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Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial
Kaisu H Pitkälä1, Jouko V Laurila, Timo E Strandberg
1The Central Union for the Welfare of the Aged, Malmin Kauppatie 26, 00700 Helsinki, Finland. kaisu.pitkala@vanhustyonkeskusliitto.fi
Summary
Intensified geriatric care for elderly patients with delirium improved cognitive function and delirium symptoms. However, this comprehensive approach did not significantly reduce mortality or long-term institutionalization rates over one year.
Area of Science:
- Geriatric Medicine
- Internal Medicine
- Clinical Gerontology
Background:
- Delirium is a prevalent condition in elderly inpatients, associated with poor prognosis and variable treatment practices.
- Investigating the efficacy of intensified, multicomponent geriatric treatment for delirious patients is crucial.
Purpose of the Study:
- To determine if an intensified, multicomponent geriatric treatment could improve the prognosis of elderly patients experiencing delirium.
Main Methods:
- A randomized controlled trial involving 174 patients with delirium across six general medicine units in Helsinki, Finland.
- The intervention group received tailored geriatric care, while the control group received standard care.
- Primary endpoint: combined mortality and permanent institutionalization; Secondary endpoints: institutionalization duration, delirium intensity, and cognitive function.
Main Results:
- The intervention group received more acetylcholinesterase inhibitors, atypical antipsychotics, specialist consultations, hip protectors, and physiotherapy, with fewer conventional neuroleptics.
- No significant difference was observed in the primary endpoint (mortality or permanent institutionalization) between groups after 1 year (60.9% vs 64.4%).
- The intervention group showed faster delirium alleviation during hospitalization and significant cognitive improvement at 6 months, despite similar institutionalization durations.
Conclusions:
- Comprehensive geriatric care for delirious elderly patients leads to faster symptom alleviation and cognitive improvement.
- While not impacting hard endpoints like mortality or long-term institutionalization, the benefits to delirium and cognition support its use.