Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis.
Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis.
复制标题
DOI：
10.1001/jamainternmed.2014.7779
复制
发表时间：
2015-04
影响因子：
39
通讯作者：
Inouye, Sharon K.
中科院分区：
文献类型：
--
作者：
Hshieh, Tammy T.;Yue, Jirong;Oh, Esther;Puelle, Margaret;Dowal, Sarah;Travison, Thomas;Inouye, Sharon K.
谵妄是一种发病率和死亡率高的急性疾病，通常可以通过多组分非药物策略进行预防。这些策略预防后续不良结局的有效性仅限于小型研究。评价多成分非药物性谵妄干预在减少谵妄事件和预防与谵妄相关的不良结局方面的现有证据。PubMed、Google Scholar、ScienceDirect和科克伦系统综述数据库，1999年1月1日至2013年12月31日。包括检查以下结局的研究：谵妄发生率、福尔斯、住院时间、出院至长期护理机构的比率、功能或认知状态的变化。两名经验丰富的医生审查独立和盲目的抽象数据的结果措施，使用标准化的方法。评审员根据科克伦偏倚风险标准对每项研究进行质量评级。我们确定了14项干预性研究。合并谵妄、福尔斯、住院时间和住院数据的结果进行荟萃分析，但异质性限制了功能和认知下降结果的荟萃分析。总体而言，11项研究显示谵妄发生率显著降低（比值比0.47，95%置信区间0.38-0.58）。4项随机或匹配（RMT）研究将谵妄发生率降低了44%（95% CI 0.42-0.76）。在4项研究中，干预患者的福尔斯发生率显著降低（OR 0.38，95% CI 0.25-0.60）;在2项RMT中，跌倒发生率降低64%（95% CI 0.22-0.61）。在干预组中，住院时间和住院率也呈下降趋势，平均差异缩短了-0.16天（95% CI-0.97-0.64），住院率降低了5%（OR 0.95，95% CI 0.71-1.26）。在质量较高的RMT中，住院时间缩短了-0.33天（95% CI-1.38-0.72），机构化的几率降低了6%（95% CI 0.69-1.30）。多组分非药物性谵妄预防干预措施在降低谵妄发生率和预防福尔斯方面有效，有缩短住院时间和避免住院的趋势。鉴于目前的重点是预防住院并发症和提高护理的成本效益，这项荟萃分析支持使用这些干预措施，以推进老年人的急性护理。
Delirium, an acute disorder with high morbidity and mortality, is often preventable through multi-component non-pharmacologic strategies. The efficacy of these strategies for preventing subsequent adverse outcomes has been limited to small studies. Evaluate available evidence on multi-component non-pharmacologic delirium interventions in reducing incident delirium and preventing poor outcomes associated with delirium. PubMed, Google Scholar, ScienceDirect and Cochrane Database of Systematic Reviews from January 1, 1999–December 31, 2013. Studies examining the following outcomes were included: delirium incidence, falls, length of stay, rate of discharge to a long-term care institution, change in functional or cognitive status. Two experienced physician reviewers independently and blindly abstracted data on outcome measures using a standardized approach. The reviewers conducted quality ratings based on the Cochrane Risk of Bias criteria for each study. We identified 14 interventional studies. Results for outcomes of delirium, falls, length of stay and institutionalization data were pooled for meta-analysis but heterogeneity limited meta-analysis of results for outcomes of functional and cognitive decline. Overall, eleven studies demonstrated significant reductions in delirium incidence (Odds Ratio 0.47, 95% Confidence Interval 0.38–0.58). The four randomized or matched (RMT) studies reduced delirium incidence by 44% (95% CI 0.42–0.76). Rate of falls decreased significantly among intervention patients in four studies (OR 0.38, 95% CI 0.25–0.60); in the two RMTs, the fall rate was reduced by 64% (95% CI 0.22–0.61). Lengths of stay and institutionalization rates also trended towards decreases in the intervention groups, mean difference −0.16 days shorter (95% CI −0.97–0.64) and odds of institutionalization 5% lower (OR 0.95, 95% CI 0.71–1.26) respectively. Among the higher quality RMTs, length of stay trended −0.33 days shorter (95% CI −1.38–0.72) and odds of institutionalization trended 6% lower (95% CI 0.69–1.30). Multi-component non-pharmacologic delirium prevention interventions are effective in reducing delirium incidence and preventing falls, with trend towards decreasing length of stay and avoiding institutionalization. Given the current focus on prevention of hospital-based complications and improved cost-effectiveness of care, this meta-analysis supports the use of these interventions to advance acute care for older persons.
登录
查看更多内容
影响因子：
158.5
作者：
Inouye, SK;Bogardus, ST;Cooney, LW
通讯作者：
Cooney, LW
DOI：
10.1016/j.jamcollsurg.2011.05.004
发表时间：
2011-08-01
影响因子：
5.2
作者：
Chen, Cheryl Chia-Hui;Lin, Ming-Tsan;Inouye, Sharon K.
通讯作者：
Inouye, Sharon K.
影响因子：
168.9
作者：
Inouye, Sharon K.;Westendorp, Rudi G. J.;Saczynski, Jane S.
通讯作者：
Saczynski, Jane S.
影响因子：
39.2
作者：
Reston, James T.;Schoelles, Karen M.
通讯作者：
Schoelles, Karen M.
DOI：
10.1046/j.1532-5415.2001.49109.x
发表时间：
2001-05-01
影响因子：
6.3
作者：
Milisen, K;Foreman, MD;Broos, PLO
通讯作者：
Broos, PLO