Intervention Review

Interventions for preventing delirium in hospitalised patients

  1. Najma Siddiqi1,*,
  2. Rachel Holt2,
  3. Annette M Britton3,
  4. John Holmes4

Editorial Group: Cochrane Dementia and Cognitive Improvement Group

Published Online: 18 APR 2007

Assessed as up-to-date: 11 JAN 2007

DOI: 10.1002/14651858.CD005563.pub2

How to Cite

Siddiqi N, Holt R, Britton AM, Holmes J. Interventions for preventing delirium in hospitalised patients. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005563. DOI: 10.1002/14651858.CD005563.pub2.

Author Information

  1. 1

    University of Leeds, Academic Unit for Psychiatry and Behavioural Sciences, Leeds, UK

  2. 2

    Leeds, UK

  3. 3

    Royal Prince Alfred Hospital, Geriatric Unit, Sydney, NSW, Australia

  4. 4

    University of Leeds, Academic Unit of Psychiatry, Leeds, UK

*Najma Siddiqi, Academic Unit for Psychiatry and Behavioural Sciences, University of Leeds, 15 Hyde Terrace, Leeds, LS2 9LT, UK.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 APR 2007




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結


Delirium is a common mental disorder with serious adverse outcomes in hospitalised patients. It is associated with increases in mortality, physical morbidity, length of hospital stay, institutionalisation and costs to healthcare providers. A range of risk factors has been implicated in its aetiology, including aspects of the routine care and environment in hospitals. Prevention of delirium is clearly desirable from patients' and carers' perspectives, and to reduce hospital costs. Yet it is currently unclear whether interventions for prevention of delirium are effective, whether they can be successfully delivered in all environments, and whether different interventions are necessary for different groups of patients.


Our primary objective was to determine the effectiveness of interventions designed to prevent delirium in hospitalised patients. We also aimed to highlight the quality and quantity of research evidence to prevent delirium in these settings.

Search methods

We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 30 September 2006. As the searches in MEDLINE, EMBASE, CINAHL and PsycINFO for the Specialized Register would not necessarily have picked up all delirium prevention trials, these databases were searched again on 28th October, 2005. We also examined reference lists of retrieved articles, reviews and books. Experts in this field were contacted and the Internet searched for further references and to locate unpublished trials.

Selection criteria

Randomised controlled trials evaluating any interventions to prevent delirium in hospitalised patients.

Data collection and analysis

Data collection and quality assessment were performed by three reviewers independently and agreement reached by consensus.

Main results

Six studies with a total of 833 participants were identified for inclusion. All were conducted in surgical settings, five in orthopaedic surgery and one in patients undergoing resection for gastric or colon cancer.

Only one study of 126 hip fracture patients comparing proactive geriatric consultation with usual care was sufficiently powered to detect a difference in the primary outcome, incident delirium. Total cumulative delirium incidence during admission was reduced in the intervention group (OR 0.48 [95% CI 0.23, 0.98]; RR 0.64 [95% CI 0.37, 0.98]), suggesting a 'number needed to treat' of 5.6 patients to prevent one case. The intervention was particularly effective in preventing severe delirium. In logistic regression analyses adjusting for pre fracture dementia and Activities of Daily Living impairment, there was no reduction in effect size, OR 0.6, but this no longer remained significant [95% CI 0.3,1.3]. There was no effect on the duration of delirium episodes, length of hospital stay, and cognitive status or institutionalisation at discharge. There was also no significant difference in cumulative delirium incidence between treatment and control groups in a sub-group of 50 patients with dementia (RR 0.9 [95% CI 0.59, 1.36]).

In another trial of low dose haloperidol prophylaxis, there was no difference in delirium incidence but the severity and duration of a delirium episode, and length of hospital stay were all reduced.

We identified no completed studies in hospitalised medical, care of the elderly, general surgery, cancer or intensive care patients. In outcomes, no studies examined for death, use of psychotropic medication, activities of daily living, psychological morbidity, quality of life, carers or staff psychological morbidity, cost of intervention and cost to health care services. Outcomes were only reported up to discharge, with no studies reporting medium or longer-term effects.

Authors' conclusions

Research evidence on effectiveness of interventions to prevent delirium is sparse. Based on a single study, a programme of proactive geriatric consultation may reduce delirium incidence and severity in patients undergoing surgery for hip fracture. Prophylactic low dose haloperidol may reduce severity and duration of delirium episodes and shorten length of hospital admission in hip surgery. Further studies of delirium prevention are needed.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

There is a lack of robust information on delirium prevention in hospitalised patients

We were only able to identify one trial with adequate power to demonstrate effectiveness of any preventive strategies. Based on this single study, proactive consultation by a consultant geriatrician before, or within 24 hours of operation may reduce the incidence and severity of delirium in patients undergoing surgery for hip fracture. Low dose haloperidol prophylaxis may be effective in reducing the severity and duration of a delirium episode and may shorten length of hospital admission. Given what is already known about how common delirium is, and how poor its outcomes are, further trials of delirium prevention are urgently needed.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結







我們在2005年9月28日搜尋了Specialized Register of the Cochrane Dementia and Cognitive Improvement Group資料庫。由於在MEDLINE、EMBASE、CINAHL及PsycINFO中針對Specialized Register所進行的搜尋未必能找到所有的譫妄預防相關試驗,因此我們在2005年10月28日再度對這些資料庫進行搜尋。我們也檢視了所取得之論文、回顧與書籍的參考文獻清單。另外也與此領域的專家取得聯繫,並搜尋網際網路,以尋求更多參考文獻並找出未發表的試驗。


我們納入了:評估任何用以預防住院患者發生譫妄的介入措施之隨機對照試驗(randomised controlled trials;RCTs)。





只有一項針對126位髖關節骨折患者、比較積極性老人諮詢(proactive geriatric consultation)與常規照護的研究,其檢定力足以偵測主要預後指標(後發性譫妄〔incident delirium〕)上的差異。結果,住院期間譫妄的總累加發生率在介入治療組中較低(OR:0.48 [95% CI:0.23, 0.98];RR:0.64 [95% CI:0.37, 0.98]),代表成功防止1個病例出現的「需治療人數」(number needed to treat)為5.6人。此介入措施對重度譫妄的預防特別有效。根據骨折前的失智症(dementia)及日常生活活動(Activities of Daily Living)障礙校正後的邏輯迴歸分析(logistic regression analysis)發現:效應大小(0.6的OR)並未下降,但卻不再顯著(95% CI:0.3, 1.3)。介入治療不影響譫妄事件的持續時間、住院天數,以及出院時的認知狀態或照護機構入住與否。而在50位失智症患者次組中,治療組與對照組之間在譫妄的累加發生率上,也有顯著的差異(RR:0.9 [95% CI:0.59, 1.36])。


我們並未找到已完成、且針對內科、老人科、一般外科、腫瘤科或加護病房之住院病患所進行的研究。預後指標方面,沒有任何研究檢視:死亡、精神藥物(psychotropic medication)的使用、日常生活活動、精神疾患發生率、生活品質、照護者或醫護人員的精神疾患發生率、介入措施的成本,以及醫療服務的成本。預後指標只報告至出院時,沒有任何研究報告中期或長期效果。





  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結





East Asian Cochrane Alliance 翻譯
翻譯由 台灣衛生福利部/台北醫學大學實證醫學研究中心 資助