Specialized Delirium Care Environments in Hospitalized Older Adults: A Systematic Review

Abstract

Purpose: Delirium is a frequent and serious condition in older patients, associated with severe adverse outcomes and lacking proven pharmacological treatments. Non-pharmacological multicomponent strategies are recommended, and specialized delirium care environments (e.g., delirium room, delirium unit, psychogeriatric unit) have been proposed as a potential strategy to improve the management of delirium in hospitalized older adults. Our objective was to provide the first systematic review and pooled analysis on the subject, synthesizing the characteristics of specialized delirium environments in the care of delirium and their association with clinical outcomes. Methods: A systematic search of MEDLINE, Cochrane, and EMBASE identified studies on patients aged 65 years and older with delirium or related acute confusional states admitted to specialized delirium care environments. Study quality was assessed using Cochrane’s risk of bias tools, and exploratory pooled analyses were conducted when at least three studies reported the same outcome. Results: Nine studies, reported across 15 publications and including 2226 patients, met the inclusion criteria. Interventions were heterogeneous in structure and content, but most combined delirium-oriented staff training, enhanced surveillance, environmental adaptation, and multicomponent non-pharmacological care. Comparator groups were also diverse and included standard wards, earlier versions of specialized care models, indirect admission pathways, and non-delirious controls. The narrative synthesis suggested that specialized delirium care environments were most consistently associated with shorter delirium duration, more favorable discharge outcomes, lower physical restraint use, and better functional recovery, while findings for length of stay, falls, psychotropic drug use, and mortality were less consistent. Exploratory pooled analyses suggested a favorable direction of effect for several outcomes, particularly discharge destination and mortality, but pooled estimates were not statistically significant and should not be interpreted as definitive evidence of efficacy. All included studies were judged to be at a high or critical risk of bias. Conclusions: Specialized delirium care environments appear promising for the management of delirium in hospitalized older adults, particularly for outcomes closely related to day-to-day delirium care. However, the current evidence base is limited by substantial heterogeneity in intervention models, comparator groups, and outcome definitions, as well as by a high risk of bias across studies. These findings support further evaluation of specialized delirium care models, but do not yet allow firm conclusions regarding their effectiveness.