Activity-based occupational therapy intervention for delirium superimposed on dementia in nursing home setting: a feasibility study

Abstract

Objective

Multi-component interventions can reduce delirium incidence. Occupational therapy (OT) has been effective in the management of dementia. We designed a real-world feasibility study of an OT intervention in the management of delirium superimposed on dementia (DSD).

Methods

We included a convenient sample of 22 patients older than 65 years of age with delirium and moderate dementia admitted to a nursing home (NH). The OT procedures were standardized according to the level of agitation or sedation of the patient and based on a structured OT evaluation. The Canadian Occupational Performance Measure (COPM) was used to evaluate the proxy perception of performance in the daily activities at baseline and at delirium resolution.

Results

The mean age was 86.45 ± 6.46 years. The first daily treatment was delivered in the entire sample, while the second was delivered in 63.46% on day 1, 72.72% on day 2, 25% on day 3, 66.67% on day 4, 100% on days 5 and 6. The main time of the first daily treatment varied, day 1 through day 6, from 14.8 ± 8.5 to 20 ± 0 min; while the second daily treatment, in the same period, from 3.9 ± 6.7 to 20.1 ± 0 min. The mean time of the first treatment varied day 1 through day 6 from 14.8 ± 8.5 to 20 ± 0 min, while the second treatment from 3.9 ± 6.7 to 20.1 ± 0 min. The COPM proxy performance and proxy satisfaction increased from delirium onset to delirium resolution.

Conclusions

This is the first study to report the feasibility of an OT intervention for the management of DSD in a NH setting. The results are important to support future trials on delirium management in a setting often understudied and underrepresented.

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References

  1. 1.

    American Psychiatric Association A (2013) Diagnostic and statistical manual of mental disorders, 5th edn. APA, Washington

    Google Scholar 

  2. 2.

    Morandi A, McCurley J, Vasilevskis EE et al (2012) Tools to detect delirium superimposed on dementia: a systematic review. J Am Geriatr Soc 60:2005–2013

    Article  Google Scholar 

  3. 3.

    Fick DM, Agostini JV, Inouye SK (2002) Delirium superimposed on dementia: a systematic review. J Am Geriatr Soc 50:1723–1732

    Article  Google Scholar 

  4. 4.

    Sampson EL, Blanchard MR, Jones L et al (2009) Dementia in the acute hospital: prospective cohort study of prevalence and mortality. Br J Psychiatry 195:61–66

    Article  Google Scholar 

  5. 5.

    Fick DM, Steis MR, Waller JL et al (2013) Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults. J Hosp Med 8:500–505

    Article  Google Scholar 

  6. 6.

    Bellelli G, Frisoni GB, Turco R et al (2007) Delirium superimposed on dementia predicts 12-month survival in elderly patients discharged from a postacute rehabilitation facility. J Gerontol Ser A Biol Sci Med Sci 62:1306–1309

    Article  Google Scholar 

  7. 7.

    Morandi A, Davis D, Fick DM et al (2014) Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients. J Am Med Dir Assoc 15:349–354

    Article  Google Scholar 

  8. 8.

    Morandi A, Lucchi E, Turco R et al (2015) Delirium superimposed on dementia: a quantitative and qualitative evaluation of patient experience. J Psychosom Res 79:281–287

    Article  Google Scholar 

  9. 9.

    Morandi A, Lucchi E, Turco R et al (2015) Delirium superimposed on dementia: a quantitative and qualitative evaluation of informal caregivers and health care staff experience. J Psychosom Res 79:272–280

    Article  Google Scholar 

  10. 10.

    Grossi E, Lucchi E, Gentile S (2019) Preliminary investigation of predictors of distress in informal caregivers of patients with delirium superimposed on dementia. Aging Clin Exp Res. https://doi.org/10.1007/s40520-019-01194-7

    Article  PubMed  Google Scholar 

  11. 11.

    Neufeld KJ, Yue J, Robinson TN (2016) Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and meta-analysis. J Am Geriatr Soc 64:705–714

    Article  Google Scholar 

  12. 12.

    Inouye SK (1999) Predisposing and precipitating factors for delirium in hospitalized older patients. Dement Geriatr Cogn Disord 10:393–400

    CAS  Article  Google Scholar 

  13. 13.

    Abraha I, Rimland JM, Trotta F et al (2016) Non-pharmacological interventions to prevent or treat delirium in older patients: clinical practice recommendations The SENATOR-ONTOP series. J Nutr Health Aging 20:927–936

    CAS  Article  Google Scholar 

  14. 14.

    Siddiqi N, Harrison JK, Clegg A et al (2016) Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev 11:CD005563

    Google Scholar 

  15. 15.

    Alvarez EA, Garrido MA, Tobar EA et al (2017) Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit. A pilot randomized clinical trial. J Crit Care 37:85–90

    Article  Google Scholar 

  16. 16.

    Schweickert WD, Pohlman MC, Pohlman AS et al (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373:1874–1882. https://doi.org/10.1016/S0140-6736(09)60658-9

    Article  PubMed  Google Scholar 

  17. 17.

    Pozzi C, Lanzoni A, Lucchi E et al (2018) A pilot study of community-based occupational therapy for persons with dementia (COTID-IT Program) and their caregivers: evidence for applicability in Italy. Aging Clin Exp Res 31:1299–1304

    Article  Google Scholar 

  18. 18.

    Pozzi C, Lucchi E, Lanzoni A et al (2017) Preliminary evidence of a positive effect of occupational therapy in patients with delirium superimposed on dementia. J Am Med Dir Assoc 18:1091–1092

    Article  Google Scholar 

  19. 19.

    Molloy DW, Standish TI (1997) A guide to the standardized mini-mental state examination. Int Psychogeriatr 9:87–94

    Article  Google Scholar 

  20. 20.

    Berg L (1988) Clinical dementia rating (CDR). Psychopharmacol Bull 24:637–639

    CAS  PubMed  Google Scholar 

  21. 21.

    Parmelee PA, Thuras PD, Katz IR et al (1995) Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatr Soc 43:130–137

    CAS  Article  Google Scholar 

  22. 22.

    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index: a simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Md State Med J 14:61–65

    CAS  PubMed  Google Scholar 

  23. 23.

    Tinetti ME, Williams TF, Mayewski R (1986) Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 80:429–434

    CAS  Article  Google Scholar 

  24. 24.

    Voyer P, Champoux N, Desrosiers J et al (2015) Recognizing acute delirium as part of your routine [RADAR]: a validation study. BMC Nurs 14:19

    Article  Google Scholar 

  25. 25.

    Chester JG, Beth Harrington M, Rudolph JL (2012) Serial administration of a modified Richmond Agitation and Sedation Scale for delirium screening. J Hosp Med 7:450–453. https://doi.org/10.1002/jhm.1003

    Article  PubMed  Google Scholar 

  26. 26.

    de Jonghe JF, Kalisvaart KJ, Timmers JF et al (2005) Delirium-O-Meter: a nurses’ rating scale for monitoring delirium severity in geriatric patients. Int J Geriatr Psychiatry 20:1158–1166. https://doi.org/10.1002/gps.1410

    Article  PubMed  Google Scholar 

  27. 27.

    Kielhofner G (2008) Model of human occupation: theory and application, 4th edn. Lippinicott Williams & Wilkins, Philadelphia

    Google Scholar 

  28. 28.

    Law M, Baptiste S, Carswell A et al (2014) Canadian occupational performance measure (COPM). CAOT publications, Ottawa

    Google Scholar 

  29. 29.

    Dyer SM, Harrison SL, Laver K et al (2017) An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia. Int Psychogeriatr 30:295–309

    Article  Google Scholar 

  30. 30.

    Piersol CV, Jensen L, Lieberman D et al (2018) Occupational therapy interventions for people with Alzheimer’s disease. Am J Occup Ther 72:7201390010p1–7201390010p6

    Article  Google Scholar 

  31. 31.

    DiZazzo-Miller R, Samuel PS, Barnas JM et al (2014) Addressing everyday challenges: feasibility of a family caregiver training program for people with dementia. Am J Occup Ther 68:212–220

    Article  Google Scholar 

  32. 32.

    Gitlin LN, Arthur P, Piersol C et al (2018) Targeting behavioral symptoms and functional decline in dementia: a randomized clinical trial. J Am Geriatr Soc 66:339–345

    Article  Google Scholar 

  33. 33.

    Graff MJ, Vernooij-Dassen MJ, Thijssen M et al (2006) Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial. BMJ 333:1196

    Article  Google Scholar 

  34. 34.

    Brummel NE, Girard TD, Ely EW et al (2013) Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the activity and cognitive therapy in ICU (ACT-ICU) trial. Intensive Care Med 40:370–379

    Article  Google Scholar 

  35. 35.

    Morandi A, Han JH, Meagher D et al (2016) Detecting delirium superimposed on dementia: evaluation of the diagnostic performance of the richmond agitation and sedation scale. J Am Med Dir Assoc 17:828–833

    Article  Google Scholar 

  36. 36.

    Chen P, Dowal S, Schmitt E et al (2015) Hospital elder life program in the real world: the many uses of the hospital elder life program website. J Am Geriatr Soc 63:797–803

    Article  Google Scholar 

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Authors

Contributions

Study conception and design—all the authors. Acquisition of data—AL, IS, LPD. Statistical analysis: EL. Interpretation of results—all the authors. Drafted manuscript—CP, AL, AM. Critically revised the manuscript—all the authors. Final approval of manuscript—all the authors.

Corresponding author

Correspondence to Alessandro Morandi.

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The authors declare no conflicts of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the Ethical Committee Val Padana (Protocol 34788/17) and with the 1964 Helsinki declaration.

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Informed consent was obtained from patients’ authorized surrogates at study enrollment.

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Pozzi, C., Lanzoni, A., Lucchi, E. et al. Activity-based occupational therapy intervention for delirium superimposed on dementia in nursing home setting: a feasibility study. Aging Clin Exp Res 32, 827–833 (2020). https://doi.org/10.1007/s40520-019-01422-0

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Keywords

  • Occupational therapy
  • Delirium
  • Dementia
  • Nursing home
  • Tailor-made activity