Harwood, RH and Teale, E orcid.org/0000-0002-5923-3170 (2018) Where next for delirium research? International Journal of Geriatric Psychiatry, 33 (11). pp. 1512-1520. ISSN 0885-6230
Abstract
Clinicians who manage delirium must do so without key information required for evidence-based practice, not least lack of any clearly effective treatment for established delirium. Both the nature of delirium and the methods used to research it contribute to difficulties. Delirium is heterogeneous, with respect to motor subtype, aetiology, setting and the co-existence of dementia, and may be almost inevitable towards the end of life. Elements of assessment are subjective, so diagnosis can be uncertain or unreliable. Defining objectives of care and outcomes is sometimes unclear. Better identification and case definition, including seeking biomarkers, stratification by type, or aetiology, and application of more complex models of causation may help. This will likely require further observational epidemiology, imaging and laboratory-based research before further rounds of large-scale randomised controlled trials. Application of trial methodologies designed for drug treatments of better-defined conditions may have failed to take account of the complexities both of diagnosis and complex intervention in delirium. Both drug and complex intervention trials need sufficient preliminary work to ensure that the right dose, duration or intensity of treatment is delivered and a range of ‘intermediate’ and ‘distal’ outcome measures assessed. Re-purposing of established drugs may provide a source of investigational products. Greater use of alternative research methodologies (qualitative and realist), or adjuvants to trials (process evaluation), will help answer questions about focus, generalisability and why interventions succeed or fail. Delirium research will have to embrace both a ‘back to basics’ approach with increased breadth of methodologies to make progress.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2017 John Wiley & Sons, Ltd. This is the peer reviewed version of the following article: Harwood, R. H., and Teale, E. (2017) Where next for delirium research?. Int J Geriatr Psychiatry; which has been published in final form at https://doi.org/10.1002/gps.4696. This article may be used for non-commercial purposes in accordance with the Wiley Terms and Conditions for Self-Archiving. |
Keywords: | delirium; dementia; taxonomy; research design; evidence-based medicine; clinical trials; health status; terminal care |
Dates: |
|
Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Elderly Care and Rehabilitation (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 06 Feb 2017 11:04 |
Last Modified: | 29 Oct 2018 15:50 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1002/gps.4696 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:111908 |