Table 10.3multicomponent interventions for the prevention of delirium: overview of different factors form each study identified

StudyMulti-disciplinary teamEducation interventionCare methodsassessment of patientsorientationDehydration nutritionSleepSensory impairment improvementEarly mobilisationEnvironmental modificationsMedication managementPain managementOther
Lundström (2005)No; mainly nursing carestaff education on Ass; PTD: NPI; Med. Monthly guidance for staffPatient-allocation care, with individualised careyes: via educationonly via educationNoNoNoNoNoonly via educationnoNo
Inouye (1999): Elder Life ProgramYes: N, Physio, G, TRS, Vyes: trained team; performance evaluated quarterlynot changedYes in order to determine risk factors addressedYes: schedule/name board; reorienting communicationYes for those with dehydration: early recognition of dehydration and volume repletionYes: non-pharmacological sleep protocol; sleep-enhancement protocolYes for visually impaired and hearing impaired peopleyesyes: unit-wide noise reduction strategiesNonocognitively stimulating activities (e.g. discussion of current events)
Gustafson (1991): Geriatric-anesthesiologic intervention programmeYes; nursing, anaesthetist and geriatrician careNonot changed; task orientedpre- and postop by geriatricianNoNoNoNoNoNoindividualised thrombosis prophylaxisnoO2 therapy from admission; phenylephrine for low systolic bp; surgical policy
Harari 2007a: Proactive care of older people undergoing surgery (POPS)Yes: N, Physio, G, OT, SWYes: patients preop (N, Ex, RT, PM); staff postop (TMC, EM, PM, BBF, N, DP)no changepreop planning and postop review by geriatrician and nurse; targetting issues identifiedNoYes: nutritionNoNoYesNoearly detection and treatment of medical complicationsYesdischarge planning
Landefeld (1995); Acute Care for Elders programmeyes: daily visits (D, N, SW, Diet, Physio, VNL)Nopatient centred careYes: daily assessment by nurses of physical, cognitive and psychosocial function; daily review of medical careYes: large clock, calendaryes nutrition (no details)yes (no details)Noyes (no details)Yes: specially designed environmt (carpeting, handrails, uncluttered hallways, elevated toilet seats, door levers)yes: minimise medications (e.g. sedative-hypnotic agentsnominimise effects of procedures (e.g. catheterisation); discharge planning
Wannich (1992):yes: for discharge planning (N, Physio, OT, SW, Diet)Yes: staff (Ass, SI, Mob, En); families (RC, O, En)Not statedYes: assessment and management plans recorded on charts and shared with staff and familiesYes (e.g. day of week, current events, updated calendars in every room)NoNoYes for visually impaired and hearing impaired people only (glasses and hearing aid + encouragement to use them)yesYes: lighting to decrease sensory deprivation; night lightsassess medicns contributing to delerium, e.g. neuroleptics, antidepressants, narcotic analgesics, sedative-hypnotics, and use discouragednodischarge planning; Communication: clear and slow, with repetition
Wong (2005)Yes: project team supervised programme (N, G, Ph, D, QI, A, Diet)Yes: staff on PTD, POD, Ass, MMDnot changedYes for identification of needsYes: clock, calendarYes: nutrition (including properly fitting dentures); maintenance of fluid/electrolyte imbalanceNoYes: sensory stimuli -glasses, hearing aidyesYes: soft lighting, not putting delirious patients in same roomtreatment of major complications; stop unnecess benzodiazepines, antihistamines, anticholinergicsYesregulation of bladder/bowel function; O2; tmt of agitated delirium
Marcantonio (2001):
Proactive geriatrics consultation
No consultation with geriatriciannoNot statedYes: consultation with geriatrician preop/within 24 h postop. Geriatrician daily visits during hospitalisation => target recs madeYes: clock, calendarYes: nutrition (including properly fitting dentures); maintenance of fluid/electrolyte imbalance; treat dehydration/overloadNoYes: sensory stimuli - glasses, hearing aidyesYes: soft lighting, use of radio/tape recorder -not rec for any patient thoughtreatment of major complications; stop benzodiazepines, antihistamines, anticholinergics; eliminate medicn redundancies; tmt to raise bpYesregulation of bladder/bowel function; O2; tmt of agitated delirium

Key: N = nurses; Physio = physiotherapists; OT = occupational therapists; D = doctor (generally); G = geriatrician; SW = social worker; TRS = therapeutic recreation specialist; V = volunteer; A = anaesthetist; QI = member of the quality improvement unit; Ph = pharmacist, Diet = dietitian/nutritionalist; VNL = visiting nurse liaison; Ass = assessment; PTD = prevention and treatment of delirium; CD = training on cognitive impairment; POD = prevalence and outcome of delirium; NPI = nurse patient interaction; N = nutrition; MMD = medication management of delirium; Ex = exercise; RT = relaxation therapy; PM = pain management; TMC = treatment of medical complications; EM = early mobilisation; PM = pain management; BBF = bowel bladder function; DP = discharge planning).

From: 10, Prevention of delirium: non-pharmacological

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Delirium: Diagnosis, Prevention and Management [Internet].
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