Melatonin and melatonin-receptor agonists to prevent delirium in hospitalized older adults: An umbrella review

•Melatonin regulates circadian processes and strongly influences the sleep-wake cycle.•Delirium and sleep-wake disturbances share a strong relationship, especially in acute illness.•Melatonin supplementation can help prevent delirium in selected groups of hospitalized older adults.•Consider using me...

Full description

Saved in:
Bibliographic Details
Published in:Geriatric nursing (New York) 2021-11, Vol.42 (6), p.1562-1568
Main Authors: Blodgett, Thomas J., Blodgett, Nicole P.
Format: Article
Language:English
Subjects:
Aged
Circadian Rhythm
Delirium
Delirium - drug therapy
Delirium - prevention & control
Hospitalization
Humans
Hypnotics and Sedatives
Length of Stay
Melatonin
Melatonin - therapeutic use
Older Adults
Ramelteon
Umbrella Review
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:•Melatonin regulates circadian processes and strongly influences the sleep-wake cycle.•Delirium and sleep-wake disturbances share a strong relationship, especially in acute illness.•Melatonin supplementation can help prevent delirium in selected groups of hospitalized older adults.•Consider using melatonin or ramelteon along with high-quality multicomponent delirium prevention efforts. Alterations in circadian rhythm play an important role in the development of delirium. In this umbrella review, we examined the efficacy of melatonin and ramelteon for delirium prevention in hospitalized older adults. Umbrella review methodology from the Joanna Briggs Institute guided the review process. Only meta-analyses were included. Risk of bias was evaluated using the AMSTAR-2 checklist. Three meta-analyses were included in this review. The quality of studies was low-to-moderate. Two meta-analyses reported a significant reduction in delirium using melatonin or ramelteon (pooled OR and 95% confidence intervals ranged from 0.41 [0.19-0.86] to 0.63 [0.46-0.87]). Melatonergics significantly reduced delirium on medical units (OR = 0.25, 95% CI 0.07-0.88) but not surgical units (OR = 0.62, 0.16-2.43). Heterogenity was high, with I2 ranging from 72.14% to 84%. Melatonergics appear to prevent delirium among hospitalized older adults, particularly those on medical units. Based on these results, providers may consider using melatonergics as complements to high-quality multicomponent delirium prevention.
ISSN:0197-4572
1528-3984
1528-3984
DOI:10.1016/j.gerinurse.2021.10.011