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Technology and health care for the elderly medical research studies

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KS 2013-10

Antipsychotics for management of delirium – A systematic review

The existing research on antipsychotics for the treatment of delirium was reviewed. Our systematic review and meta-analysis showed that antipsychotics are not associated with a significant change in duration of delirium, mortality rate or occurrence of adverse events.

Research Results

Findings: It was found that antipsychotic treatment did not affect duration of delirium, mortality rate, or incidence of adverse events. Treatment with an antipsychotic was associated with a shorter duration of hospital length of stay (i.e. antipsychotic favoured), yet intensive care unit length of stay was found to be shorter with a non-antipsychotic intervention (i.e. control group favoured). The current evidence is poor and insufficient to draw conclusions about the effect of antipsychotic medication on the duration and severity of delirium. These results should be interpreted with caution, as additional studies of improved design must be conducted before the lack of effect of antipsychotics on the aforementioned outcomes can be confirmed.

Publications, presentations and webinars

For more information on why this research matters to researchers, click here.

About the Project

At times it may be necessary to prescribe medications to treat distressing behavioral disturbances. It is suggested by clinical guidelines and experts that antipsychotics be reserved to manage delirium-associated behavioral disturbances are severe or distressing when non-drug methods fail.

Up to 75% of patients treated for delirium are prescribed antipsychotics, depending on the type of patient and severity of symptoms. Antipsychotics, however, may have significant side effects, particularly in the elderly, including the potential to worsen delirium and increased risk of sudden death.

The efficacy and safety of antipsychotics for delirium has not been clearly delineated, therefore we will conduct a systematic review through The Cochrane Collaboration to determine the efficacy and safety of antipsychotics for the treatment of delirium in hospitalized patients.

For more details on the project rationale, objectives and research plan, click here.

Project Team

Principal Investigator:

Lisa Burry, BScPharm, PharmD -- Mount Sinai Hospital

Co-Investigators:

Chaim Bell, MD, FRCPC, PhD -- Mount Sinai Hospital

Wesley Ely, MD -- Vanderbilt University

Dean Fergusson, PhD, MHA -- Ottawa Hospital Research Institute

Jay Luxenberg, MD -- University of California San Francisco

Sangeeta Mehta, MD, BSc, FRCP(C) -- Mount Sinai Hospital

Marc Perreault, PharmD, BCPS -- Université de Montréal/McGill University Health Centre

Louise Rose, RN, BN, MN, PhD -- University of Toronto

Knowledge Users and Partners:

Neill Adhikari, MDCM, MSc -- Sunnybrook Health Sciences Centre

Ingrid Egerod, RN, PhD -- University of Copenhagen

José Morais, MD -- Canadian Geriatrics Society

Doug Sellinger, BSP, MALT -- Canadian Society of Hospital Pharmacists

Samir Sinha, MD, DPhil, FRCPC -- Mount Sinai Hospital

Lesley Wiesenfeld, MD, FRCPC -- Mount Sinai Hospital

Camilla Wong, MD, MHSc, FRCPC -- St. Michael's Hospital

Project Contact: Lisa Burry -- lisa.burry@sinaihealthsystem.ca

KS 2013-10