Melatonin does not reduce delirium severity in hospitalized older adults : Results of a randomized placebo-controlled trial

Journal article


Lange, Peter W., Turbic, Alisa, Soh, Cheng Hwee, Clayton-Chubb, Daniel, Lim, Wen Kwang, Conyers, Rachel, Watson, Rosie and Maier, Andrea B.. (2024). Melatonin does not reduce delirium severity in hospitalized older adults : Results of a randomized placebo-controlled trial. Journal of the American Geriatrics Society. pp. 1802-1809. https://doi.org/10.1111/jgs.18825
AuthorsLange, Peter W., Turbic, Alisa, Soh, Cheng Hwee, Clayton-Chubb, Daniel, Lim, Wen Kwang, Conyers, Rachel, Watson, Rosie and Maier, Andrea B.
Abstract

Background
Delirium is common in older inpatients, causing distress, cognitive decline, and death. Current therapies are unsatisfactory, limited by lack of efficacy and adverse effects. There is an urgent need for effective delirium treatment. Sleep wake cycle is disturbed in delirium; endogenous Melatonin is perturbed, and exogenous Melatonin is a safe and effective medication for sleep disorders.

This study aims to determine the effect of oral Melatonin 5 mg immediate release (IR) nightly for five nights on the severity of delirium in older (≥65 years) medical inpatients.

Methods
This was a double-blinded, randomized controlled trial in general internal medicine units of a tertiary teaching hospital.

Older inpatients with Confusion Assessment Method positive, hyperactive or mixed delirium within 48 h of admission or onset of in-hospital delirium were included. The primary outcome was change in delirium severity measured with the Memorial Delirium Assessment Scale (MDAS).

A previous pilot trial showed 120 participants randomized 1:1 to Melatonin or Placebo would provide 90% power to demonstrate a 3-point reduction in the MDAS.

Results
One hundred and twenty participants were randomized, 61 to Melatonin 5 mg and 59 to Placebo. The medication was well tolerated. The mean MDAS improvement was 4.9 (SD 7.6) in the Melatonin group and 5.4 (SD 7.2) in the Placebo group, p-value 0.42, a non-significant difference. A post-hoc analysis showed length of stay (LOS) was shorter in the intervention group (median 9 days [Interquartile Range (IQR) 4, 12] vs. Placebo group 10 [IQR 6, 16] p-value = 0.033, Wilcoxon Rank Sum test).

Conclusions
This trial does not support the hypothesis that Melatonin reduces the severity of delirium. This may be due to no effect of Melatonin, a smaller effect than anticipated, an effect not captured on a multidimensional delirium assessment scale, or a type II statistical error. Melatonin may improve LOS; this hypothesis should be studied.

Keywordsaged neurocognitive disorders; delirium; inpatients; melatonin; sepsis-associated encephalopathy; sleep wake disorders
Year01 Jan 2024
JournalJournal of the American Geriatrics Society
Journal citationpp. 1802-1809
PublisherWiley-Blackwell Publishing, Inc. (US)
ISSN0002-8614
Digital Object Identifier (DOI)https://doi.org/10.1111/jgs.18825
Web address (URL)https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18825
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1802-1809
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online04 Mar 2024
Publication process dates
Accepted14 Jan 2024
Deposited16 Aug 2024
Supplemental file
License
File Access Level
Open
Additional information

© 2024 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Funding: The Royal Melbourne Hospital supported the study through project funding.

Place of publicationUnited States
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OA_Turbic_2024_Melatonin_does_not_reduce_delirium_severity.pdf
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Supplemental file
SM_Turbic_2024_Melatonin_does_not_reduce_delirium_severity.pdf
License: CC BY-NC-ND 4.0
File access level: Open

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