Effectiveness of a multi-component intervention to reduce delirium incidence in elderly care wards

Abstract

a multi-component, delirium prevention intervention directed at delirium risk factors and implemented by local clinical staff can reduce incident delirium on specialist elderly care wards.

American Geriatrics Society Abstracted Clinical Practice Guideline for Postoperative Delirium in Older Adults

“…3ET,24–31ET The strength of the recommendation is further supported by the “dose-response” evidence for effectiveness of the interventions. 3ET,24ET,25ET,29ET,33ET …”

Inclusion, characteristics and outcomes of people requiring palliative care in studies of non-pharmacological interventions for delirium: A systematic review

“…Study designs were before/after studies (one with an additional concurrent arm 62 ) (n=11), 38-41, 44, 45, 48, 52, 57, 62, 64 randomised controlled trials (RCTs) (n=10), 42,43,47,50,51,53,55,56,61,65 nonrandomised controlled trials (one with matched participants 20 ) (n=5), 20,46,54,59,63 a quasiexperimental study, 49 a pilot randomised controlled trial, 60 and a comparative time series study. 58 Services and settings were medical (n=10), 20, 41, 43, 50-52, 54, 56, 59, 63 geriatric (n=7), 39,44,55,57,59,62,63 medical and/or surgical intensive care (n=6), 38,40,47,58,61,64 perioperative hip fracture (n=6), 42,45,46,48,55,65 other perioperative (n=3) 52,53,60 and palliative care and hospice units (n=1), 49 with eight studies involving more than one service. 47,52,55,58,59,61,63,…”

“…1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Fifteen studies excluded patients with impaired verbal communication or who were otherwise unable to complete study assessments. 20,38,39,41,43,46,48,50,52,53,59,[61][62][63]65 Six studies excluded patients with hearing and/or visual impairment. 46-48, 60, 61, 64 Three studies excluded patients isolated for infection.…”

“…49,56 Sixteen studies reported illness severity for all participants using at least one measure, more often as a mean or median score (n=15) 20,38,43,46,47,50,52,55,56,59,[61][62][63][64][65] than by categorising participants proportionally (n=6). 20,39,42,47,52,62 The most frequently used illness severity measures were the Charlson Comorbidity Index (CCI) 66 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 20,43,59 Other measures were the Cumulative Illness Rating Scale-Geriatrics (CIRS-G) comorbidity and severity indexes; 52,…”

“…Two studies modified the intervention in the pilot phase, including changes in staff education and practice change materials, 39 and providing study information to family on admission rather than waiting until the researcher was present. 58 The palliative care unit study modified the primary outcome measure by not substituting the CRS for the CAM, due to CAM completion delays and poor completion rates (39% of participants) caused by "the challenge of conducting the baseline CAM structured interview in the last days or hours of 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58…”