The edition · Geriatrics
Virtual reality did no better than ordinary group cognitive stimulation for dementia symptoms in care homes
A French multicentre trial found both group activities lifted residents' immediate well-being, with more social interaction in the low-tech arm. Bright light for delirium prevention remains unproven, and blocking a fractured hip a day early did not cut delirium.
The edition in brief
In a multicentre randomised trial of 56 French nursing home residents with behavioural and psychological symptoms of dementia, twelve group sessions of immersive virtual reality were no better than non-digital cognitive stimulation at reducing symptoms on the Neuropsychiatric Inventory or improving overall well-being. Both arms improved immediate well-being within sessions, and social interaction was more frequent in the cognitive stimulation group; adverse events were few and mild. A systematic review of eight studies (1,190 hospitalised adults) found an uncertain effect of bright light therapy on delirium incidence (RR 0.64, 95% CI 0.38 to 1.07), with very low certainty. In a single-blind trial of 79 adults aged 65 or over having hip replacement for fracture, giving an anterior iliopsoas muscle space block the day before surgery rather than an hour before did not significantly reduce postoperative delirium (8.1% vs 12.8%; risk difference -4.7%, -18.4% to 9.0%). The pearl summarises the multicomponent bundle that does have evidence for preventing delirium in older inpatients.
Bright light to prevent delirium: the evidence is still uncertain
Bright light therapy may reduce delirium, but the evidence is very uncertain; rely on simple day-night measures for now.
Hip fracture block a day early did not significantly cut delirium
Giving the hip block the day before surgery rather than an hour before did not significantly reduce delirium in this small trial.
The delirium bundle that works is the simple one
Prevent delirium with orientation, sensory aids, hydration, mobility, sleep and a medicines review.
For dementia symptoms in care homes, virtual reality was no better than ordinary group activity
Virtual reality did not outperform structured group cognitive stimulation for dementia symptoms in care homes; prioritise the low-cost option.
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