Effectiveness of non-pharmacological and pharmacological interventions in preventing delirium in older adults: a systematic review and meta-analysis of randomised controlled trials.
Background Delirium is a serious neuropsychiatric condition common among older adults, associated with prolonged hospital stays, increased morbidity and mortality. Although guidelines emphasise prevention, identifying most effective measures is crucial. Objective To evaluate the efficacy of non-phar...
| Publicado en: | Age & Ageing Vol. 55; no. 3; pp. 1 - 17 |
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| Autores principales: | , , , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Oxford University Press / USA
Mar2026
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=192797135&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 192797135 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Mar2026 vid: 55 iid: 3 pid: 622 pub: Oxford University Press / USA artinfo: ui: 192797135 10.1093/ageing/afag068 ppf: 1 ppct: 16 formats: tig: atl: Effectiveness of non-pharmacological and pharmacological interventions in preventing delirium in older adults: a systematic review and meta-analysis of randomised controlled trials. aug: au: Sánchez, Alba Sawant-Uttekar, Pallavi Heinen, Darlene Pribadi, Afifah N Thomas, Christine Arnim, Christine von Kühnle, Julia Kreisel, Stefan Henner Hewer, Walter Fath, Björn affil: Department of Social and Preventive Medicine, University of Potsdam, Potsdam, Brandenburg, Germany Marien Hospital Stuttgart, Klinik für Geriatrie, Stuttgart, Baden-Württemberg, Germany Department of Old Age Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, GermanyDepartment of Neurology and Neurophysiology, Medical Center, University of Freiburg, Freiburg, Baden-Württemberg, GermanyDepartment of Anaesthesiology, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany Department of Geriatrics, University Medical Center Göttingen, Gottingen, Lower Saxony, Germany Department of Geriatrics, University Medical Center Göttingen, Gottingen, Lower Saxony, GermanyDepartment of Geriatric Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, GermanyGerman Center for Cardiovascular Research (DZHK), Göttingen, Lower Saxony, Germany Division of Geriatric Psychiatry, Department of Psychiatry and Psychotherapy Bethel, Evangelisches Krankenhaus Bielefeld, Bielefeld, North Rhine-Westphalia, Germany Clinic for Geriatric Psychiatry, Klinikum Christophsbad, Göppingen, Baden-Württemberg, Germany Department of Geriatric Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, GermanyClinic for Geriatric Psychiatry, Klinikum Christophsbad, Göppingen, Baden-Württemberg, Germany su: Hospital care Old age Insulin therapy Risk assessment Adrenocortical hormones Anti-inflammatory agents Nonsteroidal anti-inflammatory agents Oxygen saturation Cardiovascular diseases Intranasal administration Cholinesterase inhibitors Research funding Treatment effectiveness Meta-analysis Hemodynamics Antipsychotic agents Descriptive statistics Chi-squared test Systematic reviews MEDLINE Surgical complications Delirium Intensive care units Medical databases Data analysis software Confidence intervals Psychology information storage & retrieval systems Imidazoles Disease complications sug: subj: Hospital care Old age Pharmaceutical and medicine manufacturing Insulin therapy Risk assessment Adrenocortical hormones Anti-inflammatory agents Nonsteroidal anti-inflammatory agents Oxygen saturation Cardiovascular diseases Intranasal administration Cholinesterase inhibitors Research funding Treatment effectiveness Meta-analysis Hemodynamics Antipsychotic agents Descriptive statistics Chi-squared test Systematic reviews MEDLINE Surgical complications Delirium Intensive care units Medical databases Data analysis software Confidence intervals Psychology information storage & retrieval systems Imidazoles Disease complications keyword: copyrightHolder:British Geriatrics Society copyrightYear:2026 delirium dexmedetomidine https://dx.doi.org/10.1093/ageing/afag068 inLanguage:en meta-analysis older adult older adults pharmacology pharmacotherapy prevention publisher:Oxford University Press randomization sameAs:https://pubmed.ncbi.nlm.nih.gov/41911321/ systematic review copyrightHolder:British Geriatrics Society copyrightYear:2026 delirium dexmedetomidine https://dx.doi.org/10.1093/ageing/afag068 inLanguage:en meta-analysis older adult older adults pharmacology pharmacotherapy prevention publisher:Oxford University Press randomization sameAs:https://pubmed.ncbi.nlm.nih.gov/41911321/ systematic review ab: Background Delirium is a serious neuropsychiatric condition common among older adults, associated with prolonged hospital stays, increased morbidity and mortality. Although guidelines emphasise prevention, identifying most effective measures is crucial. Objective To evaluate the efficacy of non-pharmacological and pharmacological interventions in preventing delirium in older adults (≥65 years). Methods We conducted a systematic review and meta-analysis of randomised controlled trials across settings, excluding ICU-only studies. MEDLINE, Cochrane, Web of Science and PsycINFO were searched through October 2024. Comparators included standard care, placebo, or other drugs. Random-effects models estimated pooled risk ratios. Risk of bias was assessed using RoB 2.0. Subgroup analyses were performed by setting and drug type. PROSPERO: CRD42024500387. Results Eighty-seven trials (19,289 randomised patients) were included. Non-pharmacological multicomponent interventions (k = 17) significantly reduced delirium occurrence (risk ratio [RR] = 0.56, 95% CI 0.45–0.72; I = 63%) versus usual care, although certainty of evidence was very low. Effects were significant in non-cardiovascular surgical and medical patients. Single-component non-pharmacological interventions (k = 9) showed mixed or inconclusive findings. Among pharmacological trials (k = 53), dexmedetomidine reduced delirium risk (RR = 0.49; 95% CI 0.43–0.57; low-certainty) in non-cardiovascular surgical patients. Corticosteroids and intranasal insulin showed significant effects (high-certainty), based on a small number of trials. Mixed strategies, such as haemodynamic or cerebral oxygen-guided approaches, suggested potential benefit but were heterogeneous. Conclusions Non-pharmacological multicomponent interventions reduce delirium occurrence and should be prioritised. Dexmedetomidine showed benefit in non-cardiac surgical populations, while evidence for other drugs remains inconclusive. Overall, certainty was low to very low, highlighting the need for further high-quality randomised trials to ensure generalisability. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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