Abstract
Introduction: Delirium is a frequent complication in intensive care units, with a high prevalence among elderly patients, and is associated with increased mortality, cognitive decline, and higher hospital costs. Risk factors such as advanced age, pre-existing cognitive impairment, and polypharmacy require non-pharmacological strategies targeting modifiable factors like sleep, mobility, and stress. Objective: To evaluate the efficacy of non-pharmacological strategies in preventing delirium in elderly patients admitted to ICUs, analyzing their impact on delirium incidence, duration, severity, and secondary outcomes such as length of hospital stay and mortality. Methods: A systematic review was conducted using PubMed, Cochrane Library, and Embase, including studies on elderly intensive care units’ patients that assessed non-pharmacological interventions (multicomponent approaches, occupational therapy, light therapy). Studies involving exclusively pharmacological interventions or lacking a control group were excluded. Quality was assessed using tools such as RoB 2.0 and GRADE. Results: Multicomponent non-pharmacological strategies significantly reduced delirium incidence, with early mobilization and family involvement showing notable benefits. Occupational therapy decreased delirium incidence from 20% to 3%. Sleep-focused interventions showed a relative risk of 0.61 (95% CI: 0.39–0.96). Evidence quality was high for multicomponent strategies and moderate/low for other interventions. Discussion: Additional benefits were observed with family participation and environmental control, though methodological heterogeneity and potential biases limit generalizability. Standardized protocol implementation is recommended. Conclusion: Multicomponent non-pharmacological strategies are effective in preventing delirium, reducing its incidence, and improving clinical outcomes. Staff training and structured protocols are essential for success. Future research should assess scalability in resource-limited settings.