Further developments should aim to increase awareness, reduce stigma, enhance carer support improve timely diagnosis and support for special population groups, notably those from Indigenous and non-English speaking communities and those with younger onset dementia and correct relative underfunding for dementia research. Dementia care in Australia is well developed but gaps remain.

Objective: To evaluate the implementation of a model of care known as the Confused Hospitalised Older Persons (CHOPs) program to improve recognition, assessment and management of older persons with cognitive impairment (delirium and/or dementia) admitted to acute hospitals. Methods: The model of care was implemented in six selected hospitals across New South Wales. Pre-and postimplementation medical record audits, environmental audits, and staff knowledge and care confidence surveys were performed. Interviews with clinical leads postimplementation identified enablers and barriers. Results: There were significant increases in cognitive screening within 24 hours (OR = 3.32 [2.50-4.91]), delirium risk identification (OR = 4.04 [2.89-5.64]), assessment of cognitive impairment (OR = 2.55 [1.90-3.43]) and interaction with families (OR = 2.81 [2.09-3.79]). Staff education and care confidence were improved, and positive environmental changes occurred in all hospitals. Barriers and enablers to implementation were identified. Conclusion: The CHOPs program improved identification, risk assessment and management of cognitive impairment in older hospitalised patients. K E Y W O R D S cognitive dysfunction, delirium, dementia, hospitalizationThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Number of tables: 3 Number of figures: 3 Number of references: 38 Word count: 2936 Background Delirium is a common debilitating complication of advanced cancer. ObjectiveTo determine if a multicomponent non-pharmacological delirium prevention intervention was feasible for adult patients with advanced cancer, prior to a phase III (efficacy) trial. DesignPhase II (feasibility) cluster randomized controlled trial. All sites implemented delirium screening and diagnostic assessment. Strategies within sleep, vision and hearing, hydration, orientation, mobility and family domains were delivered to enrolled patients at intervention sites admission days 1-7.Control sites then implemented the intervention ('waitlist sites'). SettingFour Australian palliative care units MeasurementsThe primary outcome was adherence, with an a priori endpoint of at least 60% patients achieving full adherence. Secondary outcomes were interdisciplinary care delivery, delirium measures and adverse events, analyzed descriptively and inferentially. ResultsSixty-five enrolled patients (25 control, 20 intervention, 20 waitlist) had 98% delirium screens and 75% diagnostic assessments completed. Nurses (67%), physicians (16%), allied health (8.4%), family (7%), patients (1%) and volunteers (0.5%) delivered the intervention. There was full adherence for 5% patients at intervention sites, partial for 25%. Both full and partial adherence was higher at waitlist sites: 25% and 45%, respectively. One-third of control site patients (32%) became delirious within seven days of admission compared to one-fifth (20%) at both intervention and waitlist sites (p=0.5). Mean (SD) Delirium Rating Scale-Revised-1998 scores were 16.8 +12.0 control sites versus 18.4 +8.2 (p=0.6) intervention and 18.7 +7.8 (p=0.5) waitlist sites. The intervention caused no adverse events. ConclusionThe intervention requires modification for optimal adherence in a phase III trial.

Summary More than half of the patients in adult hospitals are over 65 years of age. Although not a normal part of ageing, many older people will present to hospital with cognitive impairment (dementia or delirium) along with other complex comorbidities. Older people, and particularly those with dementia, are also at increased risk of developing delirium during their hospital stay. Delirium has serious short and long term consequences, such as increased mortality, falls, accelerated functional and cognitive decline, and earlier entry to residential care. Appropriate delirium care consists of introducing evidence‐based prevention strategies for all patients at risk. For patients with delirium, it is crucial that delirium is not missed and that the underlying causes are identified and treated. Screening, assessment and a systematic workup is vital. As well as treating the underlying medical and surgical causes, the involvement of family members and a calm, safe environment are important. Patients with cognitive impairment should receive person‐centred, goal‐directed care so that their particular risks of harm are identified and minimised, and their care is aligned with their preferences and is medically appropriate for their circumstances. Three de‐identified, composite case scenarios illustrate, respectively, the role of medicines in causing delirium, how family members can assist in evaluation, and the importance of the appropriate management of post‐operative delirium.