The “Wholesome Contact” non-pharmacological, volunteer-delivered multidisciplinary programme to prevent hospital delirium in elderly patients: study protocol for a randomised controlled trial

Abstract

BackgroundIn hospital settings, delirium affects as many as 50% of older patients, aggravating their symptoms and worsening their condition, and therefore increasing the risk of in-hospital complications and death. The aim of this study is to assess the efficacy of structured, non-pharmacological care, delivered to older hospitalised patients by trained volunteers (students of medical fields), on the reduction of incidence of adverse health-related outcomes.Methods/designThis trial will be a randomised, investigator-blind, controlled trial conducted in an internal medicine and geriatric ward in Poland. We aim to include 416 patients who are 70 years of age and have been hospitalised for medical reasons. Eligible patients will be randomised 1:1 to receive structured, non-pharmacological care delivered by students of medicine, psychology and nursing, together with standard medical treatment or standard medical care alone. The protocol of interventions has been designed to cover nine main risk factors for delirium, with the scope of multidisciplinary interventions being individualised and tailored. The protocol will be aimed at immobilisation, vision and hearing impairment, cognitive impairment and disorientation, stress and anxiety, sleep–wake cycle disturbances, dehydration and malnutrition, and pain. A structured evaluation of patients’ cognition, mood, anxiety and functional performance is planned to be carried out twice, on the day of group allocation and at discharge; structured screening assessment for delirium will be conducted daily using the Confusion Assessment Method. The primary outcome will be the incidence of delirium in hospital; secondary outcomes will be in-hospital changes in cognition, mood and anxiety, and functional status, occurrence of falls and death.DiscussionDelirium prevention programmes are being introduced worldwide. A particular novelty of our project, however, is that invitations for voluntary work with older patients at risk for delirium will be addressed to medical students. With the use of the service learning method, the students will shape their attitudes, increase their knowledge and understanding of hospital care, and master competencies to work within interdisciplinary teams, which establishes the originality and practicality of the project.Trial registrationPolish Science Database, 317484. Registered on 23 October 2016.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2781-6) contains supplementary material, which is available to authorized users.

Sustained delirium reduction in an inpatient neuroscience unit

“…Based on the body of evidence synthesized, the evidence-based recommendations to prevent delirium included (1) providing multi- (3) a volunteer role in the hospital to provide delirium prevention interventions (Ferguson et al, 2018;Fong et al, 2009;Godfrey et al, 2013;Holt et al, 2013;Inouye et al, 1999Inouye et al, , 2014Kratz et al, 2015;Piotrowicz et al, 2018;Siddiqi et al, 2016).…”

“…Based on the body of evidence synthesized, the evidence‐based recommendations to prevent delirium included (1) providing multi‐component non‐pharmacological interventions such as frequent re‐orientation, sleep promotion, cognitively stimulating activities, sensory support, environmental factors (room temperature, lighting, noise, and familiar objects), hydration, and nutrition; (2) staff education (covering topics of delirium incidence; delirium subtypes; risk assessment; delirium contributing conditions such as pain, infection, electrolyte abnormalities, and withdrawal from alcohol or other substances; non‐pharmacological interventions); and (3) a volunteer role in the hospital to provide delirium prevention interventions (Ferguson et al., 2018; Fong et al., 2009; Godfrey et al., 2013; Holt et al., 2013; Inouye et al., 1999, 2014; Kratz et al., 2015; Piotrowicz et al., 2018; Siddiqi et al., 2016).…”

Effectiveness of Interprofessional Consultation-Based Interventions for Delirium: A Scoping Review

“…Delirium is an acute change in mental state that develops suddenly, often goes unrecognized, and increases an individual’s risk of adverse events including death, a longer hospital stay, and permanent cognitive decline (Hullick et al, 2018; Piotrowicz et al, 2018). It is a highly prevalent condition, seen in 18% to 50% of patients upon admission and incident in 11% to 82% during hospitalization, with older, medically complex populations being the most at-risk (Rubin et al, 2018).…”