Randomised controlled trials (RCTs) that focused on strategies for prevention or management of delirium in hospitalised adults primarily aged at least 65 years were eligible for inclusion in the review. Outcomes of interest were delirium rates, morbidity, length of hospital stay and mortality.
Prevention strategies included multicomponent and pharmacological interventions. Multicomponent prevention studies included hip fracture patients. Multicomponent management studies included medical in-patients. All multicomponent interventions included specialists in geriatrics and contained strategies to tackle one or more of the risk factors: cognitive impairment, functional impairment, fluid imbalance, high-risk medications, pain, impaired vision or hearing, malnutrition, iatrogenic complications and sleep deprivation. All management strategy RCTs were multicomponent interventions. Delirium management strategies comprised a range of multicomponent interventions (reported in the paper). Methods used to identify delirium varied across the studies and included Confusion Assessment Method, Organic Brain Syndrome Scale and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria. Pharmacological interventions varied between studies and included morphine, haloperidol, donepezil and diazepam given for hip or knee fractures or during bowel cancer surgery.
Two reviewers independently selected studies for inclusion. Disagreements were resolved by discussion.