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Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials
Author(s) -
Shields Lynn,
Henderson Victoria,
Caslake Robert
Publication year - 2017
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14846
Subject(s) - medicine , delirium , randomized controlled trial , cinahl , hip fracture , psychological intervention , relative risk , geriatrics , incidence (geometry) , medline , physical therapy , confidence interval , meta analysis , intensive care medicine , psychiatry , osteoporosis , physics , political science , law , optics
Objectives To assess the efficacy of comprehensive geriatric assessment ( CGA ) in prevention of delirium after hip fracture. Design Systematic review and metaanalysis. Setting Ward based models on geriatrics wards and visiting team based models on orthopaedics wards were included. Participants Four trials (three European, one U.S.; 973 participants) were identified. Two assessed ward‐based, and two assessed team‐based interventions. Measurements MEDLINE , EMBASE , CINAHL and Psyc INFO databases; Clinicaltrials.gov; and the Central Register of Controlled Trials were searched. Reference lists from full‐text articles were reviewed. Incidence of delirium was the primary outcome. Length of stay, delirium severity, institutionalization, long‐term cognition and mortality were predefined secondary outcomes. Duration of delirium was included as a post hoc outcome. Results There was a significant reduction in delirium overall (relative risk ( RR ) = 0.81, 95% confidence interval ( CI ) = 0.69–0.94) in the intervention group. Post hoc subgroup analysis found this effect to be preserved in the team‐based intervention group ( RR = 0.77, 95% CI = 0.61–0.98) but not the ward‐based group. No significant effect was observed on any secondary outcome. Conclusion There was a reduction in the incidence of delirium after hip fracture with CGA . This is in keeping with results of non‐randomized controlled trials and trials in other populations. Team‐based interventions appeared superior in contrast to the Ellis CGA paper, but it is likely that heterogeneity in interventions and population studied affected this.