G A Caplan1, E L Harper. 1. Geriatric Medicine, Prince of Wales Hospital, Sydney, NSW, Australia.
Abstract
BACKGROUND: Delirium is a common problem for frail, older patients in hospital and a marker of poor outcome and mortality. The aim of this study was to test a volunteer-mediated delirium prevention programme for efficacy, cost-effectiveness and sustainability on an Australian geriatric ward. METHODS: Two controlled before-and-after studies were conducted. In study 1, 37 patients (>70 years, admitted to the geriatric wards) were enrolled during 5 months in 2003 for intensive individual study. Twenty-one patients received usual care and 16 patients received the volunteer-mediated intervention of daily orientation, therapeutic activities, feeding and hydration assistance, vision and hearing protocols. In study 2, we examined the effects of a general implementation for the whole department by measuring use of assistants in nursing, who were employed for individual nursing of delirious patients. RESULTS: In study 1, we found a lower incidence (intervention vs control, 6.3% vs 38%; P = 0.032) and lower severity of delirium (1.2 vs 5.1; P = 0.045). There was a trend towards decreased duration of delirium (5.0 vs 12.5; P = 0.64). In study 2, use of assistants in nursing was reduced by 314 h per month suggesting a total annual saving of 129,186 Australian dollars for the hospital. CONCLUSION: The programme prevents delirium and improves outcomes for elderly inpatients. Cost-effectiveness supports the continuation of the programme and extension to other geriatric units.
RCT Entities:
BACKGROUND:Delirium is a common problem for frail, older patients in hospital and a marker of poor outcome and mortality. The aim of this study was to test a volunteer-mediated delirium prevention programme for efficacy, cost-effectiveness and sustainability on an Australian geriatric ward. METHODS: Two controlled before-and-after studies were conducted. In study 1, 37 patients (>70 years, admitted to the geriatric wards) were enrolled during 5 months in 2003 for intensive individual study. Twenty-one patients received usual care and 16 patients received the volunteer-mediated intervention of daily orientation, therapeutic activities, feeding and hydration assistance, vision and hearing protocols. In study 2, we examined the effects of a general implementation for the whole department by measuring use of assistants in nursing, who were employed for individual nursing of delirious patients. RESULTS: In study 1, we found a lower incidence (intervention vs control, 6.3% vs 38%; P = 0.032) and lower severity of delirium (1.2 vs 5.1; P = 0.045). There was a trend towards decreased duration of delirium (5.0 vs 12.5; P = 0.64). In study 2, use of assistants in nursing was reduced by 314 h per month suggesting a total annual saving of 129,186 Australian dollars for the hospital. CONCLUSION: The programme prevents delirium and improves outcomes for elderly inpatients. Cost-effectiveness supports the continuation of the programme and extension to other geriatric units.
Authors: Tammy T Hshieh; Jirong Yue; Esther Oh; Margaret Puelle; Sarah Dowal; Thomas Travison; Sharon K Inouye Journal: JAMA Intern Med Date: 2015-04 Impact factor: 21.873
Authors: Tammy T Hshieh; Tinghan Yang; Sarah L Gartaganis; Jirong Yue; Sharon K Inouye Journal: Am J Geriatr Psychiatry Date: 2018-06-26 Impact factor: 4.105