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Meta-Analysis
. 2016 Mar 11;3(3):CD005563.
doi: 10.1002/14651858.CD005563.pub3.

Interventions for preventing delirium in hospitalised non-ICU patients

Najma Siddiqi  1 , Jennifer K Harrison, Andrew Clegg, Elizabeth A Teale, John Young, James Taylor, Samantha A Simpkins
Affiliations
Meta-Analysis

Interventions for preventing delirium in hospitalised non-ICU patients

Najma Siddiqi et al. Cochrane Database Syst Rev. .

Abstract

Background: Delirium is a common mental disorder, which is distressing and has serious adverse outcomes in hospitalised patients. Prevention of delirium is desirable from the perspective of patients and carers, and healthcare providers. It is currently unclear, however, whether interventions for preventing delirium are effective.

Objectives: To assess the effectiveness of interventions for preventing delirium in hospitalised non-Intensive Care Unit (ICU) patients.

Search methods: We searched ALOIS - the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 4 December 2015 for all randomised studies on preventing delirium. We also searched MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), Central (The Cochrane Library), CINAHL (EBSCOhost), LILACS (BIREME), Web of Science core collection (ISI Web of Science), ClinicalTrials.gov and the WHO meta register of trials, ICTRP.

Selection criteria: We included randomised controlled trials (RCTs) of single and multi- component non-pharmacological and pharmacological interventions for preventing delirium in hospitalised non-ICU patients.

Data collection and analysis: Two review authors examined titles and abstracts of citations identified by the search for eligibility and extracted data independently, with any disagreements settled by consensus. The primary outcome was incidence of delirium; secondary outcomes included duration and severity of delirium, institutional care at discharge, quality of life and healthcare costs. We used risk ratios (RRs) as measures of treatment effect for dichotomous outcomes; and between group mean differences and standard deviations for continuous outcomes.

Main results: We included 39 trials that recruited 16,082 participants, 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.We found multi-component interventions reduced the incidence of delirium compared to usual care (RR 0.69, 95% CI 0.59 to 0.81; seven studies; 1950 participants; moderate-quality evidence). Effect sizes were similar in medical (RR 0.63, 95% CI 0.43 to 0.92; four studies; 1365 participants) and surgical settings (RR 0.71, 95% CI 0.59 to 0.85; three studies; 585 participants). In the subgroup of patients with pre-existing dementia, the effect of multi-component interventions remains uncertain (RR 0.90, 95% CI 0.59 to 1.36; one study, 50 participants; low-quality evidence).There is no clear evidence that cholinesterase inhibitors are effective in preventing delirium compared to placebo (RR 0.68, 95% CI, 0.17 to 2.62; two studies, 113 participants; very low-quality evidence).Three trials provide no clear evidence of an effect of antipsychotic medications as a group on the incidence of delirium (RR 0.73, 95% CI, 0.33 to 1.59; 916 participants; very low-quality evidence). In a pre-planned subgroup analysis there was no evidence for effectiveness of a typical antipsychotic (haloperidol) (RR 1.05, 95% CI 0.69 to 1.60; two studies; 516 participants, low-quality evidence). However, delirium incidence was lower (RR 0.36, 95% CI 0.24 to 0.52; one study; 400 participants, moderate-quality evidence) for patients treated with an atypical antipsychotic (olanzapine) compared to placebo (moderate-quality evidence).There is no clear evidence that melatonin or melatonin agonists reduce delirium incidence compared to placebo (RR 0.41, 95% CI 0.09 to 1.89; three studies, 529 participants; low-quality evidence).There is moderate-quality evidence that Bispectral Index (BIS)-guided anaesthesia reduces the incidence of delirium compared to BIS-blinded anaesthesia or clinical judgement (RR 0.71, 95% CI 0.60 to 0.85; two studies; 2057 participants).It is not possible to generate robust evidence statements for a range of additional pharmacological and anaesthetic interventions due to small numbers of trials, of variable methodological quality.

Authors' conclusions: 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. Using the Bispectral Index to monitor and control depth of anaesthesia reduces the incidence of postoperative delirium. The role of drugs and other anaesthetic techniques to prevent delirium remains uncertain.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 Multi‐component delirium prevention intervention (MCI) versus usual care, outcome: 1.1 Incident delirium.
4
4
Forest plot of comparison: 2 Prophylactic cholinesterase inhibitor versus placebo, outcome: 2.1 Incident delirium.
5
5
Figure 5Forest plot of comparison: 3 Prophylactic antipsychotic versus control, outcome: 3.1 Incidence of delirium.
6
6
Forest plot of comparison: 4 Prophylactic melatonin versus placebo, outcome: 4.1 Incident delirium.
7
7
Forest plot of comparison: 11 Bispectral index (BIS)‐guided anaesthesia versus BIS‐blinded anaesthesia, outcome: 11.1 Incident delirium.
1.1
1.1. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 1 Incident delirium.
1.2
1.2. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 2 Incidence of delirium in patients with dementia.
1.3
1.3. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 3 Duration of delirium.
1.4
1.4. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 4 Severity of delirium.
1.5
1.5. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 5 Length of admission.
1.6
1.6. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 6 Cognition.
1.7
1.7. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 7 Improvement in Activities of Daily Living.
1.8
1.8. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 8 Return to independent living.
1.9
1.9. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 9 Depression.
1.10
1.10. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 10 Withdrawal from protocol.
1.11
1.11. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 11 Falls.
1.12
1.12. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 12 Pressure ulcers.
1.13
1.13. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 13 Inpatient mortality.
1.14
1.14. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 14 12 month mortality.
1.15
1.15. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 15 Cardiovascular complication.
1.16
1.16. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 16 Urinary tract infection.
1.17
1.17. Analysis
Comparison 1 Multi‐component delirium prevention intervention (MCI) versus usual care, Outcome 17 Mental health worsened.
2.1
2.1. Analysis
Comparison 2 Prophylactic cholinesterase inhibitor versus placebo, Outcome 1 Incident delirium.
2.2
2.2. Analysis
Comparison 2 Prophylactic cholinesterase inhibitor versus placebo, Outcome 2 Duration of delirium.
2.3
2.3. Analysis
Comparison 2 Prophylactic cholinesterase inhibitor versus placebo, Outcome 3 Severity of delirium.
2.4
2.4. Analysis
Comparison 2 Prophylactic cholinesterase inhibitor versus placebo, Outcome 4 Length of admission.
2.5
2.5. Analysis
Comparison 2 Prophylactic cholinesterase inhibitor versus placebo, Outcome 5 Cognition.
2.6
2.6. Analysis
Comparison 2 Prophylactic cholinesterase inhibitor versus placebo, Outcome 6 Withdrawal from protocol.
2.7
2.7. Analysis
Comparison 2 Prophylactic cholinesterase inhibitor versus placebo, Outcome 7 Adverse events (continuous).
2.8
2.8. Analysis
Comparison 2 Prophylactic cholinesterase inhibitor versus placebo, Outcome 8 Adverse events (binary).
3.1
3.1. Analysis
Comparison 3 Prophylactic antipsychotic versus control, Outcome 1 Incident delirium.
3.2
3.2. Analysis
Comparison 3 Prophylactic antipsychotic versus control, Outcome 2 Duration of delirium.
3.3
3.3. Analysis
Comparison 3 Prophylactic antipsychotic versus control, Outcome 3 Severity of delirium.
3.4
3.4. Analysis
Comparison 3 Prophylactic antipsychotic versus control, Outcome 4 Length of admission.
3.5
3.5. Analysis
Comparison 3 Prophylactic antipsychotic versus control, Outcome 5 Cognition.
3.6
3.6. Analysis
Comparison 3 Prophylactic antipsychotic versus control, Outcome 6 Withdrawal from protocol.
3.7
3.7. Analysis
Comparison 3 Prophylactic antipsychotic versus control, Outcome 7 Adverse events.
3.8
3.8. Analysis
Comparison 3 Prophylactic antipsychotic versus control, Outcome 8 Pneumonia.
3.9
3.9. Analysis
Comparison 3 Prophylactic antipsychotic versus control, Outcome 9 Urinary tract infection.
3.10
3.10. Analysis
Comparison 3 Prophylactic antipsychotic versus control, Outcome 10 Congestive heart failure.
4.1
4.1. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 1 Incident delirium.
4.2
4.2. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 2 Duration of delirium.
4.3
4.3. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 3 Severity of delirium (binary severe vs. not severe).
4.4
4.4. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 4 Severity of delirium (DRS‐R‐98).
4.5
4.5. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 5 Length of admission.
4.6
4.6. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 6 Cognitive impairment.
4.7
4.7. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 7 Activities of daily living.
4.8
4.8. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 8 Use of psychotropic medication (binary).
4.9
4.9. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 9 Antipsychotic medication use (cumulative).
4.10
4.10. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 10 Benzodiazepine use (cumulative).
4.11
4.11. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 11 Withdrawal from study.
4.12
4.12. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 12 In‐hospital mortality.
4.13
4.13. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 13 Mortality by 3 months.
4.14
4.14. Analysis
Comparison 4 Prophylactic melatonin versus placebo, Outcome 14 Adverse events.
5.1
5.1. Analysis
Comparison 5 Prophylactic citicoline versus placebo, Outcome 1 Incident delirium.
5.2
5.2. Analysis
Comparison 5 Prophylactic citicoline versus placebo, Outcome 2 Cognitive status.
6.1
6.1. Analysis
Comparison 6 Oral premedication with diazepam and diphenhydramine, Outcome 1 Incident delirium.
7.1
7.1. Analysis
Comparison 7 Intravenous methylprednisolone versus placebo, Outcome 1 Incident delirium.
7.2
7.2. Analysis
Comparison 7 Intravenous methylprednisolone versus placebo, Outcome 2 Length of admission.
7.3
7.3. Analysis
Comparison 7 Intravenous methylprednisolone versus placebo, Outcome 3 Mortality at 30 days.
7.4
7.4. Analysis
Comparison 7 Intravenous methylprednisolone versus placebo, Outcome 4 Myocardial injury.
7.5
7.5. Analysis
Comparison 7 Intravenous methylprednisolone versus placebo, Outcome 5 Respiratory failure.
7.6
7.6. Analysis
Comparison 7 Intravenous methylprednisolone versus placebo, Outcome 6 Infection.
8.1
8.1. Analysis
Comparison 8 Gabapentinoids versus placebo, Outcome 1 Incident delirium.
8.2
8.2. Analysis
Comparison 8 Gabapentinoids versus placebo, Outcome 2 Length of admission.
8.3
8.3. Analysis
Comparison 8 Gabapentinoids versus placebo, Outcome 3 Cognition.
8.4
8.4. Analysis
Comparison 8 Gabapentinoids versus placebo, Outcome 4 Psychotropic Medication Use.
8.5
8.5. Analysis
Comparison 8 Gabapentinoids versus placebo, Outcome 5 Withdrawal from protocol.
9.1
9.1. Analysis
Comparison 9 Ketamine versus placebo, Outcome 1 Incident delirium.
9.2
9.2. Analysis
Comparison 9 Ketamine versus placebo, Outcome 2 Withdrawal from protocol.
10.1
10.1. Analysis
Comparison 10 Intravenous parecoxib sodium analgesia versus Morphine and Saline, Outcome 1 Incident delirium.
10.2
10.2. Analysis
Comparison 10 Intravenous parecoxib sodium analgesia versus Morphine and Saline, Outcome 2 Length of admission.
10.3
10.3. Analysis
Comparison 10 Intravenous parecoxib sodium analgesia versus Morphine and Saline, Outcome 3 Postoperative cognitive dysfunction at 3 days.
10.4
10.4. Analysis
Comparison 10 Intravenous parecoxib sodium analgesia versus Morphine and Saline, Outcome 4 Postoperative cognitive dysfunction at 1 week.
10.5
10.5. Analysis
Comparison 10 Intravenous parecoxib sodium analgesia versus Morphine and Saline, Outcome 5 Postoperative cognitive dysfunction at 3 months.
10.6
10.6. Analysis
Comparison 10 Intravenous parecoxib sodium analgesia versus Morphine and Saline, Outcome 6 Postoperative cognitive dysfunction at 6 months.
11.1
11.1. Analysis
Comparison 11 Intrathecal morphine and PCA morphine versus PCA morphine, Outcome 1 Incident delirium.
11.2
11.2. Analysis
Comparison 11 Intrathecal morphine and PCA morphine versus PCA morphine, Outcome 2 Length of admission.
11.3
11.3. Analysis
Comparison 11 Intrathecal morphine and PCA morphine versus PCA morphine, Outcome 3 Cognition ‐ days for MMSE to return to preoperative level.
11.4
11.4. Analysis
Comparison 11 Intrathecal morphine and PCA morphine versus PCA morphine, Outcome 4 Withdrawal from protocol.
11.5
11.5. Analysis
Comparison 11 Intrathecal morphine and PCA morphine versus PCA morphine, Outcome 5 Mortality.
12.1
12.1. Analysis
Comparison 12 Fascia iliaca compartment block (FICB) versus placebo, Outcome 1 Incident delirium.
12.2
12.2. Analysis
Comparison 12 Fascia iliaca compartment block (FICB) versus placebo, Outcome 2 Severity of delirium.
12.3
12.3. Analysis
Comparison 12 Fascia iliaca compartment block (FICB) versus placebo, Outcome 3 Duration of delirium.
12.4
12.4. Analysis
Comparison 12 Fascia iliaca compartment block (FICB) versus placebo, Outcome 4 Mortality.
13.1
13.1. Analysis
Comparison 13 Light versus deep propofol sedation, Outcome 1 Incident delirium.
13.2
13.2. Analysis
Comparison 13 Light versus deep propofol sedation, Outcome 2 Duration of delirium.
13.3
13.3. Analysis
Comparison 13 Light versus deep propofol sedation, Outcome 3 Length of admission.
13.4
13.4. Analysis
Comparison 13 Light versus deep propofol sedation, Outcome 4 Cognition on day 2.
13.5
13.5. Analysis
Comparison 13 Light versus deep propofol sedation, Outcome 5 In‐hospital mortality.
13.6
13.6. Analysis
Comparison 13 Light versus deep propofol sedation, Outcome 6 Postoperative complications (>=1).
14.1
14.1. Analysis
Comparison 14 Bispectral index (BIS)‐guided anaesthesia versus BIS‐blinded anaesthesia/clinical judgement, Outcome 1 Incident delirium.
14.2
14.2. Analysis
Comparison 14 Bispectral index (BIS)‐guided anaesthesia versus BIS‐blinded anaesthesia/clinical judgement, Outcome 2 Length of admission.
14.3
14.3. Analysis
Comparison 14 Bispectral index (BIS)‐guided anaesthesia versus BIS‐blinded anaesthesia/clinical judgement, Outcome 3 Cognition at 7 days.
14.4
14.4. Analysis
Comparison 14 Bispectral index (BIS)‐guided anaesthesia versus BIS‐blinded anaesthesia/clinical judgement, Outcome 4 Cognition at 3 months.
14.5
14.5. Analysis
Comparison 14 Bispectral index (BIS)‐guided anaesthesia versus BIS‐blinded anaesthesia/clinical judgement, Outcome 5 SF‐36 mental summary score.
14.6
14.6. Analysis
Comparison 14 Bispectral index (BIS)‐guided anaesthesia versus BIS‐blinded anaesthesia/clinical judgement, Outcome 6 Mortality at 7 days.
14.7
14.7. Analysis
Comparison 14 Bispectral index (BIS)‐guided anaesthesia versus BIS‐blinded anaesthesia/clinical judgement, Outcome 7 Mortality at 3 months.
14.8
14.8. Analysis
Comparison 14 Bispectral index (BIS)‐guided anaesthesia versus BIS‐blinded anaesthesia/clinical judgement, Outcome 8 Cardiac complications.
14.9
14.9. Analysis
Comparison 14 Bispectral index (BIS)‐guided anaesthesia versus BIS‐blinded anaesthesia/clinical judgement, Outcome 9 Respiratory complications.
14.10
14.10. Analysis
Comparison 14 Bispectral index (BIS)‐guided anaesthesia versus BIS‐blinded anaesthesia/clinical judgement, Outcome 10 Infective complications.
15.1
15.1. Analysis
Comparison 15 Sevoflurane versus propofol anaesthesia, Outcome 1 Incident delirium.
15.2
15.2. Analysis
Comparison 15 Sevoflurane versus propofol anaesthesia, Outcome 2 Mortality at 12 months.
16.1
16.1. Analysis
Comparison 16 Xenon versus sevoflurane anaesthesia, Outcome 1 Incident delirium.
16.2
16.2. Analysis
Comparison 16 Xenon versus sevoflurane anaesthesia, Outcome 2 Length of admission.
16.3
16.3. Analysis
Comparison 16 Xenon versus sevoflurane anaesthesia, Outcome 3 In‐hospital mortality.
16.4
16.4. Analysis
Comparison 16 Xenon versus sevoflurane anaesthesia, Outcome 4 Adverse events.
16.5
16.5. Analysis
Comparison 16 Xenon versus sevoflurane anaesthesia, Outcome 5 Sepsis.
17.1
17.1. Analysis
Comparison 17 Epidural anaesthesia versus general anaesthesia, Outcome 1 Incident delirium.
17.2
17.2. Analysis
Comparison 17 Epidural anaesthesia versus general anaesthesia, Outcome 2 Length of admission > 10 days.
17.3
17.3. Analysis
Comparison 17 Epidural anaesthesia versus general anaesthesia, Outcome 3 Cognitive decline.
17.4
17.4. Analysis
Comparison 17 Epidural anaesthesia versus general anaesthesia, Outcome 4 Urinary tract infection.
17.5
17.5. Analysis
Comparison 17 Epidural anaesthesia versus general anaesthesia, Outcome 5 Psychological morbidity.
17.6
17.6. Analysis
Comparison 17 Epidural anaesthesia versus general anaesthesia, Outcome 6 Postoperative complications.
17.7
17.7. Analysis
Comparison 17 Epidural anaesthesia versus general anaesthesia, Outcome 7 Pressure ulcer.
18.1
18.1. Analysis
Comparison 18 Liberal versus restrictive blood transfusion thresholds, Outcome 1 Incident delirium.
18.2
18.2. Analysis
Comparison 18 Liberal versus restrictive blood transfusion thresholds, Outcome 2 Delirium severity.
18.3
18.3. Analysis
Comparison 18 Liberal versus restrictive blood transfusion thresholds, Outcome 3 Length of admission.
18.4
18.4. Analysis
Comparison 18 Liberal versus restrictive blood transfusion thresholds, Outcome 4 Psychoactive medication use.
18.5
18.5. Analysis
Comparison 18 Liberal versus restrictive blood transfusion thresholds, Outcome 5 Infection.
18.6
18.6. Analysis
Comparison 18 Liberal versus restrictive blood transfusion thresholds, Outcome 6 Congestive heart failure.
19.1
19.1. Analysis
Comparison 19 Fast‐track surgery versus usual care, Outcome 1 Incident delirium.
19.2
19.2. Analysis
Comparison 19 Fast‐track surgery versus usual care, Outcome 2 Length of admission.
19.3
19.3. Analysis
Comparison 19 Fast‐track surgery versus usual care, Outcome 3 Urinary tract infection.
19.4
19.4. Analysis
Comparison 19 Fast‐track surgery versus usual care, Outcome 4 Heart failure.
20.1
20.1. Analysis
Comparison 20 Postoperative delirium‐free protocol (DFP) versus usual care, Outcome 1 Incident delirium.
20.2
20.2. Analysis
Comparison 20 Postoperative delirium‐free protocol (DFP) versus usual care, Outcome 2 Length of admission.
20.3
20.3. Analysis
Comparison 20 Postoperative delirium‐free protocol (DFP) versus usual care, Outcome 3 Behavioural disturbance.
21.1
21.1. Analysis
Comparison 21 Computerised clinical decision support system (CCDS) versus usual care, Outcome 1 Incident delirium.
21.2
21.2. Analysis
Comparison 21 Computerised clinical decision support system (CCDS) versus usual care, Outcome 2 Length of admission.
21.3
21.3. Analysis
Comparison 21 Computerised clinical decision support system (CCDS) versus usual care, Outcome 3 Mortality within 30 days of discharge.
21.4
21.4. Analysis
Comparison 21 Computerised clinical decision support system (CCDS) versus usual care, Outcome 4 Falls.
21.5
21.5. Analysis
Comparison 21 Computerised clinical decision support system (CCDS) versus usual care, Outcome 5 Pressure ulcers.
22.1
22.1. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 1 Incident delirium.
22.2
22.2. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 2 Duration of delirium.
22.3
22.3. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 3 Severity of delirium.
22.4
22.4. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 4 Length of admission.
22.5
22.5. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 5 Cognitive function (composite score) at 4 months.
22.6
22.6. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 6 Incident dementia at 12 months.
22.7
22.7. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 7 ADL function at 4 months.
22.8
22.8. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 8 Institutionalisation at 4 months.
22.9
22.9. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 9 Institutionalisation at 12 months.
22.10
22.10. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 10 Inpatient mortality.
22.11
22.11. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 11 Falls.
22.12
22.12. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 12 Pressure ulcers.
22.13
22.13. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 13 Other medical adverse events.
22.14
22.14. Analysis
Comparison 22 Geriatric unit care versus orthopaedic unit care, Outcome 14 Postoperative complications.
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Hatta 2014 {published and unpublished data}
    1. Hatta K, Kishi Y, Wada K, Takeuchi T, Odawara T, Usui C, et al. Preventive effects of ramelteon on delirium: a randomized placebo‐controlled trial. JAMA Psychiatry 2014;71(4):397‐403. - PubMed
Hempenius 2013 {published data only}
    1. Hempenius L, Slaets JPJ, Asselt D, Bock GH, Wiggers T, Leeuwen BL. Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly cancer patients: report on a multicentre, randomized, controlled trial. PLOS One 2013;8(6):e64834. - PMC - PubMed
Jeffs 2013 {published data only}
    1. Jeffs KJ, Berlowitz DJ, Grant S, Lawlor V, Graco M, Morton NA, et al. An enhanced exercise and cognitive programme does not appear to reduce incident delirium in hospitalised patients: a randomised controlled trial. BMJ Open 2013;3:e002569. - PMC - PubMed
    1. Jeffs KJ, Berlowitz DJ, Savige JA, Lim WK. Does an enhanced exercise and cognitive program reduce incident delirium in older hospital patients: results of a randomised controlled trial. Internal Medicine Journal 2008;38(Suppl 5):A121.
Jia 2014 {published data only}
    1. Jia Y, Jin G, Guo S, Gu B, Jin Z, Gao X, et al. Fast‐track surgery decreases the incidence of postoperative delirium and other complications in elderly patients with colorectal carcinoma. Langenbecks Archives of Surgery 2014;399:77‐84. - PMC - PubMed
Kalisvaart 2005 {published data only}
    1. Kalisvaart KJ, Jonghe JF, Bogaards MJ, Vreeswijk R, Egberts TCG, Burger BJ, et al. Haloperidol prophylaxis for elderly hip‐surgery patients at risk for delirium: a randomized placebo‐controlled study. Journal of the American Geriatrics Society 2005;53(10):1658‐66. - PubMed
Larsen 2010 {published data only}
    1. Larsen KA, Min D, Kelly SE, Stern TA, Bode RH Jr, Price LL, et al. Administration of olanzapine to prevent postoperative delirium in elderly joint‐replacement patients: a randomized, controlled trial. Psychosomatics 2010;51(5):409‐18. - PubMed
Leung 2006 {published data only}
    1. Leung JM, Sands LP, Rico M, Petersen KL, Rowbotham MC, Dahl JB, et al. Pilot clinical trial of gabapentin to decrease postoperative delirium in older patients. Neurology 2006;67:1251‐3. - PubMed
Li 2013 {published data only}
    1. Li J‐Z, Li X‐Z, Wang X‐M, Wang M‐S, Yu H‐F, Shi F, et al. Effects of parecoxib sodium analgesia on serum concentrations of neuron‐specific enolase and S‐100^b and postoperative cognitive function of elderly patients undergoing acute replacement of femoral head. [Chinese]. Zhonghua Yi Xue Za Zhi 2013;93(27):2152‐4. - PubMed
Liptzin 2005 {published data only}
    1. Liptzin B, Laki A, Garb J, Fingeroth R, Krushell R. Donepezil in the prevention and treatment of post‐surgical delirium. American Journal of Geriatric Psychiatry 2005;13(12):1100‐6. - PubMed
Lundstrom 2007 {published data only}
    1. Lundstrom M, Olofsson B, Stenvall M, Karlsson S, Nyberg L, Englund U, et al. Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study. Aging Clinical and Experimental Research 2007;19(3):178‐86. - PubMed
Lurati 2012 {published data only}
    1. Lurati Buse GA, Schumacher P, Seeberger E, Studer W, Schuman RM, Fassl J, et al. Randomized comparison of sevoflurane versus propofol to reduce perioperative myocardial ischemia in patients undergoing noncardiac surgery. Circulation 2012;126:2696‐704. - PubMed
Marcantonio 2001 {published data only}
    1. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. Journal of the American Geriatrics Society 2001;49(5):516‐22. - PubMed
Marcantonio 2011 {published data only}
    1. Marcantonio ER, Palihnich K, Appleton P, Davis RB. Pilot randomized trial of donepezil hydrochloride for delirium after hip fracture. Journal of the American Geriatric Society 2011;59(Suppl 2):S282‐8. - PMC - PubMed
Martinez 2012 {published data only}
    1. Martinez F. Prophylactic Environmental Management of Delirium. https://clinicaltrials.gov/ct2/show/NCT01356810 2011.
    1. Martinez FT, Tobar C, Beddings CI, Vallejo G. Preventing delirium in an acute hospital using a non‐pharmacological intervention. Age Ageing 2012;41(5):629‐34. - PubMed
Mouzopoulos 2009 {published data only}
    1. Mouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo‐controlled study. Journal of Orthopaedics and Traumatology 2009;10(3):127‐33. - PMC - PubMed
Munger 2008 {published data only}
    1. Munger S, Boustani M, Parr J. The effectiveness of donepezil in preventing delirium and post‐ operative cognitive decline following orthopaedic surgery. American Geriatrics Society Scientific Conference. 2008.
Papaioannou 2005 {published data only}
    1. Papaioannou A, Fraidakis O, Michaloudis D, Balalis C, Askitopoulou H. The impact of the type of anaesthesia on cognitive status and delirium during the first postoperative days in elderly patients. European Journal of Anaesthesiology 2005;22(7):492‐9. - PubMed
Pesonen 2011 {published data only}
    1. Pesonen A, Suojaranta‐Ylinen R, Hammarén E, Kontinen VK, Raivio P, Tarkkila P, et al. Pregabalin has an opioid‐sparing effect in elderly patients after cardiac surgery: a randomized placebo‐controlled trial. British Journal of Anaesthesia 2011;106(6):873‐81. - PubMed
Radtke 2013 {published data only}
    1. Radtke FM, Franck M, Lendner J, Kruger S, Wernecke KD, Spies CD. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. British Journal of Anaesthesia 2013;110(S1):i98‐i105. - PubMed
Sampson 2007 {published data only}
    1. Sampson EL, Raven PR, Ndhlovu PN, Vallance A, Garlick N, Watts J, et al. A randomized, double blind, placebo‐controlled trial of donepezil hydrochloride (Aricept) for reducing the incidence of postoperative delirium after elective total hip replacement. Internation Journal of Geriatric Psychiatry 2007;22(4):343‐9. - PubMed
Sieber 2010 {published data only}
    1. Brown CH 4th, Azman AS, Gottschalk A, Mears SC, Sieber FE. Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair. Anesthesia and Analgesia 2014;118(5):977‐80. - PMC - PubMed
    1. Sieber FE, Zakriya KJ, Gottschalk A, Blute MR, Lee HB, Rosenberg PB, et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proceedings 2010;85(1):18‐26. - PMC - PubMed
Stoppe 2013 {published data only}
    1. Stoppe C, Fahlenkamp AV, Rex S, Veeck NC, Gozdowsky SC, Schalte G, et al. Feasibility and safety of xenon compared with sevoflurane anaesthesia in coronary surgical patients: a randomized controlled pilot study. British Journal of Anaesthesia 2013;111(3):406‐16. - PubMed
Urban 2008 {published data only}
    1. Urban MK, Ya Deau JT, Wukovits B, Lipnitsky JY. Ketamine as an adjunct to postoperative pain management in opioid tolerant patients after spinal fusions: a prospective randomized trial. HSS Journal: the musculoskeletal journal of Hospital for Special Surgery 2008;4(1):62‐5. - PMC - PubMed
Watne 2014 {published data only}
    1. Watne LO, Torbergsen AC, Conroy S, Engedal K, Frihagen F, Hjorthaug GA, et al. The effect of a pre‐ and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial). BMC Medicine 2014;12:63. - PMC - PubMed
    1. Wyller TB, Watne LO, Torbergsen A, Engedal K, Frihagen F, Juliebø V, et al. The effect of a pre‐ and post‐operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial. BMC Geriatrics 2012;12(36):doi:10.1186/1471‐2318‐12‐36. - PMC - PubMed
Whitlock 2015 {published data only}
    1. Whitlock RP, Devereaux PJ, Teoh KH, Lamy A, Vincent J, Pogue J, et al. Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double‐blind, placebo‐controlled trial. Lancet 2015;386(10000):1243‐53. - PubMed

References to studies excluded from this review

Al Tamimi 2015a {published data only}
    1. Al Tmimi L, Hemelrijck J, Velde M, Sergeant P, Meyns B, Missant C, et al. Xenon anaesthesia for patients undergoing off‐pump coronary artery bypass graft surgery: A prospective randomized controlled pilot trial. British Journal of Anaesthesia 2015;115(4):550‐9. - PubMed
Astaneh 2007 {published data only}
    1. Astaneh A, Khajehmougahi N, Pakseresht S. The multicomponent intervention to prevent postoperative delirium after open‐heart surgery. Pakistan Journal of Medical Sciences 2007;23(2):188‐92.
Baldwin 2004 {published data only}
    1. Baldwin R, Pratt H, Goring H, Marriott A, Roberts C. Does a nurse‐led mental health liaison service for older people reduce psychiatric morbidity in acute general medical wards? A randomised controlled trial. Age and Ageing 2004;33(5):472‐8. - PubMed
Benedict 2009 {published data only}
    1. Benedict L, Hazelett S, Fleming E, Ludwick R, Anthony M, Fosnight S, et al. Prevention, detection and intervention with delirium in an acute care hospital: a feasibility study. International Journal of Older Peoples Nursing 2009;4(3):194‐202. - PubMed
Bolotin 2014 {published data only}
    1. Bolotin G, Huber CH, Shani L, Mohr FW, Carrel TP, Borger MA, et al. Novel emboli protection system during cardiac surgery: A multi‐center, randomized, clinical trial. Annals of Thoracic Surgery 2014;98(5):1627‐33. - PubMed
Brueckmann 2015 {published data only}
    1. Brueckmann B, Sasaki N, Grobara P, Li MK, Woo T, Bie J, et al. Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: A randomized, controlled study. British Journal of Anaesthesia 2015;115(5):743‐51. - PubMed
Budd 1974 {published data only}
    1. Budd S, Brown W. Effect of a reorientation technique on postcardiotomy delirium. Nursing Research 1974;23(4):341‐8. - PubMed
Caplan 2006 {published data only}
    1. Caplan GA, Coconis J, Board N, Sayers A, Woods J. Does home treatment affect delirium? A randomised controlled trial of rehabilitation of elderly and care at home or usual treatment (the REACH‐OUT trial). Age and Ageing 2006;35(1):53‐60. - PubMed
Cerchietti 2000 {published data only}
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Colak 2015 {published data only}
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Cole 2002 {published data only}
    1. Cole MG, McCusker J, Bellavance F, Primeau FJ, Bailey RF, Bonnycastle MJ, Laplante J. Systematic detection and multidisciplinary care of delirium in older medical inpatients: a randomized trial. Canadian Medical Association Journal 2002;167(7):753‐9. - PMC - PubMed
Culp 2003 {published data only}
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De Jonghe 2007 {published data only}
    1. Jonghe JFM, Kalisvaart KJ, Dijkstra M, Dis H, Vreeswijk R, Kat MG, et al. Early symptoms in the prodromal phase of delirium: a prospective cohort study in elderly patients undergoing hip surgery. American Journal of Geriatric Psychiatry 2007;15(2):112‐21. - PubMed
Del Rosario 2008 {published data only}
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Ding 2015 {published data only}
    1. Ding L, Zhang H, Mi W, Wang T, He Y, Zhang X, et al. Effects of dexmedetomidine on anesthesia recovery period and postoperative cognitive function of patients after robot‐assisted laparoscopic radical cystectomy. International Journal of Clinical and Experimental Medicine 2015;8(7):11388‐95. - PMC - PubMed
Ding 2015a {published data only}
    1. Ding L, Zhang H, Mi W, He Y, Zhang X, Ma X, et al. [Effects of dexmedetomidine on recovery period of anesthesia and postoperative cognitive function after robot‐assisted laparoscopicradical prostatectomy in the elderly people]. [Chinese]. Zhong Nan da Xue Xue Bao 2015;Yi Xue Ban = Journal of Central South University. Medical Sciences. 40(2):129‐35. - PubMed
Ely 2004a {published data only}
    1. Ely EW. A randomized, double‐blind trial in ventilated ICU patients comparing treatment with an Alpha2 Agonist versus a Gamma Aminobutyric Acid (GABA)‐Agonist to determine delirium rates, efficacy of sedation, analgesia and discharge cognitive status. ClinicalTrials.Gov 2004a.
Ely 2004b {published data only}
    1. Ely EW. Delirium in the ICU: a prospective, randomized, trial of placebo vs haloperidol vs ziprasidone. ClinicalTrials.gov 2004b.
Finotto 2006 {published data only}
    1. Finotto S, Artiolo G, Davoli L, Barbara B. Nursing interventions for the prevention of the delirium in intensive care unit (ICU): a randomized study. Professioni Infermieristiche 2006;59(4):228‐32. - PubMed
Gamberini 2009 {published data only}
    1. Gamberini M, Bolliger S, Lurati Buse GA, Burkhart CS, Grapow M, Gagneux A, et al. Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery ‐ a randomized controlled trial. Critical Care Medicine 2009;37(5):1762‐8. - PubMed
Hsieh 2015 {published data only}
    1. Hsieh S. Intranasal Insulin for neuroprotection in elderly cardiac surgery patients. ClinicalTrials.gov: NCT01561378 2012.
    1. Hsieh SJ, Fuster D, D'Alessandro DA, Leff JD, Gong MN. Feasibility and efficacy of intranasal insulin for post‐operative delirium: The CNS‐elders randomized controlled trial. American Journal of Respiratory and Critical Care Medicine 2015;May 1:A4018‐A4018.
Hu 2006 {published data only}
    1. Hu H, Deng W, Yang H, Liu Y. Olanzepine and haloperidol for senile delirium: a randomised controlled observation. Chinese Journal of Clinical Rehabilitation 2006;10(42):188‐90.
Hudetz 2009 {published data only}
    1. Hudetz JA, Patterson KM, Iqbal Z, Gandhi SD, Byrne AJ, Hudetz AG, et al. Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass. Journal of Cardiothoracic and Vascular Anesthesia 2009;23(5):651‐7. - PubMed
Hudetz 2015 {published data only}
    1. Hudetz JA, Patterson KM, Iqbal Z, Gandhi SD, Pagel PS. Remote ischemic preconditioning prevents deterioration of short‐term postoperative cognitive function after cardiac surgery using cardiopulmonary bypass: results of a pilot investigation. Journal of Cardiothoracic and Vascular Anesthesia 2015;29(2):382‐8. - PubMed
Hwang 2015 {published data only}
    1. Hwang J‐Y, Bang J‐S, Oh C‐W, Joo J‐D, Park S‐J, Do S‐H, et al. Effect of scalp blocks with levobupivacaine on recovery profiles after craniotomy for aneurysm clipping: A randomized, double‐blind, and controlled study. World Neurosurgery 2015;83(1):108‐13. - PubMed
Inouye 1993a {published data only}
    1. Inouye SK. A controlled trial of a nursing‐centered intervention in hospitalized elderly medical patients: the Yale Geriatric Care Program. Journal of the American Geriatrics Society. 1993;41(12):1353. - PubMed
Inouye 1999 {published data only}
    1. Bogardus ST Jr, Desai MM, Williams CS, Leo Summers L, Acampora D, Inouye SK. The effects of a targeted multicomponent delirium. American Journal of Medicine 2003;114(5):383‐90. - PubMed
    1. 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 see comments. New England Journal of Medicine 1999;340(9):669. - PubMed
    1. 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. Archives of Internal Medicine 2003;163(8):958‐64. - PubMed
    1. Leslie DL, Zhang Y, Bogardus ST, Holford TR, Leo‐Summers LS, Inouye SK. Consequences of preventing delirium in hospitalized older adults on nursing home costs. Journal of the American Geriatrics Society 2005;53(3):405‐9. - PubMed
    1. Rizzo JA, Bogardus ST, Leo‐Summers L, Williams CS, Acampora D, Inouye SK. Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value?. Medical Care 2001;39(7):740‐52. - PubMed
Kaneko 1999 {published data only}
    1. Kaneko T, Cai J, Ishikura T, Kobayashi M, Naka T, Kaibara N. Prophylactic consecutive administration of haloperidol can reduce the occurrence of postoperative delirium in gastrointestinal surgery. Yonago Acta Medica 1999;42(3):179‐84.
Kat 2008 {published data only}
    1. Kat MG, Vreeswijk R, Jonghe JF, Ploeg T, can Gool WA, Eikelenboom P, et al. Long term cognitive outcome of delirium in elderly hip surgery patients. A prospective matched controlled study over two and a half years. Dementia and Geriatric Cognitive Disorders 208;26(1):1‐8. - PubMed
Lackner 2008 {published data only}
    1. Lackner TE, Wyman JF, McCarthy TC, Monigold M, Davey C. Randomized, placebo‐controlled trial of the cognitive effect, safety, and tolerability of oral extended‐release oxybutynin in cognitively impaired nursing home residents with urge urinary incontinence. Journal of the American Geriatrics Society 2008;56(5):862‐70. - PubMed
Landefeld 1995 {published data only}
    1. Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. New England Journal of Medicine 1995;332(20):1338‐44. - PubMed
Lili 2013 {published data only}
    1. Lili X, Zhiyong H, Jianjun S. A preliminary study of the effects of ulinastatin on early postoperative cognition function in patients undergoing abdominal surgery. Neuroscience Letters 2013;541:15‐9. - PubMed
Lundstrom 2005 {published data only}
    1. Lundstrom M, Edlund A, Karlsson S, Brannstrom B, Bucht G, Gustafson Y. A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. Journal of the American Geriatrics Society 2005;53(4):622‐8. - PubMed
Maneeton 2007 {published data only}
    1. Maneeton B, Maneeton N, Srisurapanont M. An open‐label study of quetiapine for delirium. Journal of the Medical Association of Thailand 2007;90(10):2158‐208. - PubMed
Marcantonio 2010 {published data only}
    1. Marcantonio ER, Bergmann MA, Kiely DK, Orav EJ, Jones RN. Randomized trial of a delirium abatement program for postacute skilled nursing facilities. Journal of the American Geriatrics Society 2010;58(6):1019‐26. - PMC - PubMed
Mardani 2013 {published data only}
    1. Mardani D, Bigdelian H. Prophylaxis of dexamethasone protects patients from further post‐operative delirium after cardiac surgery: A randomized trial. Journal of Research in Medical Sciences 2013; Vol. 18, issue 2:137‐43. - PMC - PubMed
Marino 2009 {published data only}
    1. Marino J, Russo J, Kenny M, Herenstein R, Livote E, Chelly JE. Continuous lumbar plexus block for postoperative pain control after total hip arthoplasty. A randomised controlled trial. Journal of Bone and Joint Surgery 2009;91(1):29‐37. - PubMed
Mentes 2003 {published data only}
    1. Mentes JC, Culp K. Reducing hydration‐linked events in nursing home residents. Clinical Nursing Research 2003;12(3):210‐25; discussion 226‐8. - PubMed
Meybohm 2015 {published data only}
    1. Meybohm P, Bein B, Brosteanu O, Cremer J, Gruenewald M, Stoppe C, et al. A multicenter trial of remote ischemic preconditioning for heart surgery. New England Journal of Medicine 2015;373(15):1397‐407. - PubMed
Milisen 2001 {published data only}
    1. Milisen K, Foreman MD, Abraham IL, Geest S, Godderis J, Vandermeulen E, et al. A nurse‐led interdisciplinary intervention program for delirium in elderly hip‐fracture patients. Journal of the American Geriatrics Society 2001;49(5):523‐32. - PubMed
Mudge 2008 {published data only}
    1. Mudge AM, Giebel AJ, Cutler AJ. Exercising body and mind: an integrated approach to functional independence in hospitalized older people. Journal of the American Geriatrics Society 2008;56(4):630‐5. - PubMed
Myint 2013 {published data only}
    1. Myint MWW, Wu J, Wong E, Chan SP, To TSJ, Chau MWR, et al. Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: A single blind randomised controlled trial. Age and Ageing 2013; Vol. 42, issue 1:39‐45. - PubMed
Naughton 2005 {published data only}
    1. Naughton BJ, Saltzman S, Ramadan F, Chadha N, Priore R, Mylotte JM. A multifactorial intervention to reduce prevalence of delirium and shorten hospital length of stay. Journal of the American Geriatrics Society 2005;53(1):18‐23. - PubMed
Neri 2010 {published data only}
    1. Neri S, Bertino G, Petralia A, Giancarlo C, Rizzotto A, Calvagno GS, et al. A multidisciplinary therapeutic approach for reducing the risk of psychiatric side effects in patients with chronic hepatitis C treated with pegylated interferon α and ribavirin. Journal of Clinical Gastroenterology 2010;44(9):e210‐e217. - PubMed
Oldenbeuving 2008 {published data only}
    1. Oldenbeuving AW, Kort PL, Jansen BP, Kappelle LJ, Roks G. A pilot study of rivastigmine in the treatment of delirium after stroke: a safe alternative. BMC Neurology 2008;834:doi: 10.1186/1471‐2377‐8‐34. - PMC - PubMed
Overshott 2010 {published data only}
    1. Overshott R, Vernon M, Morris J, Burns A. Rivastigmine in the treatment of delirium in older people: A pilot study. International Psychogeriatrics 2010;22(5):812‐8. - PubMed
Pandharipande 2010 {published data only}
    1. Pandharipande PP, Sanders PD, Girard TD, McGrane S, Thomptosn JL, Shintani AK, et al. Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori‐designed analysis of the MENDS randomized controlled trial. Critical Care 2010;14(2):R38. - PMC - PubMed
Parker 2015 {published data only}
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Parra Sanchez 2009 {published and unpublished data}
    1. Parra Sanchez, Ivan. Intravenous lidocaine and postoperative outcomes after cardiac surgery. www.ClinicalTrials.gov (NCT00840918) 2009.
Perkisas 2015 {published data only}
    1. Perkisas SMT, Vandewoude MFJ. Ramelteon for prevention of delirium in hospitalized older patients. JAMA ‐ Journal of the American Medical Association 2015;313(17):1745‐6. - PubMed
Pitkala 2006 {published data only}
    1. Pitkala KH, Laurila JV, Strandberg TE, Tilvis RS. Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized controlled trial. Journals of Gerontology Series A (Biological Sciences and Medical Sciences) 2006;61(2):176‐81. - PubMed
Prakanrattana 2007 {published data only}
    1. Prakanrattana U, Prapaitrakool S. Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesthesia and Intensive Care 2007;35(5):714‐9. - PubMed
Pretto 2014 {published data only}
    1. Pretto G, Westphal GA, Silva E. Clonidine for reduction of hemodynamic and psychological effects of S+ ketamine anesthesia for dressing changes in patients with major burns: an RCT. Burns 2014;40(7):1300‐7. - PubMed
Ritchie 2008 {published data only}
    1. Ritchie C. A phase III, seven‐day randomised, double‐blind, placebo‐controlled, parallel group study to assess efficacy of Donsepezil for reducing the incidence and severity of post‐operative delirium after an elective total hip of knee replacement in patients over 65 years old. http://www.isrctn.com/ISRCTN55655483 2008.
Saager 2015 {published data only}
    1. Saager L, Duncan AE, Yared J‐P, Hesler BD, You J, Deogaonkar A, et al. Intraoperative tight glucose control using hyperinsulinemic normoglycemia increases delirium after cardiac surgery. Anesthesiology 2015;122(6, (NIH) *National Institutes of Health*):1214‐23. - PMC - PubMed
Sauer 2014 {published data only}
    1. Sauer A‐MC, Slooter AJ, Veldhuijzen DS, Eijk MM, Devlin JW, Dijk D. Intraoperative dexamethasone and delirium after cardiac surgery: a randomized clinical trial. Anesthesia and analgesia 2014;119(5):1046‐52. - PubMed
Short 2015 {published data only}
    1. Short TG, Leslie K, Chan MTV, Campbell D, Frampton C, Myles P. Rationale and design of the balanced anesthesia study: a prospective randomized clinical trial of two levels of anesthetic depth on patient outcome after major surgery. Anesthesia and Analgesia 2015;121(2):357‐65. - PubMed
Shu 2010 {published data only}
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Tabatabaie 2015 {published data only}
    1. Tabatabaie O, Matin N, Heidari A, Tabatabaie A, Hadaegh A, Yazdanynejad S, et al. Spinal anesthesia reduces postoperative delirium in opium dependent. Acta Anaesthesiologica Belgica 2015;66(2):49‐54. - PubMed
Tabet 2005 {published data only}
    1. Tabet N, Hudson S, Sweeney V, Sauer J, Bryant C, Macdonald A, et al. An educational intervention can prevent delirium on acute medical wards. Age and Ageing 2005;34(2):152‐6. - PubMed
Takeuchi 2007 {published data only}
    1. Takeuchi T, Furuta K, Hirasawa T, Masaki H, Yukizane T, Atsuta H, et al. Perospirone in the treatment of patients with delirium. Psychiatry and Clincial Neurosciences 2007;61(1):67‐70. - PubMed
Tokita 2001 {published data only}
    1. Tokita K, Tanaka H, Kawamoto M, Yuge O. [Patient‐controlled epidural analgesia with bupivacaine and fentanyl suppresses postoperative delirium following hepatectomy]. Masui [Japanese Journal of Anesthesiology] 2001;50(7):742‐6. - PubMed
Torres 2015 {published data only}
    1. Torres A, Sibila O, Ferrer M, Polverino E, Menendez R, Mensa J, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community‐acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA 2015;313(7):677‐86. - PubMed
van de Steeg 2014 {published data only}
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Wang 2012 {published data only}
    1. Wang W, Li HL, Wang DX, Zhu X, Li SL, Yao GQ, et al. Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial*. Critical Care Medicine 2012;40(3):731‐9. - PubMed
Wanich 1992 {published data only}
    1. Wanich CK, Sullivan‐Marx EM, Gottlieb GL, Johnson JC. Functional status outcomes of a nursing intervention in hospitalized elderly. Image ‐ the Journal of Nursing Scholarship 1992;24(3):201‐7. - PubMed
Wong 2005 {published data only}
    1. Wong Tin Niam DM, Bruce JJ, Bruce DG. Quality project to prevent delirium after hip fracture. Australasian Journal on Ageing 2005;24(3):174‐7.
Yamaguchi 2014 {published data only}
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Yang 2015 {published data only}
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