Skip to main content
Log in

The applicability and feasibility of occupational therapy in delirium care

  • Review
  • Published:
European Geriatric Medicine Aims and scope Submit manuscript

Key summary points

AbstractSection Aim

To perform a narrative review aiming at evaluating the applicability and feasibility of occupational therapy in people with delirium.

AbstractSection Findings

In this article, the current evidence of the role of occupational therapy for the prevention and management of people with delirium across different settings of care (intensive care units, rehabilitation facilities, and nursing homes) is described. Overall, the article summarizes the results of various studies, supporting the feasibility and efficacy of non-pharmacological approaches conducted by occupational therapists.

AbstractSection Message

Though further studies are required to confirm initial evidence, there is reason to believe that occupational therapy may be an effective approach to help the management of delirious people across various settings of care. Occupational therapy may therefore be included in the early stages of rehabilitation management for people with delirium.

Abstract

Purpose

To perform a narrative review of studies on the applicability and feasibility of occupational therapy in persons with delirium by analyzing evaluation and procedural methods in the therapeutic settings.

Methods

Starting from the international classification of disability, the focus was to understand if and how occupational therapy as a multi-component intervention can reduce the duration and intensity of delirium to prevent future disabilities. This review also includes scientific studies demonstrating the benefits of occupational therapy in terms of increased functional and occupational outcomes. Finally, the evaluation modalities and the therapeutic procedures performed by the occupational therapist have been analyzed.

Results

The non-pharmacological treatments occupational therapists perform in people with delirium in intensive care settings are supported by scientific evidence.

Conclusions

There is preliminary evidence of the benefit of including occupational therapy in early stages of rehabilitation in acute care to prevent and treat delirium. Nevertheless, further studies are necessary to define the different aspects of the multidisciplinary approach that is common in geriatric practice, primarily determining the adequate timing, and intensity of interventions as well as its appropriate settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Martinez F, Tobar C, Hill N (2015) Preventing delirium: should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature. Age Ageing 44(2):196–204

    Article  Google Scholar 

  2. Siddiqi N, Harrison JK, Clegg A et al (2016) Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev 3:CD005563

    PubMed  Google Scholar 

  3. Occupational Therapy Europe What is OT?—OT EU. https://www.oteurope.eu/what-is-ot. Accessed 31 July 2019

  4. Kielhofner G (2008) Model of human occupation : theory and application, 3rd edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  5. Gitlin LN, Winter L, Dennis MP et al (2010) A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers. JAMA 304(9):983

    Article  CAS  Google Scholar 

  6. World Health Organization ICF Browser. https://apps.who.int/classifications/icfbrowser/Default.aspx. Accessed 10 June 2019

  7. WHO (2018) International classification of functioning, disability and health (ICF). WHO

  8. Somerville E, Smallfield S, Stark S et al (2016) Occupational therapy home modification assessment and intervention. Am J Occup Ther. https://doi.org/10.5014/ajot.2016.705002

    Article  PubMed  Google Scholar 

  9. National Institute for Health and Care Excellence; Delirium: prevention, diagnosis and management | Guidance | NICE In https://www.nice.org.uk/guidance/cg103. Accessed 12 June 2019

  10. Rains J, Chee N (2017) The role of occupational and physiotherapy in multi-modal approach to tackling delirium in the intensive care. J Intensive Care Soc 18(4):318–322

    Article  Google Scholar 

  11. Inouye SK, Bogardus ST, Charpentier PA et al (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340(9):669–676

    Article  CAS  Google Scholar 

  12. Hshieh TT, Yue J, Oh E et al (2015) Effectiveness of multicomponent nonpharmacological delirium interventions. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2014.7779

    Article  PubMed  PubMed Central  Google Scholar 

  13. Martinez FT, Tobar C, Beddings CI et al (2012) Preventing delirium in an acute hospital using a non-pharmacological intervention. Age Ageing. 41(5):629–634

    Article  Google Scholar 

  14. Marcantonio ER, Flacker JM, Wright RJ et al (2001) Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 49(5):516–522

    Article  CAS  Google Scholar 

  15. Toye C, Kitchen S, Hill A et al (2017) Piloting staff education in Australia to reduce falls in older hospital patients experiencing delirium. Nurs Health Sci 19(1):51–58

    Article  Google Scholar 

  16. Piersol CV, Jensen L, Lieberman D et al (2017) Occupational therapy interventions for people with Alzheimer’s disease. Am J Occup Ther 72(1):72–81

    Article  Google Scholar 

  17. Zaal IJ, Slooter AJC (2012) Delirium in critically ill patients. Drugs 72(11):1457–1471

    Article  CAS  Google Scholar 

  18. Van Rompaey B, Elseviers M, Van Drom W et al (2012) The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Crit Care. https://doi.org/10.1186/cc11330

    Article  PubMed  PubMed Central  Google Scholar 

  19. Collinsworth AW, Priest EL, Campbell CR et al (2016) A review of multifaceted care approaches for the prevention and mitigation of delirium in intensive care units. J Intensive Care Med. 31(2):127–141

    Article  Google Scholar 

  20. Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F et al (2019) Assessing the impact of physical exercise on cognitive function in older medical patients during acute hospitalization: secondary analysis of a randomized trial. PLoS Med. https://doi.org/10.1371/journal.pmed.1002852

    Article  PubMed  PubMed Central  Google Scholar 

  21. Resnick B, Beaupre L, McGilton KS et al (2016) Rehabilitation interventions for older individuals with cognitive impairment post-hip fracture: a systematic review. J Am Med Dir Assoc 17(3):200–205

    Article  Google Scholar 

  22. Rogers AT, Bai G, Lavin RA et al (2017) Higher hospital spending on occupational therapy is associated with lower readmission rates. Med Care Res Rev. https://doi.org/10.1177/1077558716666981

    Article  PubMed  Google Scholar 

  23. Morandi A, Pozzi C, Milisen K et al (2019) An interdisciplinary statement of scientific societies for the advancement of delirium care across Europe (EDA, EANS, EUGMS, COTEC, IPTOP/WCPT). BMC Geriatr 19(1):253

    Article  Google Scholar 

  24. Tobar E, Alvarez E, Garrido M (2017) Cognitive stimulation and occupational therapy for delirium prevention. Rev Bras Ter Intensiva 29(2):248–252

    Article  Google Scholar 

  25. Álvarez 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 

  26. 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(9678):1874–1882

    Article  Google Scholar 

  27. 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(12):1091–1092

    Article  Google Scholar 

  28. Pozzi C, Lanzoni A, Lucchi E et al (2019) Activity-based occupational therapy intervention for delirium superimposed on dementia in nursing home setting: a feasibility study. Aging Clin Exp Res. https://doi.org/10.1007/s40520-019-01422-0

    Article  PubMed  Google Scholar 

  29. Parkinson S, Chester A, Cratchley S et al (2008) Application of the model of human occupation screening tool (MOHOST assessment) in an acute psychiatric setting. Occup Ther Health Care 22(2–3):63–75

    Article  Google Scholar 

  30. Bellelli G, Morandi A, Davis DHJ et al (2014) Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing 43(4):496–502

    Article  Google Scholar 

  31. 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(9):828–833

    Article  Google Scholar 

  32. Marcantonio ER, Ngo LH, O’Connor M et al (2014) 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med 161(8):554–561

    Article  Google Scholar 

  33. Ward G, Jagger C, Harper W (1996) The Canadian occupational performance measure: what do users consider important? Br J Ther Rehabil 3(8):448–452

    Article  Google Scholar 

  34. Brown WC (2011) Book review: the pool activity level (PAL) instrument for occupational profiling: a practical resource for carers of people with cognitive impairment, 3rd edition, by Jackie Pool. London: Jessica Kingsley Publishers, 173 pp. ISBN: 978-1-84310-594-7. Dementia 10(2):272–273

    Article  Google Scholar 

  35. Fisher AG (2009) Occupational therapy intervention process model : a model for planning and implementing top-down, client-centered, and occupation-based interventions. Three Star Press Inc, Fort Collins

    Google Scholar 

  36. De las Heras CG (1998) A User’s Manual for the Volitional Questionnaire—Carmen Gloria de las Heras—Google Libros. University of Illinois at Chicago, Chicago

    Google Scholar 

  37. Strong S, Rigby P, Stewart D et al (1999) Application of the person–environment–occupation model: a practical tool. Can J Occup Ther 66(3):122–133

    Article  CAS  Google Scholar 

  38. British Geriatrics Society. SIGN 157: Risk reduction and management of delirium. 2019. https://www.bgs.org.uk/resources/sign-157-risk-reduction-and-management-of-delirium. Accessed 29 Aug 2019

  39. Young Y, Fan M-Y, Hebel JR et al (2009) Concurrent validity of administering the functional independence measure (FIM) instrument by interview. Am J Phys Med Rehabil 88(9):766–770

    Article  Google Scholar 

  40. MacDermid J, Solomon G, Valdes K (2015) Clinical assessment recommendations. American Society of Hand Therapists, Mount Laurel

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christian Pozzi.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the 1964 Helsinki declaration.

Informed consent

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article belongs to special issue Delirium, Vol 11, Issue 1, February 2020, https://link.springer.com/journal/41999/11/1.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pozzi, C., Tatzer, V.C., Álvarez, E.A. et al. The applicability and feasibility of occupational therapy in delirium care. Eur Geriatr Med 11, 209–216 (2020). https://doi.org/10.1007/s41999-020-00308-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41999-020-00308-z

Keywords

Navigation