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DELIRIUM PREVENTED BY STICKING TO NON-DRUG THERAPEUTIC REGIMENS, YALE RESEARCHERS FIND
When older patients followed a non-drug intervention strategy for preventing delirium, their rates of delirium were lowered by as much as 89 percent, Yale researchers report in the April 28 issue of Archives of Internal Medicine. "It has been well-established that compliance with drug treatments is very important for their effectiveness, but the effect of compliance with non-drug treatments for delirium has not been studied before this report," said senior author Sharon Inouye, M.D., professor of internal medicine and geriatrics at Yale School of Medicine. "We were able to show that adherence is equally important in non-drug therapies and directly impacts the effectiveness of these interventions," Inouye added. "It really does lend credence to the fact that the amount of non-pharmacologic therapy patients receive is just as important as drug therapy, where a dose-response relationship is expected." Inouye and her team looked at 422 patients age 70 and older who were screened on admission for six delirium risk factors: cognitive impairment, sleep deprivation, immobility, dehydration, vision or hearing impairment. Delirium is characterized by reduced ability to pay attention to external stimuli or shift attention to new stimuli, disorganized thinking, confusion, sleep disturbance, memory impairment, increased or decreased motor activity and disorientation. The non-drug therapy included daily orientation to the regimen; cognitively stimulating activities such as discussion of current events and word games; walking three-times daily; improving sleep, vision and hearing; and fluids for dehydration. Patients in the highest adherence group demonstrated an 89 percent reduction in delirium risk compared with patients in the lowest group. "The implication here is that in a non-pharmacologic protocol, it is important that the patient receives all the parts of the protocol, and that it's done correctly," said Inouye
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