SYSTEMATIC INTERVENTION FOR ELDERLY INPATIENTS WITH DELIRIUM - A RANDOMIZED TRIAL

Objective: To assess a systematic intervention in cases of delirium in elderly inpatients. Design: Randomized, controlled trial. Setting: Un iversity-affiliated, primary acute care hospital. Patients: Patients a ged 75 pears or over admitted to the medical department. They were scr eened within 24 hours after admission, and 88 patients with delirium ( according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third revised edition) were detected and enrolled in the trial. The patients were randomly allocated to the treatment grou p (42) or the control group (46); all were followed up until the end o f the study. Intervention: Patients were assessed on enrolment and 1, 2, 4 and 8 weeks later. Those in the treatment group received a consul tation by a geriatric internist or psychiatrist and followup by a liai son nurse. Those in the control group received regular medical care. O utcome measures: Short Portable Mental Status Questionnaire (SPMSQ) Cr ichton Geriatric Behavioural Rating Scale (CGBRS), use of restraints, length of hospital stay, discharge to a setting providing more care th an was needed before admission and mortality rate. Results: Two weeks after admission, patients in the treatment group showed an improvement in their mean SPMSQ scores, from 8.2 (standard deviation [SD] 1.9) to 7.9 (SD 2.5), whereas the control group showed a deterioration, from 8.4 (SD 1.7) to 9.1 (SD 1.1); this difference had disappeared by the e nd of the 8-week period (p < 0.05). Mean CGBRS scores were higher in t he treatment group (32.0 [SD 8.6]) than the control group (28.5 [SD 9. 4]) on enrolment and had improved more markedly by the end of the 8-we ek period (to 23.9 [SD 7.8] v. 25.0 [SD 7.0], p = 0.06). There was no statistically significant difference between the groups in use of rest raints, length of hospital stay, discharge to a setting providing more care than was needed before admission or mortality rate. Conclusion: The beneficial effects of systematic detection and intervention in cas es of delirium in elderly inpatients were small.