MENTAL HEALTH

Health Evidence Bulletins - Wales
Team Leader: Dr. Lyn Harris

Date of Completion: 4.6.98

DELIRIUM

This document is a supplement to, not a substitute for, professional skills and experience. Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation

The Statements The Evidence
2.1 Prevention and Promotion
2.1a. Good prescribing practices are beneficial in the prevention of delirium and good hydration, electrolyte balance and oxygenation should be ensuredi. i. Original Protocol. Welsh Health Planning Forum. Protocol for investment in health gain. Mental health. Cardiff: Welsh Office, April 1993
(Type V evidence - expert opinion)
2.1b. Attention should be given to all psychological, sensory and environmental factors affecting acutely ill patients, but a systematic review suggested little benefit on the basis of the available evidencei,ii. i. Original Protocol. Welsh Health Planning Forum. Protocol for investment in health gain. Mental health. Cardiff: Welsh Office, April 1993
(Type V evidence - expert opinion)
ii. Cole M, Primeau J, McCusker J. Effectiveness of interventions to prevent delirium in hospitalised patients. A systematic review.
Canadian Medical Association Journal 1996; 155: 1263-1268

(Type I evidence - systematic review)
2.2 Diagnosis and Assessment.
2.2a. The following represent good practice in the diagnosis of delirium i:
  • Early diagnosis is beneficial
  • An active search for causal factors should be carried out
  • Training in the recognition of delirium should be provided to primary care teams

 

i. Original Protocol. Welsh Health Planning Forum. Protocol for investment in health gain. Mental health. Cardiff: Welsh Office, April 1993
(Type V evidence - expert opinion)

 

 

 

2.2b. A systematic review of the effectiveness of multidisciplinary assessment and intervention for delirium in patients with chronic cognitive impairment is underwayi. i. Britton A, Russell R. The effectiveness of interventions by multidisciplinary teams in the management of delirium in patients with chronic cognitive impairment - a review of the evidence of effectiveness. [Protocol] Cochrane Database of Systematic Reviews. Cochrane Library 1998 Issue 1
(review in preparation)

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2.2c. Prognosis is poor in elderly patients in the presence of concomitant dementia or severe physical illness i,ii. i. Cole MG, Primeau FJ. Prognosis of delirium in elderly hospital patients. Canadian Medical Association Journal 1993; 149(1): 41 - 46
(Type IV evidence - observational studies)
ii. Francis J. Delirium in hospitalized elderly patients: a meta-analysis. ACP Journal Club Nov/Dec 1993, p.87
(Commentary on reference i.)
2.3 Treatment and Care
2.3a.The following represent good practice in    the treatment and care of patients with delirium i:
  • Good prescribing practices including drug withdrawal if possible
  • Prompt and vigorous treatment of underlying medical problems
  • Normalising the environment of acutely ill patients
i. Original Protocol. Welsh Health Planning Forum. Protocol for investment in health gain. Mental health. Cardiff: Welsh Office, April 1993
(Type V evidence - expert opinion)
2.3b. There is little evidence that systematic interventions to prevent delirium among surgical patients are effective. In a systematic review, only one study showed a significant reduction in the incidence of delirium, and this was a non-randomised trial without blinded assessment of outcomes. The randomised controlled trials showed a non-significant or negative effecti. i. Cole MG, Primeau F, McCusker J. Effectiveness of interventions to prevent delirium in hospitalized patients: a systematic review.Canadian Medical Association Journal 1996; 155(9): 1263-1268
(Type I evidence - systematic review)

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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk