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Tijdschrift voor Gerontologie en Geriatrie

, Volume 36, Issue 6, pp 244–250 | Cite as

Een systematisch overzicht van multifactoriële interventies ter primaire preventie van delier bij ouderen

  • C. J. Kalisvaart
  • R. Vreeswijk
  • J. F. M. de Jonghe
  • K. Milisen
Artikel

Samenvatting

Delirium is a severe psychiatric syndrome that is highly prevalent in elderly patients in a general hospital. Primary prevention is important to prevent delirium. This article reviews recent developments with regard to multifactorial intervention trials for primary prevention of delirium. The review process involved a systematic search in MEDLINE, The Cochrane Database and CINAHL Database and subsequent examination of reference lists. Six studies were selected. Four studies showed that systemic interventions regarding medical-, nurse-led, environmental-, and educational items, were effective in preventing delirium. In one study a reduction was found in duration and severity of duration only. One study showed no effect on delirium at all. Despite the methodological weaknesses of the studies, conclusions are that different kinds of non-pharmacological interventions can be effective in preventing delirium.

Samenvatting

Delier is een ernstig psychiatrisch syndroom en kent een hoge prevalentie onder oudere patiëntenpopulaties in het ziekenhuis. Preventieve maatregelen zijn van belang ter voorkoming van een delier.

Dit overzicht schetst de waarde voor de praktijk van het beschikbare onderzoek naar multifactoriële interventies ter primaire preventie van delier. Informatie werd verzameld via zoekacties in MEDLINE, Cochrane Database en CINAHL Database en vervolgens via bestudering van relevante literatuurverwijzingen. Na toepassing van de selectiecriteria werden zes studies geselecteerd voor verdere bespreking. De resultaten laten zien dat in vier onderzoeken de systeeminterventies gericht op zowel medische-, verpleegkundige-, als omgeving- en educatieve factoren effectief blijken bij het voorkomen van delirium. Eén studie liet enkel effect zien op de duur en ernst van het delier en in één studie werd geen effect gevonden op preventie, duur en ernst van het delier. Ondanks methodologische tekortkomingen van de besproken onderzoeken is de conclusie dat verschillende soorten van niet-medicamenteuze interventies effectieve primaire preventie van delier mogelijk maken.

delier  primaire preventie interventie multifactoriële 

Literatuur

  1. Galanakis P, Bickel H, Gradinger R, Von Gumppenberg S, Forstl H. Acute confusional state in the elderly following hip surgery: incidence, risk factors and complications. Int.J.Geriatr.Psychiatry 2001;16:349-55CrossRefPubMedGoogle Scholar
  2. Lindesay J, Rockwood K, Rolfson DB. The epidemiology of delirium. In: Lindesay J, Rockwood K, Macdonald AJ, editors. Delirium in old age. 1 ed. New York: Oxford University Press; 2002. p. 27-50.Google Scholar
  3. Rockwood K. The occurrence and duration of symptoms in elderly patients with delirium. J Gerontol 1993;48:M162-M166.PubMedGoogle Scholar
  4. Meagher DJ. Delirium: optimising management. BMJ 2001;322:144-49.CrossRefPubMedGoogle Scholar
  5. Keeffe , Lavan JN. Predicting delirium in elderly patients: development and validation of a risk-stratification model. Age Ageing 1996;25:317-21CrossRefGoogle Scholar
  6. Rowe JW. Geriatrics, prevention, and the remodeling of Medicare. N.Engl.J.Med. 1999;340:720-21CrossRefPubMedGoogle Scholar
  7. CBO. Multidisciplinaire richtlijn delirium. 2004. Ref Type: ReportGoogle Scholar
  8. Cole MG, Primeau F, McCusker J. Effectiveness of interventions to prevent delirium in hospitalized patients: a systematic review. CMAJ. 1996;155:1263-68.PubMedGoogle Scholar
  9. Weber JB, Coverdale JH, Kunik ME. Delirium: current trends in prevention and treatment. Intern.Med.J. 2004;34:115-21.CrossRefPubMedGoogle Scholar
  10. American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders, third edition (DSM-III). Washington DC: American Psychiatric Association; 1980.Google Scholar
  11. American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders, third edition revised (DSM-III-R). Washington DC: American Psychiatric Association; 1987.Google Scholar
  12. American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders, fourth edition revised (DSM-IV). Washington DC: American Psychiatric Association; 1994.Google Scholar
  13. Markowitz, A. M. Making Health Care Safer. 2004. Ref Type: Internet CommunicationGoogle Scholar
  14. Guyatt GH, Haynes RB, Jaeschke RZ, Cook DJ, Green L, Naylor CD et al. Users' Guides to the Medical Literature: XXV. Evidence-based medicine: principles for applying the Users' Guides to patient care. Evidence-Based Medicine Working Group. JAMA 2000;284:1290-96.CrossRefPubMedGoogle Scholar
  15. Cole MG. Delirium: effectiveness of systematic interventions. Dement.Geriatr.Cogn Disord. 1999;10:406-11.CrossRefPubMedGoogle Scholar
  16. Inouye SK, Bogardus ST, Jr., Baker DI, Leo-Summers L, Cooney LM, Jr. The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J.Am.Geriatr.Soc. 2000;48:1697-706.PubMedGoogle Scholar
  17. Inouye SK. Prevention of delirium in hospitalized older patients: risk factors and targeted intervention strategies. Ann.Med. 2000;32:257-63.CrossRefPubMedGoogle Scholar
  18. Inouye SK, Bogardus ST, Jr., Williams CS, Leo-Summers L, Agostini JV. The role of adherence on the effectiveness of nonpharmacologic interventions: evidence from the delirium prevention trial. Arch.Intern.Med. 2003;163:958-64.CrossRefPubMedGoogle Scholar
  19. Rizzo JA, Bogardus ST, Jr., Leo-Summers L, Williams CS, Acampora D, Inouye SK. Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value? Med.Care 2001;39:740-52.CrossRefPubMedGoogle Scholar
  20. Bogardus ST, Jr., Desai MM, Williams CS, Leo-Summers L, Acampora D, Inouye SK. The effects of a targeted multicomponent delirium intervention on postdischarge outcomes for hospitalized older adults. Am.J.Med. 2003;114:383-90.CrossRefPubMedGoogle Scholar
  21. Cole MG, McCusker J, Bellavance F, Primeau FJ, Bailey RF, Bonnycastle MJ et al. Systematic detection and multidisciplinary care of delirium in older medical inpatients: a randomized trial. CMAJ. 2002;167:753-59.PubMedGoogle Scholar
  22. Owens JF, Hutelmyer CM. The effect of preoperative intervention on delirium in cardiac surgical patients. Nurs.Res. 1982;31:60-62.CrossRefPubMedGoogle Scholar
  23. Nagley SJ. Predicting and preventing confusion in your patients. J.Gerontol.Nurs. 1986;12:27-31.PubMedGoogle Scholar
  24. Williams MA, Campbell EB, Raynor WJ, Mlynarczyk SM, Ward SE. Reducing acute confusional states in elderly patients with hip fractures. Res Nurs Health 1985;8:329-37.PubMedGoogle Scholar
  25. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J.Am.Geriatr.Soc. 2001;49:516-22.CrossRefPubMedGoogle Scholar
  26. Gustafson Y, Brannstrom B, Berggren D, Ragnarsson JI, Sigaard J, Bucht G et al. A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures. J.Am.Geriatr.Soc. 1991;39:655-62.PubMedGoogle Scholar
  27. Inouye SK, Bogardus ST, Jr., Charpentier PA, Leo-Summers L, Acampora D, Holford TR et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N.Engl.J.Med. 1999;340:669-76.CrossRefPubMedGoogle Scholar
  28. Lundstrom M, Edlund A, Lundstrom G, Gustafson Y. Reorganization of nursing and medical care to reduce the incidence of postoperative delirium and improve rehabilitation outcome in elderly patients treated for femoral neck fractures. Scand.J.Caring.Sci. 1999;13:193-200.CrossRefPubMedGoogle Scholar
  29. Milisen K, Foreman MD, Abraham IL, De Geest S, Godderis J, Vandermeulen E et al. A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients. J.Am.Geriatr.Soc. 2001;49:523-32.CrossRefPubMedGoogle Scholar
  30. Wanich CK, Sullivan-Marx EM, Gottlieb GL, Johnson JC. Functional status outcomes of a nursing intervention in hospitalised elderly. Image 1992;24:201-07.Google Scholar
  31. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann.Intern.Med. 1990;113:941-48.PubMedGoogle Scholar
  32. Albert MS, Levkoff SE, Reilly C, Liptzin B, Pilgrim D, Cleary PD et al. The delirium symptom interview: an interview for the detection of delirium symptoms in hospitalized patients. J Geriatr.Psychiatry Neurol. 1992;5:14-21.PubMedGoogle Scholar
  33. Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S. The Memorial Delirium Assessment Scale. J Pain Symptom.Manage. 1997;13:128-37.CrossRefPubMedGoogle Scholar
  34. Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Impact of different diagnostic criteria on prognosis of delirium: a prospective study. Dement.Geriatr.Cogn Disord. 2004;18:240-44.CrossRefPubMedGoogle Scholar

Copyright information

© Bohn Stafleu van Loghum 2005

Authors and Affiliations

  • C. J. Kalisvaart
    • 1
  • R. Vreeswijk
  • J. F. M. de Jonghe
  • K. Milisen
  1. 1.

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