Delirium in the elderly: A systematic review of pharmacological and non-pharmacological treatments.

Dement Neuropsychol

MD, PhD, Departamento de Medicina, Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos, SP, Brazil.

Published: January 2017

AI Article Synopsis

  • Delirium is a prevalent disorder that negatively affects elderly patients, but the effectiveness of various treatment methods is not fully known.
  • A systematic review analyzed literature on pharmacological and non-pharmacological interventions for elderly patients over 60 with delirium from several databases up to 2016.
  • The findings showed that while pharmacological treatments, like rivastigmine and olanzapine, improved delirium symptoms and cognitive function, non-pharmacological approaches did not significantly affect delirium duration or mortality but did help reduce its severity.

Article Abstract

Unlabelled: Delirium is a common disorder associated with poor prognosis, especially in the elderly. The impact of different treatment approaches for delirium on morbimortality and long-term welfare is not completely understood.

Objective: To determine the efficacy of pharmacological and non-pharmacological treatments in elderly patients with delirium.

Methods: This systematic review compared pharmacological and non-pharmacological treatments in patients over 60 years old with delirium. Databases used were: MEDLINE (PubMed), EMBASE, Cochrane CENTRAL and LILACS from inception to January 6, 2016.

Results: A total of ten articles were selected. The six non-pharmacological intervention studies showed no impact on duration of delirium, mortality or institutionalization, but a decrease in severity of delirium and improvement in medium-term cognitive function were observed. The most commonly used interventions were temporal-spatial orientation, orientation to self and others, early mobilization and sleep hygiene. The four studies with pharmacological interventions found that rivastigmine reduced the duration of delirium, improved cognitive function and reduced caregiver burden; olanzapine and haloperidol decreased the severity of delirium; droperidol reduced length of hospitalization and improved delirium remission rate.

Conclusion: Although the pharmacological approach has been used in the treatment of delirium among elderly, there have been few studies assessing its efficacy, involving a small number of patients. However, the improvements in delirium duration and severity suggest these drugs are effective in treating the condition. Once delirium has developed, non-pharmacological treatment seems less effective in controlling symptoms, and there is a lack of studies describing different non-pharmacological interventions.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674671PMC
http://dx.doi.org/10.1590/1980-57642016dn11-030009DOI Listing

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