Effectiveness of a Multifaceted Delirium Screening, Prevention, and Treatment Initiative on the Rate of Delirium Falls in the Acute Care Setting

Ferguson, Alice; Uldall, Karina K.; Dunn, Jessica; Blackmore, Christopher; Williams, Barbara

doi:10.1097/ncq.0000000000000297

Cited by 15 publications

(43 citation statements)

References 21 publications

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“…Similar to frailty, delirium cannot be regarded as an isolated mental disorder, and there is some evidence that it affects motor function as well [26]. The impaired mobility occurring during delirium may be the sign of a complex system being close to failure, as has been demonstrated in many acute care units for older hospitalized inpatients [78, 79, 80]. Frailty reflects the life-long accumulation of physical and cognitive deficits, thus defining the greater or lesser extent of an individual's vulnerability [81].…”

Section: Discussionmentioning

confidence: 99%

Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

Choutko-Joaquim

Tacchini-Jacquier²,

D'Alessio

et al. 2019

Dement Geriatr Cogn Disord Extra

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Background: Switzerland’s demographic trends show, as elsewhere on the planet, increasing numbers of older and very old adults. This suggests that its healthcare system will suffer serious repercussions, including in the use of care and especially the use of emergency services. Significant numbers of older adults will be at risk of developing multiple chronic conditions including one or more geriatric syndromes, such as frailty and delirium. Few studies to date have documented associations between frailty and delirium. Aim: To explore the relationships between frailty and delirium in older adult patients consulting (n = 114) at an emergency department (ED) in Switzerland. Method: A cross-sectional study was conducted in a peripheral hospital ED in the French-speaking part of Switzerland. Frailty was assessed using the Tilburg Frailty Indicator (TFI). Delirium was assessed using the Confusion Assessment Method (CAM). Participants’ cognitive states were assessed using the 6-item Cognitive Impairment Test (6CIT) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQ-CODE), completed by the participant’s most significant informal caregiver. Results: The mean participant age was 77.6 years (SD = 7.7); the majority of the subjects were women (54%). The participants took an average of 4.7 different medications a day (SD = 3.2, median = 4). More than half (62%) of the participants were frail; 2 and 14% presented signs and symptoms of delirium and subsyndromal delirium, respectively. A weak but significant association between scores for frailty and delirium (p < 0.05) was demonstrated, and clinical observation confirmed this. A 4-h follow-up measurement of delirium in the ED revealed no significant or clinical difference. Conclusion: Although the literature describes strong associations between frailty and delirium in surgical units and community care settings, the present study only demonstrated a weak-to-moderate association between frailty and delirium in our ED.

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Section: Discussionmentioning

confidence: 99%

Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

Choutko-Joaquim

Tacchini-Jacquier²,

D'Alessio

et al. 2019

Dement Geriatr Cogn Disord Extra

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“…Of these, five were quality improvement (Babine, Farrington, & Wierman, 2013;Beasley & Patatanian, 2009;Healey et al, 2014;Isaac et al, 2018;Maia, Cruz, Shimoda, Sichieri, & Iida, 2018). (Ang et al, 2011;Ferguson et al, 2018;Groshaus et al, 2012;Toye et al, 2017; Wong Shee et al, 2014) and poorly reported intervention adherence (Ang et al, 2011;Groshaus et al, 2012;Toye et al, 2017) was a methodological issue for most studies. A detailed report of the research study quality is found in Appendix S2.…”

Section: Re Sultsmentioning

confidence: 99%

“…In one quality project that recorded falls in people with dementia, the TOP5 toolkit offered a communication intervention whereby family carers of people living with dementia share up to five essential strategies that can assist health staff to provide person-centred care (Isaac et al, 2018). In some projects, when older people with cognitive impairment were a subgroup of the sample or project population, patient education was extended to include the family (Ang et al, 2011;Ferguson et al, 2018;Maia et al, 2018). Engagement with family in care may offer new insights into how to prevent falls in older people with cognitive impairment.…”

Section: Engaging With Families In Falls Preventionmentioning

confidence: 99%

“…However, when used, falls risk assessment was undertaken in different ways. In several articles, falls risk was determined by an unspecified screening instrument as a study inclusion (Ang et al, 2011;Babine et al, 2013;Beasley & Patatanian, 2009;Ferguson et al, 2018;Wong Shee et al, 2014). With or without screening, in those projects with adult (not specifically cognitively impaired) patients, falls risk assessment was undertaken to identify modifiable risk factors using validated falls risk assessment tools such as the Hendrich II Falls Risk Model (Ang et al, 2011)…”

Section: Assessing Falls Risk To Identify Interventionsmentioning

confidence: 99%

“…The interventions subsequently were designed to address the modifiable risk factors. In one study, the John Hopkins Falls Risk Assessment Tool was used but the falls prevention programme was a universal, rather than targeted, programme (Ferguson et al, 2018). In a study led by pharmacists, older patients with high falls risk were further assessed using a medication falls risk score (Beasley & Patatanian, 2009).…”

Section: And the Morse Fallmentioning

confidence: 99%

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Interventions to prevent in‐hospital falls in older people with cognitive impairment for further research: A mixed studies review

Stockwell‐Smith

Adeleye

Chaboyer

et al. 2020

Journal of Clinical Nursing

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Background While advances in falls prevention in the adult population have occurred, the care requirements for older patients with cognitive impairment at risk of falling are less established. Objectives To identify interventions to prevent in‐hospital falls in older patients with cognitive impairment for further research and describe the strategies used to implement those interventions. Design A seven‐stage mixed studies review was used. Methods Seven electronic databases were searched. The SPIDER framework guided the review question and selection of search terms. The Mixed Methods Assessment Tool was used to appraise the quality of research studies, and the Quality Improvement Minimum Quality Data Set was used to appraise the quality of quality improvement projects. A convergent qualitative synthesis was used to analyse the extracted data. The adapted PRISMA guideline informed the procedures. Results Ten projects (five quality improvements and five researches) were included. Five themes emerged from the synthesis: engaging with families in falls prevention, assessing falls risk to identify interventions, extending nursing observation through technology, conducting a medication review and initiating nonpharmacological delirium prevention interventions. Implementation was not well described and commonly focused on capital investment to initiate a falls prevention programme and education to introduce staff to the new techniques for practice. Conclusions Emerging research and quality improvement studies demonstrate that effective falls prevention with this vulnerable population is possible but requires further investigation before widespread practice recommendations can be made. Further research and quality improvement in this area should consider adoption of an implementation framework to address sustainability. Relevance to clinical practice Reducing falls in older people with cognitive impairment requires nurses to work more closely with pharmacists, occupational therapists and social workers to develop strategies that work and are sustainable.

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Gait, balance, and falls

Berry

Lee

2022

Pathy's Principles and Practice of Geriatric Medicine

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Effectiveness of a Multifaceted Delirium Screening, Prevention, and Treatment Initiative on the Rate of Delirium Falls in the Acute Care Setting

Cited by 15 publications

References 21 publications

Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

Interventions to prevent in‐hospital falls in older people with cognitive impairment for further research: A mixed studies review

Gait, balance, and falls

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