Background Delirium is a common and severe condition. In particular for older patients the adverse effects lead to cognitive impairments in everyday functioning with substantial healthcare costs. The mortality is 20-fold increased. Irreversible cognitive deficits are proven in 50% of cases.
The age, the cognition and the multimorbidity, combined with polypharmacy are the most predisposing risk factors to a delirium.
Purpose Our university hospital established a multidisciplinary department, which developed nonpharmacological and pharmacological guidelines for diagnosis, prevention and treatment of delirium.
The primary objective of our open randomised controlled trial was to compare the effectiveness of multidisciplinary approaches in reducing the risk of delirium in surgical and nonsurgical patients aged 65 years and over.
Material and methods From January 2016 to October 2017, 1694 patients aged 65 years and over were screened on admission by using the Montreal Cognitive Assessment (MoCA). A total of 1089 patients (64%) had an elevated risk for delirium (MoCA <26 points) and 66% (723) of these patients could be included and randomised.
The intervention group (370 patients) received our standardised treatments, such as constant detection of delirium, specialised nursing and medication optimisation by pharmacists, whereas the control group (353 patients) was treated as usual without any standardised strategies.
The cognitive outcome for each patient was assessed by a second MoCA before discharge.
Results The risk of a manifest delirium during hopitalisation was more than 50% higher in the control group compared to the intervention group: (15% control group vs. 6% intervention group (OR 0.35, 95% CI: 0.21 to 0.60, p<0. 001)).
The duration of delirium in the intervention group was reduced by half, compared to the control group (4 vs. 8 days (p<0.001)).
Conclusion The results of our study have proven that not every delirium can be prevented, but the rate and the duration of delirium can be significantly reduced.
Furthermore, the results emphasise the importance of clinical pharmacists. The inappropriate use of non-evidence-based medication of delirium (e.g. inappropriate application of antipsychotics, benzodiazepines and anticholinergic substances) could be reduced by intensive training of medical staff and pharmaceutical counselling.
Considering the demographic changes, we recommend the implementation of a multidisciplinary approach for the consistent and standardised management of delirium.
Nothing to declare.
No conflict of interest
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