Prevention Of Delirium Research Articles

Pharmacological Prevention of Postoperative Delirium in Adults: A Review of Recent Literature.

Postoperative delirium (POD) is a common complication that has important implications for surgical patients, often leading to both short- and long-term cognitive deficits, worse outcomes, and increased healthcare costs. Given these implications, there may be a benefit in reducing the incidence of POD. Pharmacologic interventions may have the potential to reduce the risk of a patient developing POD. Recently studied therapies include dexmedetomidine, propofol, haloperidol, ketamine, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, acetaminophen, melatonin/ramelteon, corticosteroids, midazolam, physostigmine, and neostigmine. In addition, the implementation of regional anesthesia and reduction of overall anesthetic depth have been examined. Of these therapies, dexmedetomidine has been studied the most and has the most supporting evidence for prevention of POD, but current studies lack clarity on optimal dosing and timing of dexmedetomidine administration. Acetaminophen, corticosteroids, and melatonin/ramelteon are other plausible medications that have potential for reducing POD incidence, but they all require further investigation. Reduction of anesthetic depth and regional anesthetics are options for anesthetic management that show promise but still lack enough supporting evidence in recent literature to receive a strong recommendation. Future research should focus on identifying optimal strategies for the implementation of the pharmacological options listed, including doses and timing of administration. Attention should be given to dexmedetomidine given its promise demonstrated by recent literature.

Assessing the Usability of iPREPARED: an Application-Based, Non-Pharmacological Delirium Prevention Intervention

Assessing the Usability of iPREPARED: an Application-Based, Non-Pharmacological Delirium Prevention Intervention

A Cross-Sectional Survey on Nurses' Utilization of Risk Assessment and Screening for Postoperative Delirium in Older Patients Following Hip Fracture Surgery in Tertiary Hospitals in Jiangsu Province, China.

To analyze the current utilisation of delirium risk assessment and screening for older patients after hip fracture surgery in tertiary hospitals in Jiangsu Province, China. This cross-sectional study was conducted from April 1 to April 30, 2023 among nurses working in orthopedics from Level III hospitals in Jiangsu Province, China. Data were collected using a self-designed questionnaire that focused on the utilisation of delirium risk assessment and prevention measures for older patients after hip fracture surgery. The questionnaire was administered through the online platform Questionnaire Star. Differences between data were analyzed using chi-square and rank-sum tests. A total of 616 nurses from 48hospitals in Jiangsu province responded to the survey. Among them, 50.17% reported having no training in delirium management, 66.88% did not assess patients for delirium risk, and 73.21% did not screen patients for delirium in their clinical practice. It was observed that nurses with longer tenure, nurses specialising in orthopaedics, and nurses with ICU experience were more attentive to delirium risk assessment and delirium screening of patients (P<0.001). Medical institutions must focus on strengthening nurses' training in delirium management for older patients after hip fracture surgery, improve their ability to undertake risk assessment and risk screening, unify delirium management norms, and ultimately improve nurses' delirium management ability.

Benefits of an automated postoperative delirium risk prediction tool combined with non-pharmacological delirium prevention on delirium incidence and length of stay: a before-after analysis based on a quality improvement project.

Postoperative delirium (POD) significantly impacts older surgical patients, necessitating effective prevention strategies. To assess the effectiveness of the Pre-Interventional Preventive Risk Assessment (PIPRA) automated delirium risk prediction tool alongside non-pharmacological prevention strategies on POD incidence, hospital length of stay (LOS) and nursing time. This quality improvement project, set in a 335-bed Swiss private hospital, employed a before-after design to evaluate the impact of PIPRA and preventive measures on POD, LOS and nursing time in non-cardiac and non-intracranial surgery inpatients aged 60 or older. The control phase focused on enhancing POD screening, whilst the intervention phase incorporated PIPRA for risk assessment and staff training to enable targeted non-pharmacological prevention in patients at risk. A total of 866 patients were included; 299 control and 567 intervention. The odds ratio of POD, comparing the intervention group to the control, was 0.71 [95% confidence interval (CI) 0.44-1.16] when adjusting for baseline patient characteristics. The intervention was associated with an LOS 0.94 (95% CI 0.85-1.05) and nursing time 0.96 (95% CI 0.86-1.07) times that of the control, adjusted for baseline patient characteristics. Medium risk patients (21.6% of patients) had an LOS 0.74 (95% CI 0.59-0.92) and required nursing time 0.79 (95% CI from 0.62-1.00) times the control, adjusted for baseline patient characteristics, equivalent to an LOS reduction of 1.36days and nursing time saving of 19.3hours per patient. Medium risk patients in the intervention group had shorter LOS and nursing time compared to the control group, underscoring the importance of targeted prevention.

Core outcome set for studies evaluating interventions to prevent or treat delirium in long-term care older residents: international key stakeholder informed consensus study.

Trials of interventions to prevent or treat delirium in older adults resident in long-term care settings (LTC) report heterogenous outcomes, hampering the identification of effective management strategies for this important condition. Our objective was to develop international consensus among key stakeholders for a core outcome set (COS) for future trials of interventions to prevent and/or treat delirium in this population. We used a rigorous COS development process including qualitative interviews with family members and staff with experience of delirium in LTC; a modified two-round Delphi survey; and virtual consensus meetings using nominal group technique. The study was registered with the Core Outcome Measures in Effectiveness Trials (COMET) initiative (https://www.comet-initiative.org/studies/details/796). Item generation identified 22 delirium-specific outcomes and 32 other outcomes from 18 qualitative interviews. When combined with outcomes identified in our earlier systematic review, and following an item reduction step, this gave 43 outcomes that advanced to the formal consensus processes. These involved 169 participants from 12 countries, and included healthcare professionals (121, 72%), researchers (24, 14%), and family members/people with experience of delirium (24, 14%). Six outcomes were identified as essential to include in all trials of interventions for delirium in LTC, and were therefore included in the COS. These are: 'delirium occurrence'; 'delirium related distress'; 'delirium severity'; 'cognition including memory', 'admission to hospital' and 'mortality'. This COS, endorsed by the American Delirium Society and the European and Australasian Delirium Associations, is recommended for use in future clinical trials evaluating delirium prevention or treatment interventions for older adults residing in LTC.

Prehabilitation for delirium prevention in elderly patients with chronic limb threatening ischemia

ObjectiveElderly patients with chronic limb-threatening ischemia (CLTI) undergoing revascularization are prone to delirium and prolonged hospitalization. Preoperative prehabilitation may prevent delirium and reduce the length of stay. This study investigates the effect of multimodal prehabilitation on delirium incidence in elderly patients with CLTI undergoing revascularization. MethodsA comparative observational cohort study conducted in a large teaching hospital (intervention cohort n = 101, retrospective control cohort n = 207) and a university hospital (prospective control cohort n = 48) from 2020 to 2023. Patients aged ≥65 years undergoing revascularization were included, with acute treatment or severe cognitive impairment as exclusion criteria. The 3-week prehabilitation program included screening of general health and presence of delirium risk factors by a vascular nurse practitioner, screening and provision of personalized, home-based exercises by a physiotherapist, provision of nutritional advice by a dietician, and, if indicated, comprehensive geriatric assessment by a geriatrician, assessment of self-reliance and home situation by a prearranged homecare nurse, guidance and support for smoking cessation by a quit smoking coach, and anemia treatment. Primary outcome was 30-day delirium incidence, analyzed using regression models adjusting for potential confounders (age, physical impairment, history of delirium, preoperative anemia, and revascularization type). Secondary outcomes were length of stay, postoperative complications, 30-day mortality, and patient experiences. ResultsMedian age was 76 years (interquartile range [IQR], 71-82 years). Delirium incidence was lower in the prehabilitation cohort (n = 2/101; 2%) compared with controls (n = 23/255; 9%; odds ratio, 0.21; 95% confidence interval, 0.05-0.89; P = .04). Adjusted analysis showed a non-significant delirium reduction (odds ratio, 0.28; 95% confidence interval, 0.06-1.3; P = .097). The prehabilitation cohort had a significantly shorter length of stay (2 [IQR, 1-5] vs 4 [IQR, 2-9] days; P ≤ .001), and fewer minor complications (14% vs 26%; P=.01). No differences were present in major complications and 30-day mortality. Patients reported high compliance and satisfaction (median score, 8/10 [IQR, 7-9]). ConclusionsPrehabilitation among elderly patients with CLTI is safe and has the potential to yield multiple beneficial effects on general outcomes following revascularization, while also achieving high levels of patient satisfaction. Further validation and consideration of implementation in surgical settings is recommended.

Results From A Snapshot Survey Of Delirium Prevalence, Detection And Care In Hospitals In Ireland On World Delirium Awareness Day

Abstract Background Delirium, an acute encephalopathy characterized by acute onset, fluctuation, and attention deficits, is associated with increased mortality and morbidity, and with precipitation or worsening of dementia. Thus, delirium prevention, timely detection, and appropriate management are crucial. Methods On World Delirium Awareness Day (15th March 2023), a global survey was assessed delirium prevalence and care. A senior clinical staff member on each participating ward reported on delirium prevalence at 8AM and 8PM, and on usual ward practice; data was entered into an online survey by a data collector (typically an on-site clinician, visiting several wards to record data). This study reports data from Irish hospitals. Results In total, 132 wards from 15 hospitals across Ireland participated. Delirium prevalence, using a formal assessment tool, was 15.9% across all wards, highest in geriatric wards (20.5%). However, on wards where 'personal judgment' to detect delirium was utilized, the prevalence rate was 11.5%, implying that delirium may be missed on these wards. Intensive care units (76.2%), geriatric wards (70%), and Emergency Departments/Acute Medical Units (ED/AMUA; 66.7%) had the highest rate of written delirium protocols. Similarly, staff training (51.5% overall), was highest in ED/AMAU (88.9%), followed by general surgical (66.7%), and geriatrics wards (60%). In contrast, only 30.8% (4/13) of non-acute wards had provided staff with delirium training in the preceding year. Having at least one training session in the preceding year was associated with higher use of formal delirium tools (18.8% versus 60.3%). Wards reported staff training/educating as the main care improvement priority; 72.7% of wards identified lack of time to train staff as a key barrier. Conclusion Delirium is prevalent in Irish hospitals and appears under-detected without formal screening. Training staff in delirium-related skills, including the use of simple screening tools for delirium detection and causation, could be paramount to improving patient outcomes.

Quality Improvements in Dementia Care in an Acute Hospital Setting

Abstract Background Dementia care in acute hospital settings requires targeted quality improvement initiatives based on national standards. This poster highlights key interventions to enhance care, aligning with local hospital group key performance indicators (KPIs), in one large teaching hospital. Methods Delirium screening (4AT) was implemented in the Emergency Department and geriatric ward, with education to increase staff awareness of delirium screening, prevention, and management. Audits assessed compliance with the 4AT tool. An audit evaluated the geriatric ward environment, including dementia-friendly painting, decorating, and signage, at baseline. Psychotropic prescribing practices were audited in 20 inpatient charts. A Life story Information tool (Sunflower Tool) was implemented to display personalized patient information at the end of the bed. Semi-annual audits assessed usage and effectiveness in the geriatric ward. Results The initial audit showed 85% compliance with the 4AT tool, dropping to 40% in a repeat audit after 6 months. Initially, 17 of 20 charts had complete 4AT scores; in the re-audit, 11 of 20 had scores recorded, with only 8 fully completed. The first environmental audit revealed poor compliance with dementia-friendly standards, especially in signage, clutter, and bedroom colour contrasts. Best compliance was seen with colour contrast in bathroom toilets and handrails. A quality improvement plan was developed to address gaps. The adoption and impact of the Sunflower tool improved patient-staff interactions and personalized care. All ward staff were trained in using the Sunflower tool. Conclusion A robust quality improvement plan, with measurable, achievable, relevant, and time-defined actions, aligned with national standards and local KPIs, is crucial to achieve and sustain positive audit results. Continuous education, resource allocation, and regular audits are required to ensure high-quality care for patients with dementia. Future efforts will focus on addressing identified challenges, refining interventions based on audit feedback, and maintaining care improvements.

Preventing delirium in post-acute care.

Older adults admitted to post-acute care often are frail with multiple comorbidities, making them particularly vulnerable to developing delirium. The purpose of this quality improvement project was to create, implement, and evaluate an NP-led, evidence-based delirium prevention protocol in a skilled nursing facility (SNF). The incidence of new-onset delirium was assessed pre- and postimplementation; following implementation, no patients were diagnosed with new-onset delirium, and nurses and certified nursing assistants reported changes to their practice. Based on project design, the approximately 42,000 NPs in the US with nursing home or long-term-care facility privileges are optimally positioned to lead SNFs in the prevention of new-onset delirium.

Co-designing a digital family-led intervention for delirium prevention and management in adult critically ill patients: An application of the double diamond design process

BackgroundCo-designing healthcare interventions is gaining recognition as a novel and collaborative method. Co-design involves end-users from the start, ensuring that an intervention best meets their needs. Despite its potential benefits, this approach is not yet widely used in developing clinical interventions within intensive care units where the perspectives of patients, family members, and clinicians are crucial. ObjectiveTo describe the application, benefits and challenges of the Double Diamond model to co-design a digital family-led voice reorientation intervention for delirium prevention and management in critically ill adult patients. MethodsThe co-design process was guided by the Double Diamond model over a period of 12 months. Development involved patients, family members, and nursing and medical staff as co-designers and decision-makers in the iterative development of the intervention. Data from field notes and group meetings were audio recorded, transcribed verbatim, and content analysed at each phase, which were then presented to the co-designers for verification and refinement. FindingsCo-designers included people with lived experience of the ICU as patients (n = 5) and family members (n = 1) and clinical experts (nursing staff n = 3; medical staff n = 3). Co-designers were highly engaged and reported positive experiences and collaboration in the co-design process. Sharing the diversity of their own personal ICU experiences was found to be beneficial as it not only validated individual feelings but also strengthened intervention development. Differences in interpretations and meanings of the voice messages proposed as part of the intervention were challenging. Maintaining sufficient focus on each phase of the Double Diamond was difficult due to the complexity of the context in which the intervention was being co-designed and the resulting challenges of maintaining the engagement of the co-designers throughout the process. ConclusionsThere were benefits and challenges of engaging people with lived experience in an intensive care unit as co-designers through the Double Diamond design process to develop a digital family-led intervention for delirium prevention and management. Overall, applying the Double Diamond to co-design a clinical intervention is recommended, whereby the collaboration process benefits patients, family members, and clinical staff. Registration numberACTRN12622001568707; ANZCTR — Registration.

Effect of Implementing Delirium Prevention Bundle on Clinical Outcomes of Critically Ill Patients

Effect of Implementing Delirium Prevention Bundle on Clinical Outcomes of Critically Ill Patients

Author Response: Nocturnal Infusion of Low-dose Dexmedetomidine and Propofol for Delirium Prevention.

How to cite this article: Ekkapat G, Chokengarmwong N. Author Response: Nocturnal Infusion of Low-dose Dexmedetomidine and Propofol for Delirium Prevention. Indian J Crit Care Med 2024;28(9):896.

Comparison of the Validity of the PRE-DELIRIC model and the E-PRE-DELIRIC model for Predicting Delirium in patients after Cardiac Surgery

Purpose: The purpose of this study was to analyze the validity of the PRE-DELIRIC model and E-PRE-DELIRIC model.Methods: Patients who underwent cardiac surgery at a tertiary hospital between January 2019 and December 2022 were included. The presence or absence of delirium was determined based on risk groups, and the sensitivity, specificity, positive predictive power, and negative predictive power were verified using the Youden index. Receiver operating characteristic curves were derived for the PRE-DELIRIC model and E-PRE-DELIRIC model, the area under the curve was calculated, and the 95% confidence interval (CI) was presented.Results: The incidence of delirium was 28.8%. The average scores of the PRE-DELIRIC model and E-PRE-DELIRIC model were 49.72±29.91 and 18.14±0.41, respectively. In the PRE-DELIRIC model, for which a cut-off point of 14.05 was established using the Youden index, the sensitivity, specificity, positive predictive power, and negative predictive power were 64.8%, 83.2%, 61.0%, and 85.4%, respectively. In the E-PRE-DELIRIC model, with a cut-off point of 64.01, the corresponding indicators were 73.1%, 51.5%, 37.8%, and 82.6%, respectively. The areas under the curve for the PRE-DELIRIC model and the E-PRE-DELIRIC model were 0.77 (95% CI, 0.74~0.82) and 0.65 (95% CI, 0.61~0.69), respectively.Conclusion: It may be helpful to use both the E-PRE-DELIRIC and PRE-DELIRIC models. The two prediction models are expected to help improve the quality of nursing for the early detection and prevention of delirium, enabling intensive observations and interventions for patients at high risk of delirium.

Evaluation of postoperative delirium in geriatric patients given acetaminophen with and without melatonin: A retrospective cohort study.

Postoperative delirium has many consequences and should be prevented when possible. Non-opioid pain treatments have known delirium prevention benefits, while melatonin has promising prevention data in non-surgical populations. The incidence of postoperative delirium was retrospectively compared in patients prescribed acetaminophen with and without melatonin following orthopedic surgery. Retrospective data was analyzed in adults ≥65-years-old who were hospitalized within one health system following an orthopedic procedure. Patients receiving at least acetaminophen 1000mg/day with and without melatonin 1mg/day for at least 48hours perioperatively were included. Patients were excluded if they had prior delirium, an intensive care unit placement >24hours, or other risk factors for developing delirium to reduce confounders. The primary outcome was delirium incidence or positive CAM-ICU score. Key secondary endpoints included hospital length of stay and 30-day hospital readmission. Two hundred patients were assessed, and 134 patients were included in the analysis (ie, 66 acetaminophen plus melatonin, 68 acetaminophen alone). There was a lower rate of delirium when comparing the combination vs acetaminophen alone (5% vs 25%; P = 0.001). There were no differences in 30-day readmission. Patients taking the combination had a longer length of stay than acetaminophen alone (5 vs 4 days; P = 0.04). Geriatric patients taking acetaminophen plus melatonin after orthopedic surgery had a significantly lower risk of delirium than patients receiving acetaminophen alone. Using combination melatonin and acetaminophen before orthopedic surgery is a promising delirium prevention strategy and should be considered in future prospective trials.

Care models for older people based on a case study-Geriatrics as an active discipline

Geriatrics can enable and monitor aholistic care of older people through acomprehensive geriatric assessment in a structured way. Therefore, it must be integrated much more closely with preventive, rehabilitative and acute care units. Geriatrics are not seen in any aspects as areplacement for general practitioners or in-hospital structures but much more as asupplement to them. With its function-oriented concept, geriatrics can best coordinate the demographically necessary triage between prevention, acute treatment, rehabilitation and palliative care, thus avoiding undertreatment and overtreatment. This can only succeed in collaboration with general practitioners and specialist colleagues. The article categorizes geriatric care structures, such as preventive home visits, acute complex medical treatment, delirium prevention, outpatient and inpatient rehabilitation services based on acase example and makes proposals for structural changes that urgently need to be considered in the current healthcare reform, such as outpatient geriatric centers (AGZ).

Impact of a Delirium Protocol on Deliriogenic Medication Use in Hospitalized Older Veterans.

Background The Southern Arizona VA Health Care System (SAVAHCS) implemented a delirium prevention and treatment protocol in 2019. Objective The primary objective of this study was to determine if the implementation of a delirium protocol influenced deliriogenic medication use in hospitalized geriatric veterans. The secondary objectives were to compare the rates of delirium diagnosis, hospital length-of-stay, and rates of newly started deliriogenic medications during admission pre- and post-protocol. Methods This study was a retrospective, secondary data analysis study. Veterans 65 years of age and older who were admitted to an inpatient medical ward at the SAVAHCS for 24 hours or more between January 1, 2018 and December 31, 2018 (pre-protocol) or January 1, 2021 and December 31, 2021 (post-protocol) were included. Patients were excluded if they had a diagnosis of alcohol or benzodiazepine withdrawal upon admission. Results A total of 5491 patients were included in this study; 2940 (53.5%) in the pre-protocol group and 2551 (46.5%) in the post-protocol group. Patients received at least one deliriogenic medication during their admission in the post-protocol group (36.2%) compared with the pre-protocol group (34.1%), but there was no statistically significant difference (P = 0.098). There were also no significant differences in the rates of documentation of delirium as a diagnosis at discharge, hospital length-of-stay, or the rates of newly started deliriogenic medications during admission between the groups. Conclusion Implementation of a delirium prevention and treatment protocol at the SAVAHCS did not significantly impact the use of deliriogenic medications in hospitalized geriatric veterans.

Effectiveness of a delirium risk assessment and multidisciplinary care approach in reducing delirium incidence among surgical intensive care unit patients: A retrospective pre-post intervention study

BackgroundDelirium is a common complication in intensive care unit (ICU) patients. It can lead to various adverse events. In this study, we investigated the effectiveness of combining the use of the PREdiction of DELIRium (PRE-DELIRIC) model for delirium risk assessment and the use of a multicomponent care bundle for delirium assessment, prevention, and care in terms of reductions in the incidence of delirium among surgical ICU patients. MethodsThis retrospective study included surgical ICU patients who had received PRE-DELIRIC-guided SMART/SmART care (SMART care: SmART bundle plus multidisciplinary team; SmART care: Sleep/sweet sense of home (creating a comforting and restful environment for patients), Assessment (regular and thorough evaluation of patient needs and conditions), Release (revised endotracheal tube care/removal, restraint device care, and immobility reduction for patient comfort), and Time (reorientation of time to optimize patient care schedules) in our hospital between May 2022 and March 2023 (intervention group) and individuals who had received usual care between January 2021 and April 2022 (historical control group). The SmART intervention involves providing care in the following domains: sleep/sweet sense of home, assessment, release, and time. Patients with a PRE-DELIRIC score of >30% received SMART care, which includes multidisciplinary (physicians, pharmacists, respiratory therapists, and physiotherapists) care in addition to SmART care. For the control group, usual care was provided following the guidelines for the prevention and management of pain, agitation, delirium, immobility, and sleep disruption. The primary outcome was delirium incidence during ICU stay, which was assessed using the Intensive Care Delirium Screening Checklist. The secondary outcomes were the duration of ICU stay, rate of unplanned self-extubation, and status of ICU discharge. ResultsThe intervention and control groups comprised 184 and 197 patients, respectively; their mean ages were 63.7 ± 18.4 years and 62.4 ± 19.5 years, respectively. The incidence of delirium was significantly lower (p = 0.001) in the intervention group (22.3%) than in the control group (47.7%). ConclusionOur findings suggest that the PRE-DELIRIC-guided SMART/SmART care intervention is effective in preventing and managing delirium among surgical ICU patients.

Digital transformation for the prevention of delirium in older adults with dementia: Development of simulation intervention using virtual reality and augmented reality programs and its subjective effects

We aimed to develop a simulation program for physicians and nurses involved in virtual reality (VR) and augmented reality (AR) treatment and care from the perspective of these professionals and older adults with dementia who developed delirium, and to test the effectiveness of the program. effectiveness of the program was analyzed through free-response statements from 67 nurses (84.8%) and 12 doctors (15.2%) who participated in the program between February 16 and April 18, 2023. Regarding the experience of delirium from the perspective of older adults with dementia (personal experience), the following statements were extracted "1. I do not understand where I am, the situation, and the treatment/care that is about to be given"; "2. I want the situation to be explained to me so that I can understand the reasons for my hospitalization and the treatment/care I am receiving"; "3. The eerie environment of the hospital and the high pressure of the staff made me feel anxious and fearful"; "4. Please respect my existence as I endure pain, anxiety, and loneliness"; "5. I feel relieved when doctors and nurses deal with me from my point of view"; and "6. I feel relieved when there is a familiar presence, such as a family member or the name I am calling on a daily basis". Specific categories of self-oriented empathy were extracted from the experience of physical restraint at night using VR and the experience of delirium using AR. This suggests the possibility of objective effects on treatment and care in future practice.

Effect of occupational therapy on the occurrence of delirium in critically ill patients: a systematic review and meta-analysis.

Delirium poses a major challenge to global health care, yet there is currently a dearth of single effective interventions or medications. Particularly, addressing delirium induced by critical illness is a complex process. Occupational therapy is considered to have a high potential for use in the prevention of delirium, as it involves both cognitive training and training in ADL. To comprehensively analyze the effect of occupational therapy on delirium prevention, we evaluated the effects of occupational therapy vs. standard non-pharmacological prevention on incidence and duration of delirium, clinical outcomes and rehabilitation outcomes in critically ill patients. The data sources, including PubMed/Medline, Web of Science, EMBASE, and Cochrane Library, were comprehensively searched from their inception until 15 October 2023. Following the PICOS principle, a systematic screening of literature was conducted to identify relevant studies. Subsequently, the quality assessment was performed to evaluate the risk of bias in the included literature. Finally, outcome measures from each study were extracted and comprehensive analysis was conducted using Review Manager 5.4. A total of four clinical trials met the selection criteria. The pooled analysis indicated no significant difference in the incidence and duration of delirium between the OT group and standard non-pharmacological interventions. A comprehensive analysis of clinical outcomes revealed that OT did not significantly reduce the length of hospital stay or ICU stay. Meanwhile, there was no significant difference in mortality rates between the two groups. It is noteworthy that although grip strength levels did not exhibit significant improvement following OT intervention, there were obvious enhancements observed in ADL and MMSE scores. Although occupational therapy may not be the most effective in preventing delirium, it has been shown to significantly improve ADL and cognitive function among critically ill patients. Therefore, we contend that occupational therapy is a valuable component of a comprehensive multidisciplinary approach to managing delirium. In the future, high-quality researches are warranted to optimize the implementation of occupational therapy interventions for delirium prevention and further enhance their benefits for patients.

Pharmacological and non-pharmacological prevention and management of delirium in critically ill and palliative patients in the inpatient setting: a review.

This review explores delirium in critically ill patients in the inpatient setting, focusing on its prevention and management. It evaluates the efficacy of both current pharmacological and non-pharmacological interventions, aiming to provide a comprehensive overview. A systematic literature search was conducted to identify relevant studies investigating the prevention and management of delirium resulting in a final sample of 26 articles for analysis. Of the 26 articles analyzed for this review (N = 8,831 participants) of controlled trials, 16 studies examined the prevention of delirium, 9 explored the treatment of delirium, and 1 investigated both prevention and treatment of delirium. Among the reviewed studies, there is evidence that non-pharmacologic methods are effective in the prevention of delirium. Evidence regarding pharmacological interventions for delirium prevention is varied and inconclusive, with some indication that atypical antipsychotics like aripiprazole and quetiapine may reduce the incidence of delirium. Regarding the treatment of delirium, there is limited evidence supporting the use of pharmacological agents. Additional double-blinded, randomized, placebo-controlled clinical trials are needed to investigate the efficacy of pharmacologic agents for diverse hospitalized populations.