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Melatonin decreases delirium in elderly patients: A randomized, placebo‐controlled trial
Author(s) -
AlAama Tareef,
Brymer Christopher,
Gutmanis Iris,
WoolmoreGoodwin Sarah M.,
Esbaugh Jacquelin,
Dasgupta Monidipa
Publication year - 2011
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.2582
Subject(s) - melatonin , delirium , placebo , medicine , odds ratio , randomized controlled trial , confidence interval , anesthesia , psychiatry , alternative medicine , pathology
Background Disturbance in the metabolism of tryptophan and tryptophan‐derived compounds (e.g., melatonin) may have a role in the pathogenesis of delirium. Objective To evaluate the efficacy of low dose exogenous melatonin in decreasing delirium. Design A randomized, double‐blinded, placebo‐controlled study. Setting An Internal Medicine service in a tertiary care centre in London, Ontario, Canada. Participants 145 individuals aged 65 years or over admitted through the emergency department to a medical unit in a tertiary care hospital. Intervention Patients were randomized to receive either 0.5 mg of melatonin or placebo every night for 14 days or until discharge. Measurements The primary outcome was the occurrence of delirium as determined by Confusion Assessment Method (CAM) criteria. Results Of a total of 145 individuals (mean age (standard deviation): 84.5 (6.1) years) 72 were randomly assigned to the melatonin group and 73 to the placebo group. Melatonin was associated with a lower risk of delirium (12.0% vs . 31.0%, p = 0.014), with an odds ratio (OR), adjusted for dementia and co‐morbidities of 0.19 (95% confidence intervals (CI): 0.06–0.62). Results were not different when patients with prevalent delirium were excluded. Limitation An intention to treat analysis was not possible due to loss to follow‐up. Conclusion Exogenous low dose melatonin administered nightly to elderly patients admitted to acute care may represent a potential protective agent against delirium. Copyright © 2010 John Wiley & Sons, Ltd.