Delirium in the elderly: A systematic review of pharmacological and non-pharmacological treatments

ABSTRACT Delirium is a common disorder associated with poor prognosis, especially in the elderly. The impact of different treatment approaches for delirium on morbimortality and long-term welfare is not completely understood. OBJECTIVE: To determine the efficacy of pharmacological and non-pharmacological treatments in elderly patients with delirium. METHODS: This systematic review compared pharmacological and non-pharmacological treatments in patients over 60 years old with delirium. Databases used were: MEDLINE (PubMed), EMBASE, Cochrane CENTRAL and LILACS from inception to January 6th, 2016. RESULTS: A total of ten articles were selected. The six non-pharmacological intervention studies showed no impact on duration of delirium, mortality or institutionalization, but a decrease in severity of delirium and improvement in medium-term cognitive function were observed. The most commonly used interventions were temporal-spatial orientation, orientation to self and others, early mobilization and sleep hygiene. The four studies with pharmacological interventions found that rivastigmine reduced the duration of delirium, improved cognitive function and reduced caregiver burden; olanzapine and haloperidol decreased the severity of delirium; droperidol reduced length of hospitalization and improved delirium remission rate. CONCLUSION: Although the pharmacological approach has been used in the treatment of delirium among elderly, there have been few studies assessing its efficacy, involving a small number of patients. However, the improvements in delirium duration and severity suggest these drugs are effective in treating the condition. Once delirium has developed, non-pharmacological treatment seems less effective in controlling symptoms, and there is a lack of studies describing different non-pharmacological interventions.

摘要：谵妄（Delirium）是一类常见病症，与不良预后紧密相关，在老年群体中尤为高发。目前，不同谵妄治疗方案对患者病残率与病死率及长期健康福祉的影响尚未完全明确。
研究目的：明确药物与非药物治疗手段在老年谵妄患者中的临床疗效。
研究方法：本系统综述对比了60岁以上谵妄患者接受药物治疗与非药物治疗的效果。检索数据库涵盖MEDLINE（PubMed）、EMBASE、Cochrane CENTRAL及LILACS，检索时限为各数据库建库至2016年1月6日。
研究结果：最终共纳入10项符合标准的研究。其中6项非药物干预研究显示，此类干预无法显著影响谵妄持续时长、病死率及机构安置率，但可降低谵妄严重程度，并改善患者中期认知功能。临床中最常应用的非药物干预措施包括时空定向训练、自我与他人定向引导、早期活动及睡眠卫生管理。4项药物干预研究结果表明：利斯的明（rivastigmine）可缩短谵妄持续时间、改善认知功能并减轻照料者负担；奥氮平（olanzapine）与氟哌啶醇（haloperidol）均可降低谵妄严重程度；氟哌利多（droperidol）可缩短住院时长并提升谵妄缓解率。
研究结论：尽管药物治疗已应用于老年谵妄患者的临床诊疗，但相关疗效评估研究数量较少，且纳入患者规模有限。不过现有数据显示，此类药物可有效改善谵妄持续时长与严重程度，对该病症具有明确治疗价值。一旦谵妄发作，非药物治疗在症状控制方面的效果相对有限，且目前仍缺乏针对不同非药物干预方案的对比研究。