The incidence of delirium in an acute geriatric community hospital: an observational cohort feasibility study

Abstract

Background Delirium in hospitalised older adults is associated with negative health outcomes. Admission to an alternative care setting may lower the incidence of delirium. The Acute Geriatric Community Hospital (AGCH) was recently opened in the Netherlands and uses a multi-component non-pharmacological intervention strategy to prevent delirium. Objective To describe the incidence of delirium found in the AGCH and compare this incidence to a hospital control group found in literature. Design Prospective cohort study; exploratory meta-analysis of proportions. Setting The AGCH is an acute geriatric unit in an intermediate care facility. Participants Patients aged >65 years with acute medical conditions admitted to the AGCH. Methods Delirium assessment using the Confusion Assessment Method (CAM) upon admission and on day one, two and three or until delirium had resolved. Patients charts were reviewed if CAM was missing. In an logistic mixed-effects model, the delirium incidence rate in AGCH was compared to pooled delirium incidence rates from six studies found in a high-quality review. Results 214 patients from the AGCH (mean age 81.9 years, 47% male, 12% with a history of dementia) were included in the analysis. Delirium developed in 8% (18/214) (95% CI [confidence interval] 5-13%) of patients during AGCH admission compared to 16% (95% CI 12-21%) in hospitals. Admission to the AGCH was associated with a decreased delirium incidence rate compared to the hospital control group (OR [odds ratio]= 0.49, 95% CI 0.24-0.98, p-value=0.044). Conclusions The delirium incidence in the AGCH was relatively low compared to those incidences found in general hospitals.

A case vignette study to refine the target group of an intermediate care model: the Acute Geriatric Community Hospital

“…When nurse practitioners and physician assistants at the AGCH provide the care of the ECP (and/or hospital geriatrician), the legal consequences of transferring responsibilities should be clear [34]. Fourth, nursing home organizations will need to adjust their operations, logistics, and billing to provide acute care 24/7 because patient turnover is higher at the AGCH (x̄ length of stay 10 days [27]) than at the STRC (x̄ 34 days [35]) or GR (x4 3 days [36]). Finally, those providing specialized services at intermediate care facilities should use the 13 re ned admission criteria to determine which of these services can be de ned as AGCH care.…”

“…A prospective controlled observational study showed that patients admitted to the AGCH had a lower risk of readmission or death within 90 days after discharge than patients admitted to the hospital [25]. Patient satisfaction was high [26] and incident rates for delirium were lower [27] compared with control groups. These ndings have motivated multiple stakeholders to scale up the model to other sites in "XXXX".…”