Systematic review of interventions targeting fundamental care to reduce hospital‐associated decline in older patients

Foubert, Marguerite de; Cummins, Helen; McCullagh, Ruth; Brueton, Valerie; Naughton, Corina

doi:10.1111/jan.14954

Cited by 16 publications

(19 citation statements)

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“…There is evidence that multicomponent interventions addressing fundamental principles of age-friendly care, including mobility, cognitive and social activities, nutrition and hydration, sleep, and pain management, significantly reduce the incidence of delirium 8 and may reduce the incidence of falls 9 and hospital-associated disability, 10 suggesting that systematic attention to these fundamental principles could have an additive effect on HAC-OPs and mediate better outcomes for older people. 11,12 However, these principles remain challenging to implement within complex health services. 13,14 "Eat Walk Engage" is a ward-based improvement program designed to support more consistent delivery of the key principles of nutrition and hydration, mobility, and meaningful cognitive and social engagement, as well as improve multidisciplinary teamwork.…”

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confidence: 99%

Effect of a Ward-Based Program on Hospital-Associated Complications and Length of Stay for Older Inpatients

et al. 2022

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Hospital-associated complications of older people (HAC-OPs) include delirium, hospital-associated disability, incontinence, pressure injuries, and falls. These complications may be preventable by age-friendly principles of care, including early mobility, good nutrition and hydration, and meaningful cognitive engagement; however, implementation is challenging.OBJECTIVES To implement and evaluate a ward-based improvement program ("Eat Walk Engage") to more consistently deliver age-friendly principles of care to older individuals in acute inpatient wards.DESIGN, SETTING, AND PARTICIPANTS This cluster randomized CHERISH (Collaboration for Hospitalised Elders Reducing the Impact of Stays in Hospital) trial enrolled 539 consecutive inpatients aged 65 years or older, admitted for 3 days or more to study wards, from October 2, 2016, to April 3, 2017, with a 6-month follow-up. The study wards comprised 8 acute medical and surgical wards in 4 Australian public hospitals. Randomization was stratified by hospital, providing 4 clusters in intervention and in control groups. Statistical analysis was performed from August 28, 2018, to October 17, 2021, on an intention-to-treat basis.INTERVENTION A trained facilitator supported a multidisciplinary work group on each intervention ward to improve the care practices, environment, and culture to support key age-friendly principles.MAIN OUTCOMES AND MEASURES Primary outcomes were incidence of any HAC-OP and length of stay. Secondary outcomes were incidence of individual HAC-OPs, facility discharge, 6-month mortality, and all-cause readmission. Outcomes were analyzed at the individual level, adjusted for confounders and clustering.RESULTS A total of 265 participants on 4 intervention wards (124 women [46.8%]; mean [SD] age, 75.9 [7.3] years) and 274 participants on 4 control wards (145 women [52.9%]; mean [SD] age, 78.0 [8.2] years) were enrolled. The composite primary outcome of any HAC-OP occurred for 115 of 248 intervention participants (46.4%) and 129 of 249 control participants (51.8%) (intervention group: adjusted odds ratio, 1.07; 95% CI, 0.71-1.61). The median length of stay was 6 days (IQR, 4-9 days) for the intervention group and 7 days (IQR, 5-10 days) for the control group (adjusted hazard ratio, 0.96; 95% credible interval, 0.80-1.15). The incidence of delirium was significantly lower for intervention participants (adjusted odds ratio, 0.53; 95% CI, 0.31-0.90). There were no significant differences in other individual HAC-OPs, facility discharge, mortality, or readmissions. CONCLUSIONS AND RELEVANCEThe Eat Walk Engage program did not reduce the composite primary outcome of any HAC-OP or length of stay, but there was a significant reduction in the incidence of delirium.

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confidence: 99%

Effect of a Ward-Based Program on Hospital-Associated Complications and Length of Stay for Older Inpatients

et al. 2022

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“…Of these, 12 were excluded for failing to meet the inclusion criteria or the objective of the umbrella review. Fourteen reviews met the inclusion criteria [ 31 , 32 , 34 , 35 , 41 , 42 , 43 , 44 , 45 , 46 , 53 , 54 ]. The results are presented in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

Non-Pharmacological Nursing Interventions to Prevent Delirium in ICU Patients—An Umbrella Review with Implications for Evidence-Based Practice

Lange

Mędrzycka‐Dąbrowska

Friganović

et al. 2022

JPM

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Delirium in ICU patients is a complication associated with many adverse consequences. Given the high prevalence of this complication in critically ill patients, it is essential to develop and implement an effective management protocol to prevent delirium. Given that the cause of delirium is multifactorial, non-pharmacological multicomponent interventions are promising strategies for delirium prevention. (1) Background: To identify and evaluate published systematic review on non-pharmacological nursing interventions to prevent delirium in intensive care unit patients. (2) Methods: An umbrella review guided by the Joanna Briggs Institute was utilized. Data were obtained from PubMed, Scopus, EBSCO, Web of Science, Cochrane Library, and Google Scholar. The last search was conducted on 1 May 2022. (3) Results: Fourteen reviews met the inclusion criteria. Multicomponent interventions are the most promising methods in the fight against delirium. The patient’s family is an important part of the process and should be included in the delirium prevention scheme. Light therapy can improve the patient’s circadian rhythm and thus contribute to reducing the incidence of delirium. (4) Conclusions: Non-pharmacological nursing interventions may be effective in preventing and reducing the duration of delirium in ICU patients.

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“…Richards et al reviewed nurse‐led interventions to address FoC and concluded that evidence remained sparse and of insufficient quality to provide guidance to nursing practice (Richards et al, 2018). In contrast, de Foubert et al took a broader view and included interventions involving ward nurses which were led by any health professional and found promising evidence for improving both processes and outcomes of FoC for older people (de Foubert et al, 2021). They highlighted the value of multi‐component approaches, recognizing the importance of integration across domains, and recommended the explicit use of knowledge translation frameworks to guide improvement, acknowledging the powerful influence of local and wider contextual factors on nursing practice.…”

Section: Discussionmentioning

confidence: 99%

“…Comorbidity, frailty and hospital care processes interact to increase the risk of hospital‐associated complications in older people including delirium, functional decline, incontinence, falls and pressure injuries, which affect almost half of hospitalized older people (Bail & Grealish, 2016; Hubbard et al, 2017; Mudge et al, 2019; Zisberg et al, 2015). These risks can be mitigated by the consistent provision of high‐quality fundamentals of care (FoC) such as adequate nutrition and hydration; support for physical, cognitive and social activities to maintain and recover function; and adequate sleep and pain relief (Burton et al, 2021; de Foubert et al, 2021). In this discussion paper, we argue that leadership approaches to reliable provision of FoC must embrace complexity, both of older patients' needs and the complex setting in which nurses and other health care staff work, through multidisciplinary partnerships, application of knowledge translation tools appropriate for complex interventions and enabling emergent leadership at every level.…”

Section: Introductionmentioning

confidence: 99%

Eat Walk Engage: Enabling acute care teams to deliver consistent fundamentals of care for older people

Cahill

Neill

Treleaven

et al. 2022

Journal of Advanced Nursing

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Aims Fundamentals of care are particularly important for older people in acute inpatient settings, who are at increased risk of serious hospital‐associated complications like delirium and functional decline. These complications occur due to interactions between clinical complexity and the complex processes and context of hospital care and can be reduced by consistent attention to the fundamentals of care. This paper aims to illustrate of how multi‐level nursing leadership of fundamentals of care can be supported to emerge within complex multidisciplinary delivery systems in acute care. Design Discussion paper informed by clinical and organizational experience of a multidisciplinary leadership team and complexity leadership theory. Data sources We provide a series of vignettes as practical illustrations of a successful multidisciplinary improvement program called Eat Walk Engage which supports the delivery of better care for older inpatients, significantly reducing delirium. We argue that taking a broader complexity‐based approach including collaborative multidisciplinary engagement, iterative and integrated interventions and appropriate knowledge translation frameworks can enable emergent leadership by nurses at all levels. Implications for nursing This promising approach to improving care for older patients requires organizational support for facilitation and reflective practice, and for meaningful data to support change. Our discussion challenges nursing leaders to support the time, agency and connections their nursing staff need in order to emerge as local leaders in fundamental care. Conclusion The debate around scope and responsibilities for fundamentals of care in hospital care has important practical implications for conceptualizing leadership and accountability for improvement. Impact Our discussion illustrates how a structured multidisciplinary approach that acknowledges and navigates complexity can empower nurses to lead and improve outcomes of older patients in acute care.

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Systematic review of interventions targeting fundamental care to reduce hospital‐associated decline in older patients

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 16 publications

References 71 publications

Effect of a Ward-Based Program on Hospital-Associated Complications and Length of Stay for Older Inpatients

Effect of a Ward-Based Program on Hospital-Associated Complications and Length of Stay for Older Inpatients

Non-Pharmacological Nursing Interventions to Prevent Delirium in ICU Patients—An Umbrella Review with Implications for Evidence-Based Practice

Eat Walk Engage: Enabling acute care teams to deliver consistent fundamentals of care for older people

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