A research team at Seoul National University Bundang Hospital has developed an integrated delirium management program — combining high-risk medication adjustment with cognitive boards and morning light exposure — and found it effective in reducing delirium severity among elderly inpatients, according to findings released Tuesday.
The team, led by Park Hye-yeon, a professor in the psychiatry department, and Kim Seon-uk, a professor in the department of internal medicine, consolidated multiple intervention elements for delirium management into a single framework and confirmed its effectiveness by applying it in actual hospital wards.
Delirium is an acute brain dysfunction marked by disorientation to time and place, abnormal behavior and hallucinations. It occurs in roughly one in four elderly inpatients, raising the risk of falls and impairing physical function, with negative effects on recovery and prognosis.
Major clinical guidelines recommend adjusting high-risk medications and applying non-pharmacological interventions — such as helping patients maintain awareness of time and place and restoring sleep-wake cycles — as core prevention strategies. In practice, however, elderly patients often take multiple medications for various conditions, making high-risk drug adjustment difficult. Systematically combining diverse non-pharmacological interventions within the constraints of limited medical staff and time has also proven challenging, leaving a gap in practically applicable integrated models.
In response, the research team designed an integrated delirium management program that could be carried out within those staffing and time constraints, with the goal of preventing delirium from worsening even when it does occur in inpatients.
Under the program, psychiatry staff review and adjust high-risk medications — including benzodiazepines and anticholinergic drugs — upon a patient's admission. This is combined with a preventive education video, a cognitive orientation board placed near the patient's bed to help maintain awareness of time, place and people, and daily morning light therapy to help restore the sleep-wake cycle.
The program also extends the care framework beyond medical staff to include family caregivers, who are best positioned to know the patient's baseline condition and can provide continuous information at the bedside to help maintain orientation.
The research team conducted a prospective observational study from March 2023 to April 2025, enrolling 203 patients with an average age in their 70s admitted to internal medicine wards. Of these, 64 patients in the intervention group received the integrated management program, while the remaining 139 in the observation group received standard care. The team then compared changes in delirium severity on days 1, 3 and 7 of hospitalization.
The intervention group showed significantly lower delirium severity on day 7 compared with the observation group. Among the individual intervention elements, medication adjustment produced the fastest effect, emerging as early as day 3 and persisting through day 7. The study also confirmed a cumulative effect: the more intervention elements a patient received, the greater the improvement in delirium severity by day 7, underscoring the importance of integrated management.
fob140@heraldcorp.com
