Does delirium prevention reduce risk of in-patient falls among older adults? A systematic review and trial sequential meta-analysis
Steven He
South Western Sydney Nursing and Midwifery Research Alliance, Western Sydney University and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
Search for more papers by this authorKaye Rolls
South Western Sydney Nursing and Midwifery Research Alliance, Western Sydney University and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
Search for more papers by this authorKatrina Stott
Bankstown Lidcombe Hospital, New South Wales, Australia
Search for more papers by this authorRozina Shekhar
South Western Sydney Local Health District, Liverpool, New South Wales, Australia
Fairfield Hospital, Fairfield, New South Wales, Australia
Search for more papers by this authorVaulina Vueti
Fairfield Hospital, Fairfield, New South Wales, Australia
Search for more papers by this authorKelli Flowers
Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
Search for more papers by this authorMargaret Moseley
Liverpool Hospital, Liverpool, New South Wales, Australia
Search for more papers by this authorBernadette Shepherd
Camden and Campbelltown Hospital, New South Wales, Australia
Search for more papers by this authorMandana Mayahi-Neysi
Bowral Hospital, Bowral, New South Wales, Australia
Search for more papers by this authorBriony Chasle
South Western Sydney Local Health District, Liverpool, New South Wales, Australia
Search for more papers by this authorBradley Warner
South Western Sydney Local Health District, Liverpool, New South Wales, Australia
Search for more papers by this authorDanielle Ni Chroinin
Liverpool Hospital, Liverpool, New South Wales, Australia
South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
Search for more papers by this authorCorresponding Author
Steven A. Frost
South Western Sydney Nursing and Midwifery Research Alliance, Western Sydney University and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
Correspondence
Steven A. Frost, CANR, Ingham Institute of Applied Medical Research, 1-3 Campbell Street, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
Email: [email protected]
Search for more papers by this authorSteven He
South Western Sydney Nursing and Midwifery Research Alliance, Western Sydney University and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
Search for more papers by this authorKaye Rolls
South Western Sydney Nursing and Midwifery Research Alliance, Western Sydney University and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
Search for more papers by this authorKatrina Stott
Bankstown Lidcombe Hospital, New South Wales, Australia
Search for more papers by this authorRozina Shekhar
South Western Sydney Local Health District, Liverpool, New South Wales, Australia
Fairfield Hospital, Fairfield, New South Wales, Australia
Search for more papers by this authorVaulina Vueti
Fairfield Hospital, Fairfield, New South Wales, Australia
Search for more papers by this authorKelli Flowers
Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
Search for more papers by this authorMargaret Moseley
Liverpool Hospital, Liverpool, New South Wales, Australia
Search for more papers by this authorBernadette Shepherd
Camden and Campbelltown Hospital, New South Wales, Australia
Search for more papers by this authorMandana Mayahi-Neysi
Bowral Hospital, Bowral, New South Wales, Australia
Search for more papers by this authorBriony Chasle
South Western Sydney Local Health District, Liverpool, New South Wales, Australia
Search for more papers by this authorBradley Warner
South Western Sydney Local Health District, Liverpool, New South Wales, Australia
Search for more papers by this authorDanielle Ni Chroinin
Liverpool Hospital, Liverpool, New South Wales, Australia
South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
Search for more papers by this authorCorresponding Author
Steven A. Frost
South Western Sydney Nursing and Midwifery Research Alliance, Western Sydney University and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
Correspondence
Steven A. Frost, CANR, Ingham Institute of Applied Medical Research, 1-3 Campbell Street, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
Email: [email protected]
Search for more papers by this authorFunding information
None
Abstract
Objectives
To determine whether delirium prevention interventions reduce the risk of falls among older hospitalised patients.
Methods
A systematic search of health-care databases was undertaken. Given the frequency of small sample sized trials, a trial sequential meta-analysis was conducted to present estimate summary effects to date. A Bayesian approach was used to estimate the posterior probability of the delirium prevention interventions reducing falls risk by various clinically relevant levels.
Results
Five randomised controlled trials were included in our final meta-analysis. There was a 43% reduction in the risk of falls among participants in the delirium prevention intervention arm, compared to the control; however, confidence intervals were wide (RE RR = 0.57, 95% CI 0.32; 1.00, p = 0.05). This result was found to be statistically significant, according to traditional significance levels (z > 1.96) and the more conservative trial sequential analysis monitoring boundaries. The posterior probabilities of the delirium prevention intervention reducing the risk of falls by 10%, 20% and 30% were 0.86, 0.63 and 0.29 respectively.
Conclusions
The results of this systematic review and trial sequential meta-analysis suggest that delirium prevention trials may reduce the risk of in-hospital falls among older patients by 43%. However, despite significant risk reduction found upon meta-analysis, the variation among study populations and intervention components raised questions around its application in clinical practice. Further research is required to investigate what the necessary components of a multifactorial intervention are to reduce both delirium and fall incidence among older adult in-patients.
CONFLICTS OF INTEREST
No conflicts of interest declared.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Citing Literature
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