Long article chosen for the October 2014 #GeriMedJC.

What does a long article mean?  In the live version of the Geriatric Medicine Journal Club held at the University of Toronto, 45 minutes is devoted to the presentation and discussion of the article.

de Jonghe A, van Munster BC, Goslings JC, Kloen P, van Rees C, Wolvius R, van Velde R, Levi M, de Haan RJ, de Rooij SE; Amsterdam Delirium Study Group. Effect of melatonin on incidence of delirium among patients with hip fracture: a multicentre, double-blind randomized controlled trial. CMAJ. 2014 Oct 7;186(14):E547-56.

Melatonin previously showed promise in a Canadian randomized trial for delirium prevention among medical patients (Int J Geriatr Psychiatry. 2011 Jul;26(7):687-94) and similarly, a melatonin agonist showed promise in another delirium prevention trial (JAMA Psychiatry. 2014 Apr;71(4):397-403). The new study chosen for the long article was a study conducted by the Amsterdam Delirium Study Group. This will surely be of interest to geriatricians, orthopedic surgeons, and generalists alike!

The article can be found here: and the abstract is posted below.

Engage in the discussion October 31, 2014 at 08:00 EDT / noon GMT and don't forget to use the hashtag #GeriMedJC.

BACKGROUND:
Disturbance of the sleep-wake cycle is a characteristic of delirium. In addition, changes in melatonin rhythm influence the circadian rhythm and are associated with delirium. We compared the effect of melatonin and placebo on the incidence and duration of delirium.

METHODS:
We performed this multicentre, double-blind, randomized controlled trial between November 2008 and May 2012 in 1 academic and 2 nonacademic hospitals. Patients aged 65 years or older who were scheduled for acute hip surgery were eligible for inclusion. Patients received melatonin 3 mg or placebo in the evening for 5 consecutive days, starting within 24 hours after admission. The primary outcome was incidence of delirium within 8 days of admission. We also monitored the duration of delirium.

RESULTS:
A total of 452 patients were randomly assigned to the 2 study groups. We subsequently excluded 74 patients for whom the primary end point could not be measured or who had delirium before the second day of the study. After these postrandomization exclusions, data for 378 patients were included in the main analysis. The overall mean age was 84 years, 238 (63.0%) of the patients lived at home before admission, and 210 (55.6%) had cognitive impairment. We observed no effect of melatonin on the incidence of delirium: 55/186 (29.6%) in the melatonin group v. 49/192 (25.5%) in the placebo group; difference 4.1 (95% confidence interval -0.05 to 13.1) percentage points. There were no between-group differences in mortality or in cognitive or functional outcomes at 3-month follow-up.

INTERPRETATION:
In this older population with hip fracture, treatment with melatonin did not reduce the incidence of delirium.