A multicomponent intervention to prevent delirium in hospitalized older patients

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 admit ted to the general-medicine service at a teaching hospital. Patients from o ne intervention unit and two usual-care units were enrolled by means of a p rospective matching strategy. The intervention consisted of standardized pr otocols for the management of six risk factors for delirium: cognitive impa irment, sleep deprivation, immobility, visual impairment, hearing impairmen t, and dehydration. Delirium, the primary outcome, was assessed daily until discharge. Results Delirium developed in 9.9 percent of the intervention group, as com pared 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 wit h delirium (105 vs. 161, P=0.02) and the total number of episodes (62 vs. 9 0, 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 reduce d. Intervention was associated with significant improvement in the degree o f cognitive impairment among patients with cognitive impairment at admissio n and with a significant reduction in the rate of use of sleep medications among all patients. Among the other risk factors, 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 deliriu m in hospitalized older patients. The intervention had no significant effec t on the severity of delirium or on recurrence rates; this finding suggests that primary prevention of delirium is probably the most effective treatme nt strategy. (N Engl J Med 1999;340:669-76.) (C) 1999, Massachusetts Medica l Society.