Interventions to support recovery following an episode of delirium: A realist synthesis

TY - JOUR

T1 - Interventions to support recovery following an episode of delirium

T2 - A realist synthesis

AU - O’Rourke, Gareth

AU - Parker, Daisy

AU - Anderson, Rob

AU - Morgan-Trimmer, Sarah

AU - Allan, Louise

PY - 2020/7/31

Y1 - 2020/7/31

N2 - Objectives: Persistent delirium is associated with poor outcomes in older adults but little is known about how to support longer-term recovery from delirium. The aim of this review was to identify and synthesise literature to understand mechanisms of recovery from delirium as a basis for designing an intervention that enables more effective recovery. Methods: A systematic search of literature relevant to the research question was conducted in two phases. Phase one focused on studies evaluating the efficacy of interventions to support recovery from delirium, and stage two used a wider search strategy to identify other relevant literature including similar patient groups and wider methodologies. Synthesis of the literature followed realist principles. Results: Phase one identified four relevant studies and stage two identified a further forty-six studies. Three interdependent recovery domains and four recovery facilitators were identified. Recovery domains were 1) support for physical recovery through structured exercise programmes; 2) support for cognitive recovery through reality orientation and cognitive stimulation; 3) support for emotional recovery through talking with skilled helpers. Recovery facilitators were 1) involvement and support of carers; 2) tailoring intervention to individual needs, preferences and abilities; 3) interpersonal connectivity and continuity in relationships and; 4) facilitating positive expressions of self. Conclusions: Multicomponent interventions with elements that address all recovery domains and facilitators may have the most promise. Future research should build on this review and explore patients’, carers’, and professionals’ tacit theories about the persistence of delirium or recovery from delirium in order to inform an effective intervention.

AB - Objectives: Persistent delirium is associated with poor outcomes in older adults but little is known about how to support longer-term recovery from delirium. The aim of this review was to identify and synthesise literature to understand mechanisms of recovery from delirium as a basis for designing an intervention that enables more effective recovery. Methods: A systematic search of literature relevant to the research question was conducted in two phases. Phase one focused on studies evaluating the efficacy of interventions to support recovery from delirium, and stage two used a wider search strategy to identify other relevant literature including similar patient groups and wider methodologies. Synthesis of the literature followed realist principles. Results: Phase one identified four relevant studies and stage two identified a further forty-six studies. Three interdependent recovery domains and four recovery facilitators were identified. Recovery domains were 1) support for physical recovery through structured exercise programmes; 2) support for cognitive recovery through reality orientation and cognitive stimulation; 3) support for emotional recovery through talking with skilled helpers. Recovery facilitators were 1) involvement and support of carers; 2) tailoring intervention to individual needs, preferences and abilities; 3) interpersonal connectivity and continuity in relationships and; 4) facilitating positive expressions of self. Conclusions: Multicomponent interventions with elements that address all recovery domains and facilitators may have the most promise. Future research should build on this review and explore patients’, carers’, and professionals’ tacit theories about the persistence of delirium or recovery from delirium in order to inform an effective intervention.

KW - Delirium

KW - older adults

KW - realist review

KW - rehabilitation

UR - http://www.scopus.com/inward/record.url?scp=85088951644&partnerID=8YFLogxK

U2 - 10.1080/13607863.2020.1793902

DO - 10.1080/13607863.2020.1793902

M3 - Article

AN - SCOPUS:85088951644

SN - 1360-7863

JO - Aging and Mental Health

JF - Aging and Mental Health

ER -