Nurse‐Led Multicomponent Interventions for Delirium Prevention in Hospitalised Older Adults: A Systematic Review and Meta‐Analysis

Abstract

AIMS: To quantify the effect of nurse-led or nurse-coordinated multicomponent non-pharmacological interventions on delirium incidence in hospitalised older adults and to examine secondary outcomes, intervention components and moderators of effect. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Nine electronic databases (PubMed/MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, Scopus, PsycINFO, LILACS and ICTRP) were searched from January 1999 to March 2026. REVIEW METHODS: Randomised controlled trials and quasi-experimental studies evaluating nurse-led multicomponent interventions targeting ≥ 2 delirium risk factors in adults aged ≥ 60 years were included. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analysis generated pooled risk ratios (RR) and mean differences (MD). Subgroup analyses, meta-regression and GRADE assessment were conducted. The review followed PRISMA 2020 and was registered in PROSPERO. RESULTS: = 0%). HELP-based protocols demonstrated the largest subgroup effect (RR 0.58). Interventions also reduced delirium duration (MD-0.91 days), falls (RR 0.63) and length of stay (MD -1.23 days). Subgroup and meta-regression analyses did not identify statistically significant effect moderators. Evidence certainty was moderate. CONCLUSION: Nurse-led multicomponent interventions significantly reduce delirium incidence and related adverse outcomes in hospitalised older adults (moderate certainty of evidence). Structured programmes such as HELP represent evidence-informed best practice and should be strongly considered for implementation within acute care systems. IMPACT: These findings provide moderate-certainty evidence supporting nurse-led delirium prevention as a high-value, scalable strategy to improve patient outcomes and reduce healthcare burden. The results inform clinical practice, workforce planning and policy by emphasising the central role of nursing in delivering effective multicomponent care. PATIENT OR PUBLIC CONTRIBUTION: Not applicable. REGISTRATION: This review was prospectively registered in PROSPERO (CRD420261338135).