Abstract

Delirium is highly prevalent in NHS hospitals, estimated to affect 11-51% of inpatients.[1] It is distressing for patients, families and staff.[2,3,4] It is associated with adverse outcomes including longer inpatient stays, care home admission and death.[5,6,7] Evidence is emerging of the links between delirium and developing dementia,[8,9] making delirium prevention a public health priority. The Cochrane Review identified that multicomponent interventions reduced delirium incidence by a third.[10] However, there was a lack of clarity around the components required (range 2-13) and no reduction in adverse outcomes, despite prevention.[10] The findings NICE recommend delirium prevention interventions,[11] and our review findings were incorporated into the SIGN Guideline.12 However, further specific research evidence is needed to inform these guidelines on which interventions are effective and how they should be implemented. The NIHR CRSU analysis will help in determining which components are necessary for intervention efficacy. This analysis requires more studies than were identified originally, thus an updated review of the literature is required to deliver this. Delirium is growing research area. The previous review has been highly referenced by the delirium research community. Non-pharmacological methods are appealing and considered safe in this vulnerable population. The findings will be directly applicable to frontline practice. 1. Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. The Lancet. 2014;383(9920):911-22. 2. Finucane AM, Lugton J, Kennedy C, Spiller JA. The experiences of caregivers of patients with delirium, and their role in its management in palliative care settings: an integrative literature review. Psychooncology. 2017;26(3):291-300. 3. Partridge JS, Martin FC, Harari D, Dhesi JK. The delirium experience: what is the effect on patients, relatives and staff and what can be done to modify this? International Journal of Geriatric Psychiatry. 2013;28(8):804-12. 4. Waterfield K, Weiand D, Dewhurst F, Kiltie R, Pickard J, Karandikar U, et al. A qualitative study of nursing staff experiences of delirium in the hospice setting. International Journal of Palliative Nursing. 2018;24(11):524-34. 5. Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA: The Journal of the American Medical Association. 2010;304(4):443-51. 6. Burton JK, Guthrie B, Hapca SM, Cvoro V, Donnan PT, Reynish EL. Living at home after emergency hospital admission: prospective cohort study in older adults with and without cognitive spectrum disorder. BMC Medicine. 2018;16(1):231-. 7. Jackson TA, Wilson D, Richardson S, Lord JM. Predicting outcome in older hospital patients with delirium: a systematic literature review. International Journal of Geriatric Psychiatry. 2016;31(4):392-9. 8. Tsui A, Kuh D, Richards M, Davis D. Delirium symptoms are associated with decline in cognitive function between ages 53 and 69 years: Findings from a British birth cohort study. Alzheimers and Dementia. 2018;14(5):617-22. 9. Davis DH, Muniz Terrera G, Keage H, Rahkonen T, Oinas M, Matthews FE, et al. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain. 2012;135(Pt 9):2809-16. 10. Siddiqi N, Harrison JK, Clegg A, Teale EA, Young J, Taylor J, et al. Interventions for preventing delirium in hospitalised non-ICU patients. The Cochrane Database of Systematic Reviews. 2016 Mar 11;3:CD005563. 11. National Institute for Health and Care Excellence. Delirium: diagnosis, prevention and management. Clinical guideline [CG103]. 2010: Available from: https://www.nice.org.uk/guidance/cg103 12. Scottish Intercollegiate Guidelines Network. SIGN 157: Risk reduction and management of delirium. 2019: Available from: https://www.sign.ac.uk/sign-157-delirium.html