Ann Kolanowski1, Donna Fick1, Mark Litaker2, Paula Mulhall3, Linda Clare4, Nikki Hill1, Jacqueline Mogle1, Malaz Boustani5, David Gill6,7, Andrea Yevchak-Sillner1. 1. College of Nursing, Pennsylvania State University, University Park, Pennsylvania. 2. School of Dentistry, University of Alabama, Birmingham, Alabama. 3. Prevention Research Center, College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania. 4. Centre for Research in Ageing and Cognitive Health, Washington Singer Laboratories, Exeter, United Kingdom. 5. School of Medicine and Aging Brain Center, Indiana University, Indianapolis, Indiana. 6. Rochester Regional Health, University of Rochester, Rochester, New York. 7. Department of Neurology, University of Rochester, Rochester, New York.
Abstract
OBJECTIVE: To determine whether cognitively stimulating activities would reduce duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care. DESIGN: Single-blind randomized clinical trial. SETTING:Eight post-acute care (PAC) facilities. PARTICIPANTS: Community-dwelling older adults with dementia and delirium (N = 283). INTERVENTION: Research staff provided cognitively stimulating activities daily for up to 30 days. MEASUREMENTS: Primary outcomes were delirium duration (Confusion Assessment Method) and delirium severity (Delirium Rating Scale). Secondary outcomes were cognitive function (Digits Forward, Montreal Cognitive Assessment, CLOX) and physical function (Barthel Index). RESULTS: Mean percentage of delirium-free days (intervention: 64.8%, 95% confidence interval (CI) = 59.6-70.1; control: 68.7%, 95% CI = 63.9-73.6; P = .37, Wilcoxon rank sum test) and delirium severity (range 0-39: intervention: 10.77, 95% CI = 10.10-11.45; control: 11.15, 95% CI = 10.50-11.80; difference 0.37, 95% CI = 0.56-1.31, P = .43) were similar in both groups. Significant differences for secondary outcomes favoring intervention were found (executive function (range 0-15): intervention: 6.58, 95% CI = 6.12-7.04; control: 5.89, 95% CI = 5.45-6.33; difference -0.69, 95% CI = 1.33 to -0.06, P = .03; constructional praxis (range 0-15): intervention: 8.84, 95% CI = 8.83-9.34; control: 7.53, 95% CI = 7.04-8.01; difference -1.31, 95% CI = 2.01 to -0.61, P < .001). After adjusting for baseline constructional praxis, the group comparison was no longer significant. Average length of stay was shorter in the intervention (36.09 days) than the control (53.13 days) group (standard error = 0.15, P = .01, negative binomial regression). CONCLUSION:Cognitively stimulating activities did not improve delirium but improved executive function and reduced length of stay. Resolution of delirium may require more-intense nonpharmacological management when the individual has dementia.
RCT Entities:
OBJECTIVE: To determine whether cognitively stimulating activities would reduce duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care. DESIGN: Single-blind randomized clinical trial. SETTING: Eight post-acute care (PAC) facilities. PARTICIPANTS: Community-dwelling older adults with dementia and delirium (N = 283). INTERVENTION: Research staff provided cognitively stimulating activities daily for up to 30 days. MEASUREMENTS: Primary outcomes were delirium duration (Confusion Assessment Method) and delirium severity (Delirium Rating Scale). Secondary outcomes were cognitive function (Digits Forward, Montreal Cognitive Assessment, CLOX) and physical function (Barthel Index). RESULTS: Mean percentage of delirium-free days (intervention: 64.8%, 95% confidence interval (CI) = 59.6-70.1; control: 68.7%, 95% CI = 63.9-73.6; P = .37, Wilcoxon rank sum test) and delirium severity (range 0-39: intervention: 10.77, 95% CI = 10.10-11.45; control: 11.15, 95% CI = 10.50-11.80; difference 0.37, 95% CI = 0.56-1.31, P = .43) were similar in both groups. Significant differences for secondary outcomes favoring intervention were found (executive function (range 0-15): intervention: 6.58, 95% CI = 6.12-7.04; control: 5.89, 95% CI = 5.45-6.33; difference -0.69, 95% CI = 1.33 to -0.06, P = .03; constructional praxis (range 0-15): intervention: 8.84, 95% CI = 8.83-9.34; control: 7.53, 95% CI = 7.04-8.01; difference -1.31, 95% CI = 2.01 to -0.61, P < .001). After adjusting for baseline constructional praxis, the group comparison was no longer significant. Average length of stay was shorter in the intervention (36.09 days) than the control (53.13 days) group (standard error = 0.15, P = .01, negative binomial regression). CONCLUSION: Cognitively stimulating activities did not improve delirium but improved executive function and reduced length of stay. Resolution of delirium may require more-intense nonpharmacological management when the individual has dementia.
Authors: Martin G Cole; Robert Bailey; Michael Bonnycastle; Jane McCusker; Shek Fung; Antonio Ciampi; Eric Belzile; Chun Bai Journal: J Am Geriatr Soc Date: 2015-10-30 Impact factor: 5.562
Authors: James C Jackson; E Wesley Ely; Miriam C Morey; Venice M Anderson; Laural B Denne; Jennifer Clune; Carol S Siebert; Kristin R Archer; Renee Torres; David Janz; Elena Schiro; Julie Jones; Ayumi K Shintani; Brian Levine; Brenda T Pun; Jennifer Thompson; Nathan E Brummel; Helen Hoenig Journal: Crit Care Med Date: 2012-04 Impact factor: 7.598
Authors: Iosief Abraha; Fabiana Trotta; Joseph M Rimland; Alfonso Cruz-Jentoft; Isabel Lozano-Montoya; Roy L Soiza; Valentina Pierini; Paolo Dessì Fulgheri; Fabrizia Lattanzio; Denis O'Mahony; Antonio Cherubini Journal: PLoS One Date: 2015-06-10 Impact factor: 3.240
Authors: A Morandi; D Davis; J K Taylor; G Bellelli; B Olofsson; S Kreisel; A Teodorczuk; B Kamholz; W Hasemann; J Young; M Agar; S E de Rooij; D Meagher; M Trabucchi; A M MacLullich Journal: Int Psychogeriatr Date: 2013-08-20 Impact factor: 3.878
Authors: Rosa R Baier; Eric Jutkowitz; Susan L Mitchell; Ellen McCreedy; Vincent Mor Journal: BMC Med Res Methodol Date: 2019-07-18 Impact factor: 4.615
Authors: Dan Liu; Guirong Cheng; Lina An; Xuguang Gan; Yulian Wu; Bo Zhang; Sheng Hu; Yan Zeng; Liang Wu Journal: Int J Environ Res Public Health Date: 2019-10-31 Impact factor: 3.390
Authors: Gill Livingston; Jonathan Huntley; Andrew Sommerlad; David Ames; Clive Ballard; Sube Banerjee; Carol Brayne; Alistair Burns; Jiska Cohen-Mansfield; Claudia Cooper; Sergi G Costafreda; Amit Dias; Nick Fox; Laura N Gitlin; Robert Howard; Helen C Kales; Mika Kivimäki; Eric B Larson; Adesola Ogunniyi; Vasiliki Orgeta; Karen Ritchie; Kenneth Rockwood; Elizabeth L Sampson; Quincy Samus; Lon S Schneider; Geir Selbæk; Linda Teri; Naaheed Mukadam Journal: Lancet Date: 2020-07-30 Impact factor: 79.321