Non-Drug Options Can Help Curb Delirium in Hospital Patients, Study Finds

Simply reminding patient each morning of date, place can help, researchers found

By Robert Preidt

Monday, February 2, 2015

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MONDAY, Feb. 2, 2015 (HealthDay News) -- Delirium is a common and troubling symptom for critically ill hospital patients, and medications are often used to ease the condition. But a new study suggests that non-drug alternatives are available.

According to the study authors, delirium -- a sudden onset of confusion -- is common among older hospital patients and raises their risk of falls, physical decline and longer hospital stays.

The researchers, from Brigham and Women's Hospital in Boston, reviewed 14 studies that assessed the use of drug-free strategies to reduce delirium in older patients at 12 hospitals around the world.

Those methods included proper nutrition and hydration, adequate sleep, daily exercise, activities to improve thinking and memory and telling patients where they are, and the date and time, every day.

These techniques appeared to reduce patients' odds of delirium and falls. They also led to shorter hospital stays, according to the study published online Feb. 2 in JAMA Internal Medicine.

"Delirium is a major problem at many hospitals and preventing its downstream consequences, including falls, is a priority," Dr. Tammy Hshieh, of the hospital's Division of Aging and the Aging Brain Center, said in a hospital news release.

"Delirium can be the source of anxiety for many patients and their families and often they wish that there was a pill that would make the patient's symptoms go away," Hshieh added. "Our study demonstrates that there are effective strategies for preventing delirium and treating patients that don't rely on medications."

It's estimated that 29 percent to 64 percent of elderly hospital patients suffer delirium, but the condition is likely underdiagnosed, the researchers added.

They estimate that drug-free prevention methods could prevent 1 million cases of delirium a year in the United States, and save Medicare $10 billion annually.

Two experts agreed that alternative approaches are needed.

"The use of medications to control delirious behavior is common, but poses other problems for the patient, including actually increasing risk for further illness," said Dr. Gayatri Devi, a neurologist specializing in memory disorders at Lenox Hill Hospital in New York City.

She said that the "simple interventions" outlined in the study "are not only cost-effective, but also humane and a welcome addition in treating our ailing elders."

Dr. Gisele Wolf-Klein is director of geriatric education at North Shore-LIJ Health System in New Hyde Park, N.Y. She said that interventions mentioned in the study are "already known to health care workers, but need to be further emphasized and recognized."

Wolf-Klein added a few other measures that she believes can help keep delirium at bay. They include "making sure elderly patients have access to their glasses or hearing aids to alleviate visual or hearing difficulties while in the unfamiliar confines of the hospital.

She said hospital visitors can play a vital role, too. "Family members, friends or even paid assistants should attempt to spend as much time with these hospitalized older patients as possible to chat, answer questions and hold them onto reality," Wolf-Klein said.

SOURCES: Gisele Wolf-Klein, M.D., director, geriatric education, North Shore-LIJ Health System, New Hyde Park, N.Y.; Gayatri Devi, M.D., neurologist, Lenox Hill Hospital, New York City; Brigham and Women's Hospital, Boston, news release, Feb. 2, 2015

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