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Delirium Prevention: Update on Multidisciplinary, Non-drug Prevention of Delirium Among Hospitalized Elderly

  • Miriam B. Rodin
  • Joseph H. Flaherty
Chapter

Abstract

Delirium is a common complication of hospitalized elderly (Inouye et al. 2014). The risk factors for delirium are well understood by hospital care providers (Lee et al. 2013; Cohen and Klein 1958). The focus here will be on non-pharmacological interventions to prevent delirium in non-ICU medical patients for the following reasons: First, the largest patient population is in the general medical wards. Second, the complexity of multicomponent interventions (MCIs) makes them hard to measure since there are many moving parts and disciplines that are not focused on individual clinicians and which vary somewhat from study to study. Lastly, the data from different meta-analyses are not in agreement. Thus, the purpose of this paper is to help clinicians to conceptualize delirium based on risk factors for delirium and the basic principles of MCIs in a way that helps them as an individual clinician “do” their part of the MCI within a supportive hospital system (Bergmann 2005; Clegg et al. 2014).

References

  1. Abizanda P, Leon M, Dominguez-Martin L et al (2011) Effects of a short-term occupational therapy intervention in an acute geriatric unit. Maturitas 69:273–278CrossRefPubMedGoogle Scholar
  2. Ahmed NN, Pearce SE (2010) Acute care for the elderly: a literature review. Popul Health Manag 13:219–225CrossRefPubMedGoogle Scholar
  3. Albrecht JS, Marcantonio ER, Roffey DM, Orwig D, Magaziner J, Terrin M, Carson JL, Barr E, Brown JP, Gentry EG, Gruber-Baldini AL (2015) Functional outcomes in cardiovascular patients undergoing surgical hip fracture repair cognitive ancillary study investigators. Stability of postoperative delirium psychomotor subtypes in individuals with hip fracture. J Am Geriatr Soc 63:970–976CrossRefPubMedPubMedCentralGoogle Scholar
  4. Allen KR, Hazelett SE, Palmer RR et al (2003) Developing a stroke unit using the acute care for elders intervention and model of care. J Am Geriatr Soc 51:1660–1667CrossRefPubMedGoogle Scholar
  5. Andro M, Comps E, Estivin S, Gentric A (2012) Prevention of delirium in demented hospitalized patients. Eur J Intern Med 23:124–125CrossRefPubMedGoogle Scholar
  6. Aspelund K, Gustafson Y, Jacobsson C et al (2000) Geriatric-based vs general wards for older acute medical patients: a randomized comparison of outcomes and use of resources. J Am Geriatr Soc 48:1381–1388CrossRefGoogle Scholar
  7. Avendano-Cespedes A, Garcia Cantos N, Gonzalez-Teruel M et al (2016) Pilot study of a preventive multicomponent nurse intervention to reduce the incidence and severity of delirium in hospitalized older adults: MID-Nurse-P. Maturitas 86:86–94CrossRefPubMedGoogle Scholar
  8. Babine RL, Farrington S, Wierman HR (2013) HELP prevent falls by preventing delirium. Nursing 43:18–21CrossRefPubMedGoogle Scholar
  9. Bakker FC, Persoon A, Bredie SJH et al (2014) The CareWell in Hospital program to improve the quality of care for frail elderly inpatients: results of a before-after study with focus on surgical patients. Am J Surg 208:735–746CrossRefPubMedGoogle Scholar
  10. Benedict L, Robinson K, Holder C (2006) Clinical nurse specialist practice within the Acute Care for Elders interdisciplinary team model. Clin Nurse Spec 20:248–251CrossRefPubMedGoogle Scholar
  11. Bergmann MA (2005) Outcomes of older people admitted to post-acute facilities with delirium. J Am Geriatr Soc 53:963–969CrossRefPubMedGoogle Scholar
  12. Bo M, Martini M, Ruatta C et al (2009) Geriatric ward hospitalization reduced incidence delirium among older medical inpatients. Am J Geriatr Psychiatry 17:760–768CrossRefPubMedGoogle Scholar
  13. Bogardus ST, Desai MM, Williams CS et al (2003) The effects of a targeted multicomponent delirium intervention on post discharge outcomes for hospitalized older adults. Am J Med 114:383–390CrossRefPubMedGoogle Scholar
  14. Bonaventura M, Zanotti R (2007) Effectiveness of “IPD” treatment for delirium prevention in hospitalized elderly: a controlled randomized clinical trial. Prof Inferm 60:230–236PubMedGoogle Scholar
  15. Caplan GA, Harper EL (2007) Recruitment of volunteers to improve vitality in the elderly: the REVIVE study. Intern Med J 37:95–100CrossRefPubMedGoogle Scholar
  16. Chen CC, Lin MT, Tien YW et al (2011) Modified hospital elder life program effects on abdominal surgery patients. J Am Coll Surg 213:245–252CrossRefPubMedGoogle Scholar
  17. Clegg A, Siddiqui N, Heaven A et al (2014) Interventions for preventing delirium in older people in institutional long term care. Cochrane Database Syst Rev. (1)CD009537Google Scholar
  18. Cohen S, Klein HK (1958) The delirious patient. Am J Nursing 58:685–687Google Scholar
  19. Corsovini L, Bo M, Aimonino NR et al (2009) Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit. Arch Gerontol Geriatr 49:142–145CrossRefGoogle Scholar
  20. Counsell SR, Holder CM, Liebenauer LL et al (2000) Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients. A randomized, controlled trial of Acute Care for Elders (ACE) in a community hospital. J Am Geriatr Soc 48:1572–1581CrossRefPubMedGoogle Scholar
  21. Covinsky KE, King JT Jr, Quinn LM et al (1997) Do acute care for the elders units increase hospital costs? A cost analysis using the hospital perspective. J Am Geriatr Soc 45:729–734CrossRefPubMedGoogle Scholar
  22. De J, Wand AP (2015) Delirium screening: a systematic review of delirium screening tools in hospitalized patients. Gerontologist 55:1079–1099CrossRefPubMedGoogle Scholar
  23. Doherty-King B, Bowers B (2010) How nurses decide to ambulate hospitalized older adults: development of a conceptual model. Gerontologist 51:786–797CrossRefGoogle Scholar
  24. Flaherty JH, Tariq SH, Raghavan S et al (2003) A model for managing delirious older inpatients. J Am Geriatr Soc 51:1031–1035CrossRefPubMedGoogle Scholar
  25. Fletcher K, Hawkes P, Williams-Rosenthal S et al (2007) Using nurse practitioners to implement best practice care for the elderly during hospitalization: the NICHE journey at the University of Virginia Medical Center. Crit Care Clin North Am 19:321–337CrossRefGoogle Scholar
  26. Flood KL, MacClennan PA, McGrew D et al (2013) Effects of an acute care for elders unit on costs and 30-day readmissions. JAMA Intern Med 173:981–987CrossRefPubMedGoogle Scholar
  27. Gentric A, Le Deum P, Estivin S (2007) Prevention du syndrome confusionnel dans un service de medicine interne geriatrique. La Rev Med Interne 28:589–593CrossRefPubMedGoogle Scholar
  28. Hempenius L, Slaets JPJ, van Asselt D et al (2013) Outcomes of a geriatric iaison intervention to prevent the development of post-operative delirium in frail elderly cancer patients: report on a multicenter, randomized, controlled trial. PLoS One 8:e64834CrossRefPubMedPubMedCentralGoogle Scholar
  29. Holt R, Young J, Heseltine D (2013) Effectiveness of a multi-component intervention to reduce delirium incidence in elderly care wards. Age Ageing 42:721–727CrossRefPubMedGoogle Scholar
  30. Hshieh TT, Yue JR, Oh E et al (2015) Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Intern Med 175:512–520CrossRefPubMedPubMedCentralGoogle Scholar
  31. Inouye SK, Bogardus ST Jr, Charpentier PA et al (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676CrossRefPubMedGoogle Scholar
  32. Inouye SK, Westendorp RG, Saczynski JS (2014) Delirium in elderly people. Lancet 383:911–922CrossRefPubMedGoogle Scholar
  33. Jeffs KJ, Berlowitz DJ, Grant S et al (2013) An enhanced exercise and cognitive programme does not appear to reduce incident delirium in hospitalized patients: a randomized, controlled trial. BMJ Open 3:e002569CrossRefPubMedPubMedCentralGoogle Scholar
  34. Kratz A (2008) Use of the acute confusion protocol: a research utilization project. J Nurs Care Qual 23:331–337CrossRefPubMedGoogle Scholar
  35. Lafont C, Gerard S, Voisin T et al (2011) Reducing “iatrogenic disability” in the hospitalized frail elderly. J Nutr Health Aging 15:645–660CrossRefPubMedGoogle Scholar
  36. Lee EA, Gibbs NE, Fahey L, Whiffen TL (2013) Making hospitals safer for older adults: updating quality metrics by understanding hospital-acquired delirium and its link to falls. Perm J 17:32–36CrossRefPubMedPubMedCentralGoogle Scholar
  37. Lindquist R, Sendelbach SE (2007) Maximizing safety of hospitalized elders. Crit Care Nurs Clin North Am 19:277–284CrossRefPubMedGoogle Scholar
  38. Lundstrom M, Olofsson B, Stenvall M et al (2007) Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study. Aging Clin Exp Res 19:178–186CrossRefPubMedGoogle Scholar
  39. Malmstron TK, Miller DK, Morley JE (2014) A comparison of four frailty models. J Am Geriatr Soc 62:721–726CrossRefGoogle Scholar
  40. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM (2001) Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 49:516–522CrossRefPubMedGoogle Scholar
  41. Martinez FT, Tobar C, Beddings CI, Vallejo G (2012) Preventing delirium in an acute hospital using a non-pharmacological intervention. Age Ageing 41:629–634CrossRefPubMedGoogle Scholar
  42. Otremba I, Wilczynski K, Szewieczek J (2016) Delirium in the geriatric unit: proton-pump inhibitors and other risk factors. Clin Interv Aging 11:397–405PubMedPubMedCentralGoogle Scholar
  43. Palmer R (2003) Acute care for elders: practical considerations for optimizing health outcomes. Dis Manag Health Outcomes 11:507–517CrossRefGoogle Scholar
  44. Pitkala KH, Laurila JV, Standberg TE et al (2008) Multicomponent geriatric intervention for elderly inpatients with delirium: effects on costs and health-related quality of life. J Gerontol Med Sci 63A:56–61CrossRefGoogle Scholar
  45. Siddiqui N, Harrison JK, Clegg A et al (2007) Interventions for preventing delirium in hospitalized non-ICU patients (Review) Update of Cochrane Database of Systematic Reviews. (2)CD005563. PMID 17443600, (2016)Google Scholar
  46. SteelFisher GK, Martin LA, Dowal SL, Inouye SK (2013) Learning from the closure of clinical programs: a case series from the Hospital Elder Life Program. J Am Geriatr Soc 61:994–1004CrossRefGoogle Scholar
  47. Stenvall M, Olofsson B, Lundstrom M et al (2007) A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporos Int 18:167–175CrossRefPubMedGoogle Scholar
  48. Tay LBG, Chan MPC (2013) Functional improvement in hospitalized older adults is independent of dementia diagnosis: experience of a specialized delirium management unit. J Hosp Med 8:321–327CrossRefGoogle Scholar
  49. Teale E, Young J (2015) Multicomponent delirium prevention: not as effective as NICE suggests? Age Ageing 44:915–917CrossRefPubMedGoogle Scholar
  50. Theou O, Brothers TD, Mitnitski A, Rockwood K (2013) Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. J Am Geriatr Soc 61:1537–1551CrossRefPubMedGoogle Scholar
  51. Vidan MT, Sanches E, Alonso M et al (2009) An intervention integrated into daily clinical practice reduces the incidence of delirium during hospitalization in elderly patients. J Am Geriatr Soc 57:2029–2036CrossRefPubMedGoogle Scholar
  52. Watne LO, Torbergsen AC, Conroy S, Engedal K, Frihagen F, Hjorthaug GA, Juliebo V, Raeder J, Saltvedt I, Skovlund E, Wyller TB (2014) The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial). BMC Med 12:63CrossRefPubMedPubMedCentralGoogle Scholar
  53. Wong KS, Ryan DP, Liu BA (2014) A system-wide analysis using a senior-friendly hospital framework identifies current practices and opportunities for improvement in the care of hospitalized older adults. J Am Geriatr Soc 62:2163–2170CrossRefPubMedGoogle Scholar
  54. Young J, Murthy L, Westby M (2010) Diagnosis, prevention and management of delirium: summary of NICE guidance. BMJ 341:c3704CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Miriam B. Rodin
    • 1
  • Joseph H. Flaherty
    • 1
  1. 1.Division of Geriatric Medicine, Department of Internal MedicineSt. Louis School of MedicineSt. LouisUSA

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