Implementation of a model of care for hospitalised older persons with cognitive impairment (the Confused Hospitalised Older Persons program) in six New South Wales hospitals

Abstract

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.

Multicomponent, nonpharmacological delirium interventions for older inpatients

“…3 (“overview of included studies”), the selected studies were performed in 12 countries with 13 studies (52%) from Europe [55–67], eight (32%) from North America [68–75] and four (16%) from Australia [76–79]. Of the studies 11 (44%) were conducted using a pre-test and post-test design [55, 59, 60, 65, 68, 71–73, 75, 78, 79], six (24%) studies were performed as a prospective observational study [57, 62, 63, 67, 69, 70] and four (16%) studies were RCTs [56, 64, 66, 77]. Furthermore, one nonrandomized study (combined with pre-test and post-test design) [61], one propensity-matched cohort study [74], and two qualitative studies were conducted [58, 76].…”

“…The age cohorts of older individuals varied considerably: one study recruited patients at the age of ≥60 years [69], eight (32%) included participants at the age of ≥65 years [56, 68, 70, 74, 76–79], two included patients at ≥69 years [66, 73], 7 (28%) recruited patients at ≥70 years [57, 59, 61, 63, 64, 67, 75], and one included patients at ≥75 years of age [55]. Of the included studies two used two age cohorts of older inpatients (80 years and older/70–79 years [71]; 64 years/74 years and older [72]).…”

“…The reason is on the one hand by the author’s descriptions of the setting as “elderly care” [58], “for elderly” [60] and “acute ortho-geriatric ward” [62] and on the other hand legitimized by the advanced mean age [65] (intervention group: 82 years, controls: 80 years). Of the studies 11 (44%) were performed in geriatric wards [55–58, 60, 62, 64, 67–69, 72], one study [79] was partially conducted in the geriatric setting (in 2 of 13 wards) and two studies (8%) held an intermediate position, as they were performed on regular units, but provided a geriatric care concept [66, 71]. Another 11 studies (44%) were conducted in nongeriatric units.…”

“…Of the studies 14 (56%) also recruited patients with pre-existing dementia or cognitive impairment [56, 60, 62–69, 73, 74, 78, 79], whereas in other studies patients with severe cognitive decline were excluded. One study reported that significantly ( p < 0.001) more patients with dementia (69.0%) developed delirium compared to patients without dementia (5.6%) [69]; however, in the investigation ( N = 125) by Lundström et al.…”

Organising care, practice and participative research: Papers from the cognitive decline partnership centre

“…Kurrle et al explore the implementation of a model of care for hospitalised older patients with cognitive impairment, called the CHOPS program. In six New South Wales hospitals, increases in cognitive screening, risk identification, assessment and the management of cognitive impairment, plus communication with carers, were found.…”