Is dexmedetomidine effective for delirium prevention in older adults? A scoping review

Delirium is a common neuropsychiatric syndrome in older adults, associated with significant functional and cognitive decline as well as increased mortality. Although multicomponent non-pharmacological interventions are the first-line strategy for prevention, their implementation may be challenging in certain clinical settings. The role of pharmacological strategies remains controversial. This review aimed to analyze the efficacy of dexmedetomidine in preventing delirium in older adults, assessing its impact on incidence, duration, severity, and motor subtypes, as well as its safety profile. A systematic search was conducted in PubMed, Web of Science, and The Cochrane Library for randomized controlled trials published in English or Spanish up to January 2024, including studies involving participants aged ≥65 years. Twenty-two eligible studies were identified. Fifteen of them demonstrated a significant reduction in delirium incidence among patients treated with dexmedetomidine, particularly in the context of orthopedic surgery. Three studies reported a shorter duration of delirium; however, no consistent differences were observed in severity or motor subtypes. Dexmedetomidine was also associated with improved sleep quality and better pain control, without significant effects on length of hospital stay or mortality. The most common adverse events were bradycardia and hypotension, with no serious adverse events reported. Overall, the available evidence suggests that dexmedetomidine may be effective in preventing delirium in older adults, particularly in surgical settings; however, further research is needed to confirm its efficacy and safety in the broader geriatric population.