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This Cochrane review assessed interventions for preventing delirium in hospitalised patients (excluding the intensive care unit).

The review included 39 trials, assessing 22 different interventions or comparisons. Fourteen trials were placebo‐controlled, 15 evaluated a delirium prevention intervention against usual care, and 10 compared two different interventions. Thirty‐two studies were conducted in patients undergoing surgery, the majority in orthopaedic settings. Seven studies were conducted in general medical or geriatric medicine settings.

There is strong evidence supporting multi‐component interventions to prevent delirium in hospitalised patients. There is no clear evidence that cholinesterase inhibitors, antipsychotic medication or melatonin reduce the incidence of delirium.

Research team: Najma Siddiqi, Jennifer Harrison, Andrew Clegg, Elizabeth Teale, John Young, James Taylor.

Follow the link to the Cochrane review of interventions to prevent delirium in hospitalised non-ICU patients (PDF , 2,272kb)

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This Cochrane review will assess the effectiveness of non-pharmacological interventions for preventing delirium in hospitalised patients outside the intensive care unit (ICU) setting. Non-pharmacological interventions can be broadly divided into those with a single intervention, which often target a specific risk factor, and those providing a multicomponent intervention, which target multiple risk factors for delirium. Multicomponent interventions are often based around care delivered according to specific protocols, and target risk factors such as sleep deprivation, immobility, dehydration and sensory impairment.

We will include randomised controlled trials (RCTs), including cluster-RCTs. We will include studies of adult participants (aged 18 years and over) who are admitted to general-hospital settings. This will include acute and rehabilitation hospitals and sub-acute care provided in hospital.

Primary outcomes include incidence of delirium, mortality as an inpatient, and new diagnosis of dementia.

This review, focusing on non-pharmacological interventions will allow a synthesis of the most contemporaneous specific evidence to inform and improve clinical practice.

Research team: Jennifer Burton, Najma Siddiqi, Elizabeth Teale, Amanda Barugh, Alex Sutton

Follow the link to the Cochrane protocol of non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients (PDF , 204kb)

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The aim of this Cochrane review is to determine the effectiveness of single or multicomponent non-pharmacological interventions in reducing the symptoms, duration or severity of an established episode of delirium in hospitalised people outside intensive care settings.

Pharmacological treatment strategies for delirium are currently aimed at reducing symptoms of hyperactivity. Removing or modifying factors likely to be contributing to an episode of delirium is a common clinical treatment strategy but this approach is unsupported by the current evidence base: it is unclear whether an episode of established delirium can be attenuated through non-pharmacological strategies.

This review will establish the clinical effectiveness of non-pharmacological interventions for the treatment of established delirium, through examination of randomised and cluster-randomised trials. This will help to inform service design for the management of this distressing and harmful condition in older people.

Follow the link to the Cochrane Protocol of non-pharmacological interventions for managing delirium in hospitalised patients (PDF , 162kb)

The aim of this study is to further develop and investigate the diagnostic accuracy of a new screening instrument for delirium triage in older emergency patients requiring hospital assessment. This study’s primary objective is to validate the 4AT against a reference standard. Secondary objectives include (1) comparing the 4AT with another widely used test (the Confusion Assessment Method (CAM)); (2) determining if the 4AT is sensitive to general cognitive impairment; (3) assessing if 4AT scores predict outcomes, including (4) a health economic analysis. 900 patients aged 70 or over in EDs or acute general medical wards will be recruited in three sites (Edinburgh, Bradford and Sheffield) over 18 months. Each patient will undergo a reference standard delirium assessment and will be randomised to assessment with either the 4AT or the CAM. At 12 weeks, outcomes (length of stay, institutionalisation and mortality) and resource utilisation will be collected by a questionnaire and via the electronic patient record.

Research team: Susan Shenkin, Christopher Fox, Mary Godfrey, Najma Siddiqi, Steve Goodacre, John Young, Atul Anand, Alasdair Gray, Joel Smith, Tracy Ryan, Janet Hanley, Allan MacRaild, Jill Steven, Polly Black, Julia Boyd, Christopher Weir, Alasdair MacLullich

Funder: National Institute of Health Research Technology Assessment Programme (NIHR DTA) grant number 11/143/01

Follow the links to the Protocol for validation of the 4AT (PDF , 535kb) and the 4AT validation paper (PDF , 2,096kb)

The project aimed to improve delirium prevention for older people admitted to NHS acute hospitals through a programme of three linked projects to investigate the feasibility, acceptability, potential effectiveness and cost-effectiveness of a delirium prevention system of care.

The Prevention of Delirium Programme is a multicomponent delirium prevention intervention and implementation process. A pilot study to test the feasibility and acceptability of implementation of the programme was successfully carried out. We have now undertaken preliminary testing of the programme. The Prevention of Delirium Study is a multicentre, cluster randomised feasibility study designed to explore the potential effectiveness and cost-effectiveness of the Prevention of Delirium Programme. Sixteen elderly care medicine and orthopaedic/trauma wards in eight National Health Service acute hospitals were be randomised to receive the Prevention of Delirium Programme or usual care. Patients were eligible for the trial if they had been admitted to a participating ward and aged 65 years or over. The primary objectives of the study were to provide a preliminary estimate of the effectiveness of the Prevention of Delirium Programme as measured by the incidence of new onset delirium, assess the variability of the incidence of new-onset delirium, estimate the intracluster correlation coefficient and likely cluster size, assess barriers to the delivery of the Prevention of Delirium Programme system of care, assess compliance with the Prevention of Delirium Programme system of care, estimate recruitment and follow-up rates, assess the degree of contamination due to between-ward staff movements, and investigate differences in financial costs and benefits between the Prevention of Delirium Programme system of care and standard practice. Secondary objectives were to investigate differences in the number, severity and length of delirium episodes (including persistent delirium); length of stay in hospital; in hospital mortality; destination at discharge; health-related quality of life and health resource use; physical and social independence; anxiety and depression; and patient experience. This feasibility study will be used to gather data to inform the design of a future definitive randomised controlled trial.

Research team: John Young, Francine Cheater, Michelle Collinson, Marie Fletcher, Anne Forster, Mary Godfrey, John Green, Shamaila Anwar, Suzanne Hartley, Claire Hulme, Sharon Inouye, David Meads, Gillian Santorelli, Najma Siddiqi, Jane Smith, Elizabeth Teale and Amanda Farrin

Funding acknowledgement and disclaimer
This study is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme (RP-PG-0108-10037). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Follow the link to the Protocol for the older people in hospital feasibility trial (PDF , 961kb)

For further information please see (http://www.bradfordresearch.nhs.uk/research/an-investigation-of-the-hospital-elder-life-program-help-system-of-care-to-prevent-delirium/86)