Impact of sequenced pharmacological optimisation and multicomponent bundle on early delirium severity trajectories in general medical inpatients.
Background Delirium is common in older medical inpatients, associated with prolonged hospitalisation, falls and cognitive decline. Despite recommendations for multicomponent non-pharmacological interventions, the additional benefit of structured pharmacological guidance and the impact on early delir...
| Publicado en: | Age & Ageing Vol. 55; no. 4; pp. 1 - 13 |
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| Autores principales: | , , , , , , , |
| Formato: | Artículo |
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Oxford University Press / USA
Apr2026
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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=193500104&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 193500104 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: Apr2026 vid: 55 iid: 4 pid: 622 pub: Oxford University Press / USA artinfo: ui: 193500104 10.1093/ageing/afag110 ppf: 1 ppct: 12 formats: tig: atl: Impact of sequenced pharmacological optimisation and multicomponent bundle on early delirium severity trajectories in general medical inpatients. aug: au: Yoon, E Kyong Jang, Yuna Kim, Sun-wook Han, Soowan Park, Hye Yoon Moon, Sungdo Lee, Jae Hyun Park, Hye Youn affil: Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, the Republic of Korea Department of Hospital Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, the Republic of KoreaDepartment of Internal Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, the Republic of Korea Department of Psychiatry, Seoul National University Hospital, Jongno-gu, Seoul, the Republic of Korea Department of Psychiatry, Seoul National University Hospital, Jongno-gu, Seoul, the Republic of KoreaDepartment of Psychiatry, Seoul National University College of Medicine, Jongno-gu, Seoul, the Republic of Korea Department of Internal Medicine, Hospital Medicine Center, Seoul National University Hospital, Jongno-gu, Seoul, the Republic of Korea Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, the Republic of KoreaDepartment of Psychiatry, Seoul National University College of Medicine, Jongno-gu, Seoul, the Republic of Korea su: South Korea Hospital care Combination drug therapy Patient education Research funding T-test (Statistics) Data analysis Acute diseases Early medical intervention Scientific observation Descriptive statistics Polypharmacy Severity of illness index Longitudinal method Dose-effect relationship in pharmacology Delirium Medication therapy management Statistics Confidence intervals Data analysis software Time sug: subj: Hospital care South Korea Combination drug therapy Patient education Research funding T-test (Statistics) Data analysis Acute diseases Early medical intervention Scientific observation Descriptive statistics Polypharmacy Severity of illness index Longitudinal method Dose-effect relationship in pharmacology Delirium Medication therapy management Statistics Confidence intervals Data analysis software Time keyword: acute medical inpatients copyrightHolder:British Geriatrics Society copyrightYear:2026 delirium dose–response relationship https://dx.doi.org/10.1093/ageing/afag110 inLanguage:en inpatients multicomponent intervention older people pharmacological guidance pharmacology publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42059636/ symptom trajectory acute medical inpatients copyrightHolder:British Geriatrics Society copyrightYear:2026 delirium dose–response relationship https://dx.doi.org/10.1093/ageing/afag110 inLanguage:en inpatients multicomponent intervention older people pharmacological guidance pharmacology publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42059636/ symptom trajectory ab: Background Delirium is common in older medical inpatients, associated with prolonged hospitalisation, falls and cognitive decline. Despite recommendations for multicomponent non-pharmacological interventions, the additional benefit of structured pharmacological guidance and the impact on early delirium trajectories remain unclear. Methods This study used a two-phase before–after design in a prospective cohort of 203 inpatients in two university-affiliated acute medical wards. Sixty-four patients received interventions comprising structured pharmacological guidance, educational videos, cognitive activity boards and light therapy. Delirium severity was assessed with the K-4AT on Days 1, 3 and 7. Mixed-effects models estimated time-by-intervention interactions, and dose–response analyses examined cumulative effects. Secondary outcomes included incident delirium, length of stay, falls, ICU transfer and in-hospital mortality. Exploratory paired analyses assessed within-group changes. Findings Delirium occurred in 24.1%, associated with older age, prior delirium, psychotropic exposure and illness-severity. The time-by-exposure interaction favoured intervention at Day 7 (exp(β) = 0.40; 95% CI = [0.24, 0.66]; P = .001), with earlier improvements for pharmacologic guidance (Day 3, exp(β) = 0.64 [0.43, 0.95]; P = .026; Day 7, exp(β) = 0.46 [0.28, 0.76]; P = .002). Educational videos were associated with improvement by Day 7 (exp(β) = 0.39 [0.22, 0.67]; P = .001), and cognitive activity boards showed the largest effect (exp(β) = 0.09 [0.04, 0.17]; P < .001) in a small subgroup. A time-by-dose interaction indicated additive benefits with multiple components (Day 7, exp(β) = 0.72 [0.6, 0.85] per component; P < .001). Secondary outcomes did not differ. Interpretation Multicomponent bundles combining pharmacological guidance and cognitive stimulation may attenuate delirium trajectories. Pharmacological guidance showed earlier improvements, and combined exposure showed additive benefits. These findings support further development of protocols to reduce delirium burden. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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