Non-drug methods effectively treat delirium

Non-medication strategies were effective in hospital patients with delirium, according a new study published in the February 2 edition of JAMA Internal Medicine.

After analyzing 14 studies involving multicomponent non-pharmacologic interventions, the researchers at Brigham and Women’s Hospital in Boston, Mass., and other facilities found that older patients who received non-medication based interventions were at decreased risk of bothdelirium and falls. They also found trends toward decreased length of hospital stay and institutionalization.

One million cases of delirium could be prevented using non-medication based interventions, resulting in a Medicare cost savings of $10 billion per year, they concluded.

Tammy Hshieh, MD"Delirium is a major problem at many hospitals and preventing its downstream consequences, including falls, is a priority,” said Tammy Hshieh, MD, of BWH’s Division of Aging and the Aging Brain Center in Hebrew SeniorLife’s Institute for Aging Research. “Delirium can be the source of anxiety for many patients and their families and often they wish that there was a pill that would make the patient’s symptoms go away. Our study demonstrates that there are effective strategies for preventing delirium and treating patients that don’t rely on medications.”

The researchers analyzed studies that had examined six interventions that targeted delirium risk factors, guided by principles derived from the original delirium prevention study, the Hospital Elder Life Program (HELP).

Interventions included strategies to improve a person’s nutrition and hydration and to ensure uninterrupted sleep; daily exercise and therapeutic activities to improve cognition; and “re-orientation”, or telling patients where they are and the date and time every day. The studies were conducted at 12 hospital sites from all over the world.

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“These preventive approaches provide evidence-based models to improve processes of care for older hospitalized persons. The fact that these approaches are so effective for prevention of delirium, falls and institutionalization provides strong support for their importance in the setting of accountable, cost-effective care. We hope this study will bring to attention these important models for hospital administrators and policymakers,” said Sharon K. Inouye, MD, MPH, director of the Aging Brain Center at the Institute for Aging Research at Hebrew SeniorLife and the senior author on the paper.