consensus is to institute management for delirium precipitants supported by non-pharmacological essential care, with the support of an interdisciplinary team. Medication management should be used sparingly and for a limited period of time wherever possible for severe perceptual disturbance or agitation which has not improved with non-pharmacological approaches. Clinicians should be familiar with the registered indication for medications and seek informed consent for off-label use. All interventions put in place to manage delirium need to consider net clinical benefit, including harms such as sedation and loss of capacity for meaningful interaction. Clear communication and explanation are needed regularly, with the person with delirium as far as possible and with surrogate decision makers. Delirium can herald a poor prognosis and this needs to be considered and be discussed as appropriate in shared decision-making. Recall after delirium has resolved is common, and opportunity to talk about this experience and the related distress should be offered during the period after recovery.

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“…Melatonin, ein Hormon, das den zirkadianen Rhythmus mitsteuert, reduziert bei präventiver Gabe die Delirinzidenz von postoperativen und Intensivstationspatienten [39]. Allerdings ist die optimale Dosis und Substanzformulation von Melatonin noch ungenügend untersucht.…”

Section: Reduktion Der Lärmassoziierten Unerwünschten Neuronalen Stimulationunclassified

Konzepte zur Reduktion der Lärmbelastung auf der Intensivstation

Theuerkauf¹,

Putensen²,

Schewe³

2022

Anästhesiol Intensivmed Notfallmed Schmerzther

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ZusammenfassungDie Lärmbelastung auf der Intensivstation ist ein allgegenwärtiges, erhebliches Problem für Patienten und Personal. Viele maßgebliche Lärmquellen sind mitverantwortlich für die häufigen Schlafstörungen der Patienten, die das Auftreten eines Delirs begünstigen. Der Beitrag fasst die aktuelle Evidenz zur Entstehung lärmassoziierter Auswirkungen zusammen und zeigt Optionen zur Lärmreduktion und Verbesserung der Therapie von Intensivpatienten auf.

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Melatonin for delirium prevention in hospitalized patients: A systematic review and meta-analysis

Cited by 60 publications

References 35 publications

Delirium in geriatric patients

Delirium in geriatric patients

The Dilemma of Treating Delirium: the Conundrum of Drug Management

Konzepte zur Reduktion der Lärmbelastung auf der Intensivstation

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