Interventions for preventing delirium in older people in institutional long-term care

Clegg, Andrew; Siddiqi, Najma; Heaven, Anne; Young, John; Holt, Rachel

doi:10.1002/14651858.cd009537.pub2

Cited by 64 publications

(26 citation statements)

References 42 publications

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“…Therefore, delirium can be a sign of underlying diseases in rehabilitation patients [5]. Delirium significantly impedes the rehabilitation process, and it is important to prevent delirium by discerning its risk factors [67]. Most patients in rehabilitation units are elderly and they exhibit known delirium-inducing factors besides age.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Delirium During Acute and Subacute Stages of Various Disorders in Patients Admitted to Rehabilitation Units

et al. 2016

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ObjectiveTo assess the risk factors for delirium in patients admitted to a rehabilitation unit for acute or subacute neurological or musculoskeletal disorders.MethodsWe reviewed the medical records of 537 patients admitted to a rehabilitation unit and selected 398 patients in the acute or subacute stage of various neurological or musculoskeletal disorders. Among them, patients who had suffered from delirium were categorized into the delirium group (n=65), and the other patients were categorized into the non-delirium group (n=333). As potential risk factors for delirium, the patients' diagnosis, underlying disease, demographic data, hospital stay duration, surgery, and laboratory findings were reviewed, and the differences between the two groups with respect to independent risk factors were analyzed.ResultsThe average age in the delirium group was higher; the hospital stay and pre-transfer periods were longer. A large proportion of the patients were admitted for musculoskeletal disorders, and many patients had diabetes mellitus, dementia, and depression as underlying diseases. Laboratory tests revealed increases in the white blood cells (WBC), glucose, blood urea nitrogen (BUN), total bilirubin, aspartate transaminase (AST), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels in the delirium group, while the hemoglobin, calcium, phosphorus, protein, albumin, and potassium levels were decreased. Depression, musculoskeletal disorders, traumatic brain injury, elevated WBC, BUN, AST, and CRP levels, and decreased potassium and phosphorus levels were identified as independent risk factors for delirium.ConclusionRisk factors treatable before delirium onset were identified in rehabilitation patients in acute and subacute stages of various disorders. Early diagnosis and prevention of these risk factors could decrease delirium occurrence and increase rehabilitation effectiveness.

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Section: Introductionmentioning

confidence: 99%

Risk Factors for Delirium During Acute and Subacute Stages of Various Disorders in Patients Admitted to Rehabilitation Units

et al. 2016

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“…64–66 Geriatric consultative approaches have been applied in different settings, but their success is dependent on adherence of the health care staff to recommendations made by the consultants. 1 …”

Section: Resultsmentioning

confidence: 99%

Delirium in Older Persons

Fong

Hshieh

et al. 2017

JAMA

656

306

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Importance-Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual's function and quality of life, as well as broad societal effect with substantial health care costs.Objective-To summarize the current state of the art in diagnosis and treatment of delirium and to highlight critical areas for future research to advance the field.Evidence Review-We searched Ovid MEDLINE, Embase, and the Cochrane Library for the past 6 years, from January 1, 2011 until March 16, 2017 using a combination of controlled vocabulary and keyword terms. Since delirium is more prevalent in older adults, the focus was on studies in elderly populations; studies based solely in the intensive care unit (ICU) and non-English-language articles were excluded.Findings-Of 127 articles included, 25 were clinical trials, 42 cohort studies, 5 systematic reviews and meta-analyses, and 55 were other categories. A total of 11 616 patients were represented in the treatment studies. Advances in diagnosis have included the development of brief screening tools with high sensitivity and specificity, such as the 3-Minute Diagnostic Assessment, 4 A's test, and proxy-based measures such as the Family Confusion Assessment Method. Measures of severity, such as the Confusion Assessment Method-Severity Score, can aid in monitoring response to treatment, risk stratification, and assessing prognosis. Nonpharmacologic approaches focused on risk factors such as immobility, functional decline, visual or hearing impairment, dehydration, and sleep deprivation are effective for delirium prevention and also are recommended for delirium treatment. Current recommendations for pharmacologic treatment of

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“…A Cochrane review 18 identified only 2 prior prevention trials in nursing homes: one small study (n=98) of a hydration intervention that showed no reduction in delirium, 10 and one of a medication reduction intervention that reduced “potential” delirium by 58%. 19 Among the few nursing home delirium treatment trials, a multi-factorial intervention that was designed to be delivered by existing nursing home staff to delirious post-acute nursing home patients was not effective in shortening delirium or reducing its severity.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long‐Term Care Delivered by Certified Nursing Assistants

Boockvar

Teresi

Inouye

2016

J American Geriatrics Society

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Nursing home (NH) patients have a high prevalence of delirium risk factors, experience 2-4 acute medical conditions (e.g., infections) each year, and have an incidence of delirium during these conditions that is similar to that of hospitalized older adults. Many NH patients with delirium do not return to their prior level of cognitive function. As compared to those without delirium, they are more likely to die, be hospitalized, and less likely to be discharged home. Research on the prevention or treatment of delirium in the NH remains limited. This article describes the development and pilot-testing of a multicomponent delirium prevention intervention in the NH setting adapted from the Hospital Elder Life Program (“HELP-LTC”). We developed delirium-risk reducing activities appropriate for functionally-impaired NH patients that were delivered during treatment for and recovery from acute illness, a novel patient targeting approach. Activities were provided by an expertly trained certified nursing assistant (CNA) who visited patients throughout the facility. We report on incident delirium, delirium remission, cognitive and physical function change, hospitalization, and death associated with acute medical conditions as ascertained by a program coordinator. We also report on the integration and acceptance of the CNAs’ activities by patients and staff. Hospitalization and death were ascertained in a non-intervention comparison group. Findings support a test of the intervention in a controlled trial. The potential impact is great: there are approximately 1.4 million NH patients in the U.S. and an estimated 1 million with dementia or cognitive impairment, a key delirium risk factor. An intervention would be broadly adoptable if the cost of the program’s CNAs were offset by a reduction in health care costs through prevention of hospitalization.

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Interventions for preventing delirium in older people in institutional long-term care

Cited by 64 publications

References 42 publications

Risk Factors for Delirium During Acute and Subacute Stages of Various Disorders in Patients Admitted to Rehabilitation Units

Risk Factors for Delirium During Acute and Subacute Stages of Various Disorders in Patients Admitted to Rehabilitation Units

Delirium in Older Persons

Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long‐Term Care Delivered by Certified Nursing Assistants

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