Overview and Strategy Analysis of Technology-based Non-pharmacological Interventions for Delirium Prevention: Systematic Review

Background: Delirium prevention is crucial, especially in critically ill patients. Increasingly, non-pharmacological multicomponent interventions for preventing delirium are recommended and technology-based interventions have developed to support them. Despite the increasing number and diversity in technology-based interventions, there has been no systematic effort to create an overview.

Objective: The systematic review was carried out to answer the following questions: (1) What are technologies currently used in non-pharmacological technology-based interventions for preventing and reducing delirium?, (2) What are the strategies underlying these currently used technologies?

Methods: A systematic search was conducted in Scopus and Embase between 2015 and 2020. A selection was made following the PRISMA guideline. Studies were eligible if they contained any types of technology-based interventions and assessed delirium-/risk factor-related outcome measures in a hospital setting. Data extraction and quality assessment were performed using a predesigned data form.

Results: A total of 31 studies were included and analyzed focusing on the types of technology and the strategies used in the interventions. The review revealed eight different technology types and 14 strategies that were categorized into seven pathways: (1) restore circadian rhythm, (2) activate the body, (3) activate the mind, (4) induce relaxation, provide (5) a sense of security, (6) a sense of control, and (7) a sense of being connected. For all technology types, significant positive effects were found on direct and/or indirect delirium outcome. Several similarities were found across effective interventions: using a multicomponent approach and/or including components comforting psychological needs of patients (e.g., familiarity, distraction and soothing elements).

Conclusions: Technology-based interventions have a high potential when multidimensional needs of patients (e.g., physical, cognitive and emotional) are incorporated. The seven pathways pinpoint starting points for building more effective technology-based interventions. Opportunities were discussed for transforming the Intensive Care Unit (ICU) into a healing environment as a powerful tool to prevent delirium.