Delirium is a neuropathological syndrome that is associated with several negative outcomes. Nursing home residents are vulnerable to developing delirium. Valid prevalence data and associated factors are not yet available for Germany. Therefore, the aim of the prevalence study of the DeliA project (Delirium in Nursing Homes) is to assess the prevalence of delirium and its associated factors in 750 nursing home residents.

Trained registered nurses from each participating nursing home will collect the data in a multicentre cross-sectional study. The inclusion criteria for residents are valid informed consent, age ≥65 years and sufficient language skills. The exclusion criteria are aphasia, coma, deafness or end-of-life status. The 4 'A's Test will be used as the primary measurement. Delirium motor subtypes will be determined using the Delirium Motor Subtype Scale. Covariables for associated factors, including functional impairments, pain, cognitive status and nutritional status, are assessed through standardised measurements. Moreover, data such as prescribed drugs or medical diagnosis, hearing impairment or falls will be assessed from the nursing records. Furthermore, the Drug Burden Index will be calculated, and associated factors will be determined using a logistic regression model. The period for data collection in participating nursing homes is planned for 2 consecutive weeks in April 2024.

This study was approved by the Ethics Committee of Witten/Herdecke University (no. 82/2023). Findings will be published in peer-reviewed journals and presented at conferences.

https://osf.io/xkfvh/ (DOI 10.17605/OSF.IO/XKFVH).

Delirium is a syndrome commonly seen in intensive care unit (ICU) patients. It is characterized by acute changes in mental status, inattention, disorganized thinking, and altered level of consciousness. Due to its higher prevalence in mechanically ventilated ICU patients, it is crucial to recognize it early and implement standardized evidence-based protocols for preventing it in regular practice.

To identify the benefits and effectiveness of nonpharmacological interventions for preventing delirium among critically ill patients admitted to the ICU.

The preferred reporting items for systematic reviews and meta-analyses statement guidelines were followed. Two independent authors searched electronic and grey literature for systematic review and meta-analysis in the following databases: PubMed, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar.

This umbrella review included 12 studies on delirium prevention interventions, excluding reviews, abstracts, case studies, and pharmacological interventions. Our finding shows that multicomponent strategies are the most promising intervention for preventing delirium. Inclusion of family participation is the most vital part, with flexible visitation to be included in delirium care protocols. Multidisciplinary approaches raise workloads among healthcare professionals through increased coordination, assessments, and documentation.

Multicomponent interventions are regarded as the most effective among all nonpharmacological interventions for reducing and preventing delirium.

Delirium syndrome is preventable among mechanically ventilated patients. The study aims to identify the benefits and effectiveness of nonpharmacological interventions for preventing delirium among critically ill patients admitted to the ICU.

Sonia M, Kaur S, Kothari N. Prevention of Delirium in the Intensive Care Unit through Nonpharmacological Interventions: An Umbrella Review. Indian J Crit Care Med 2025;29(1):75-83.

Delirium is an acute reversible neuropsychiatric syndrome caused by multiple factors. It is associated with many adverse clinical outcomes including cognitive impairment, functional decline, prolonged hospitalization, and increased nursing service. The prevalence of delirium was high in department of cardiology, geriatric, and intensive care unit of hospital. With the increase in the aged population, further increases in delirium seem likely. However, it remains poorly recognized in the clinical practice. This article comprehensively discusses the latest research perspectives on the epidemiological data, risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium, including specific measures to manage delirium in clinical real-world situations. This article helps readers improve their knowledge and understanding of delirium and helps clinicians quickly identify and implement timely therapeutic measures to address various delirium subtypes that occur in the clinical settings to ensure patients are treated as aggressively as possible.

The Drug Burden Index (DBI) is a validated tool for assessing the dose-dependent cumulative exposure to sedative and anticholinergic medications. However, the increased risk of delirium superimposed dementia (DSD) with high DBI levels has not yet been investigated.

This study aimed to examine the potential association between DBI scores and delirium in community-dwelling older adults with dementia.

A total of 1105 participants with cognitive impairment underwent a comprehensive geriatric assessment. Experienced geriatricians made the final diagnosis of delirium based on DSM-IV-TR and DSM-V. We calculated the DBI as the sum of all sedatives and anticholinergics taken continuously for at least four weeks before admission. Polypharmacy was defined as regular use of five or more medications. We classified the participants as having no exposure (DBI = 0), low exposure (0 < DBI < 1), and high exposure (DBI ≥ 1).

Of the 721 patients with dementia, the mean age was 78.3 ± 6.7 years, and the majority were female (64.4%). In the whole sample, low and high exposures to anticholinergic and sedative medications at admission were 34.1% (n = 246) and 38.1% (n = 275), respectively. Patients in the high-exposure group had higher physical impairment (p = 0.01), higher polypharmacy (p = 0.01), and higher DBI scores (p = 0.01). In the multivariate Cox regression analysis, high exposure to anticholinergic and sedative medications increased the risk of delirium 4.09-fold compared to the no exposure group (HR = 4.09, CI: 1.63-10.27, p = 0.01).

High exposure to drugs with sedative and anticholinergic properties was common in community-dwelling older adults. A high DBI was associated with DSD, highlighting the need for an optimal prescription in this vulnerable population.

The trial was retrospectively registered at ClinicalTrials.gov. Identifier: NCT04973709 Registered on 22 July 2021.

Studies focusing on patterns of psychotropic drug prescriptions (PDPs) for subpopulations of community-dwelling older people with dementia are lacking.

The aim of this study was to identify the longitudinal patterns of PDPs in subpopulations.

This retrospective study used electronic health records from general practitioners (GPs) in the Netherlands. People (N = 1278) firstly diagnosed with dementia between 2013 and 2015, aged 65 years or older, were selected and categorized into four subpopulations: community-dwelling (CD) group throughout follow-up, ultimately admitted to nursing homes (NH) group, ultimately died (DIE) group, and ultimately deregistered for unclear reasons (DeR) group. Generalised estimating equations were used to estimate the patterns of psychotropic drug prescriptions, after the diagnosis of dementia for a five-year follow-up, and 0-3 months before institutionalisation or death.

Over the five-year follow-up, antipsychotic prescriptions increased steadily in CD (OR = 1.07 [1.04-1.10]), NH (OR = 1.10 [1.04-1.15]), and DIE (OR = 1.05 [1.02-1.08]) groups. Similarly, prescriptions of antidepressants also showed upward trends in CD (OR = 1.04 [1.02-1.06]), NH (OR = 1.10 [1.02-1.18]), and DIE (OR = 1.04 [1.00-1.08]) groups. The other psychotropic drugs did not show clear changes over time in most of the subpopulations. In the three months before institutionalisation, antipsychotic prescriptions increased (OR = 2.12 [1.26-3.57]) in the NH group compared to prior periods. Likewise, before death, prescriptions of antipsychotics (OR = 1.74 [1.28-2.38]) and hypnotics and sedatives (OR = 2.11 [1.54-2.90]) increased in the DIE group, while anti-dementia drug prescriptions decreased (OR = 0.42 [0.26-0.69]).

After community-dwelling older people are diagnosed with dementia, all subpopulations' prescriptions of antipsychotics and antidepressants increase continuously during the follow-up. While we cannot judge whether these prescriptions are appropriate, GPs might consider a more reluctant use of psychotropic drugs and use alternative psychosocial interventions. Additionally, antipsychotic prescriptions rise considerably shortly before institutionalisation or death, which might reflect that older people experience more neuropsychiatric symptoms during this period.

Light therapy has been used as a non-pharmacologic treatment to modulate biorhythms in patients with mental and psychological conditions. These conditions include affective disorders and depression. Delirium is a syndrome characterized by an acute change in a patient's mental status. We hypothesized that light therapy might suppress delirium in patients with Alzheimer's disease (AD). A 4-week randomized controlled trial was conducted in which AD participants were randomly assigned to a treatment group or a control group. Delirium, defined by the Confusion Assessment Method (CAM), was evaluated at baseline and after 4 weeks. The Neuropsychiatric Inventory (NPI) and Zarit Caregiver Burden Interview (ZBI) were also conducted to assess the behavior of patients and the burden of their caregivers. For this study, 61 participants were initially recruited. A total of 34 and 27 participants were included in the treatment and control groups, respectively. After treatment with light therapy, the CAM score decreased during the second and fourth week. The NPI score in the therapy group also decreased during the second and fourth week. From the caregiver's perspective, after light therapy, the ZBI score significantly decreased during the second and fourth week. Compared with the control group, patients who underwent CAM and NPI assessments showed a small but significant improvement after 4 weeks of light therapy. In conclusion, a course of 4-week light therapy significantly suppressed delirium in patients with AD. The combined effects of light therapy and conventional treatment were superior to that of conventional treatment alone.

Delirium superimposed on dementia (DSD) is associated with adverse outcomes in older adults. Nonetheless, little is known about the association between inflammatory markers and clinical outcomes of DSD.

This research investigated the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for short- and long-term mortality among community-dwelling older adults with DSD.

This retrospective cohort study included 9755 older outpatients who were referred to a tertiary hospital between January 2010 and June 2021. All patients underwent a comprehensive geriatric assessment and routine laboratory tests. Delirium and dementia was diagnosed with the DSM-4 or DSM-5 criteria. We recorded information on mortality during 1 year following the delirium episode.

Among 615 patients with dementia, 170 (26.3%) had delirium. Patients with delirium were predominantly older, with higher Deyo-Charlson comorbidity index scores, lower general cognitive performance, lower functional capability, and higher anticholinergic burden compared to those without delirium. At the 1-year follow-up, the mortality rate of DSD was 29.3%. Multivariate analysis showed that NLR at admission was an independent predictor of 1-month mortality (HR = 1.03; 95% CI 1.00-1.05; p = 0.04) and 1-year mortality (HR = 1.02; 95% CI 1.01-1.05; p = 0.01) of DSD patients.

NLR can predict prognosis in various diseases including cardiovascular disease, malignancies, and cerebrovascular disease, but as yet there is no similar prognostic measure in delirium. Moreover, recent previous studies demonstrated NLR is a potential marker for the prediction of delirium in older adults with different clinical settings. In the current study, we demonstrated that NLR is also a prognostic marker for DSD.

NLR could be useful marker for predicting short- and long-term mortality in patients with DSD. However, further studies are needed to validate these findings.

Our aim was to measure the prevalence of delirium, its clinical features, and outcomes in older patients referred to a memory clinic.

A retrospective cohort study of 109 older outpatients with delirium referred to a memory clinic with a home care service. Delirium was diagnosed using the confusion assessment method and dementia with the DSM-5 criteria. We collected information on cognitive and functional status, mortality, institutionalization, and hospitalization during 6 months following the delirium episode.

Delirium prevalence was 3.6%, mostly of hyperactive type. Delirium worsened functional (ADL 2.95 ± 1.95 vs. 2.16 ± 1.84) and cognitive (MMSE 13.88 ± 8.96 vs.11.0 ± 9.49) status after 6 months compared to the baseline. The mortality rate was 29.4%, and 28.3% were admitted to a long-term facility after the episode of delirium. Of these patients, more than half were hospitalized during the follow-up. Of the 109 patients with delirium, 85 were managed at home and 24 were hospitalized. Patients who were hospitalized had more severe behavioral symptoms during the delirium episode. There was no difference in mortality and institutionalization according to the home or hospital management.

This retrospective cohort study adds novel information to the existing literature of an understudied setting and population. The study supports the need to further investigate the feasibility and efficacy of the hospital at home models for the prevention and management of delirium in a high-risk population.

Delusions are part of the neuropsychiatric symptoms that patients suffering from neurodegenerative conditions frequently develop at some point of the disease course and are associated with an increased risk of cognitive and functional decline. Delirium is a syndrome characterized by acute onset of deficits in attention, awareness, and cognition that fluctuate in severity over a short time period. Delusions and delirium are frequently observed in the context of neurodegeneration, and their presence can easily mislead clinicians toward a misdiagnosis of psychiatric disorder further delaying the proper treatment. Risk factors for developing delusion and delirium in neurodegenerative conditions have been investigated separately while the possible interplay between these two conditions has not been explored so far. With this study, we aim to achieve a more comprehensive picture of the relationship between delusions and delirium in neurodegeneration by analyzing prevalence and subtypes of delusions in different neurodegenerative disorders; providing an overview of clinical tools to assess delusions in neurodegenerative patients and how delusions are covered by delirium assessment tools and discussing the possible common pathophysiology mechanisms between delusion and delirium in neurodegenerative patients. A more extensive characterization of the relationship between delusions and delirium may help to understand whether delusions may constitute a risk factor for delirium and may ameliorate the management of both conditions in patients with neurodegenerative disorders.

Delirium is a geriatric syndrome that presents in 1 out of 5 hospitalized older patients. It is also common in the community, in hospices, and in nursing homes. Delirium prevalence varies according to clinical setting, with rates of under 5% in minor elective surgery but up to 80% in intensive care unit patients. Delirium has severe adverse consequences, but despite this and its high prevalence, it remains undetected in the majority of cases. Optimal delirium care requires an interdisciplinary, multi-dimensional diagnostic and therapeutic approach involving doctors, nurses, physiotherapists, and occupational therapists. However, there are still important gaps in the knowledge and management of this syndrome.

The objective of this paper is to promote the interdisciplinary approach in the prevention and management of delirium as endorsed by a delirium society (European Delirium Association, EDA), a geriatrics society (European Geriatric Medicine Society, EuGMS), a nursing society (European Academy of Nursing Science, EANS), an occupational therapy society (Council of Occupational Therapists for European Countries, COTEC), and a physiotherapy society (International Association of Physical Therapists working with Older People of the World Confederation for Physical Therapy, IPTOP/WCPT).

In this paper we have strongly promoted and supported interdisciplinary collaboration underlying the necessity of increasing communication among scientific societies. We have also provided suggestions on how to fill the current gaps via improvements in undergraduate and postgraduate delirium education among European Countries.