Can a Coordinated Intervention Program Prevent Delirium in Older Hospital Patients?

An upcoming study will look at an experimental delirium prevention care system to see if it can be effective in either preventing or ameliorating delirium in older patients in a hospital setting, a report in Trials explains.

Delirium is the most frequent complication among older patients following hospitalization. The study authors developed a novel Prevention of Delirium Programme (POD), a multicomponent delirium prevention intervention and implementation process, that has shown effectiveness in an early pilot study.

According to the authors, “there is much evidence that delirium represents a largely unrecognized condition affecting older people within health care services internationally. It is also now recognized that health care systems and services frequently have attributes that unintentionally stimulate or aggravate delirium in older people… Perhaps the most important aspect of delirium is that multicomponent non-pharmacological interventions can significantly reduce delirium incidence.”

This is a particularly vulnerable group that is often overlooked and has complex care needs. Untreated delirium can lead to later neuropsychiatric symptoms, increased mortality rates, functional decline, falls, and increased requirement for institutional care. The authors noted that researchers have primarily examined outcomes in a research context and, with few exceptions, have not addressed how to achieve sustainability in routine care.

The program was developed with a team-based approach that included clinicians, nurse consultants, specialist nurses, therapists, and patient care representatives, among others to review an evidence-based, multicomponent delirium prevention system of care (HELP) previously developed in the United States. This was augmented by up-to-date evidence for delirium prevention from the United Kingdom’s National Institute for Health and Care Excellence (NICE). The researchers then produced the POD system of care and tested it in an implementation pilot in five wards in four NHS hospitals. This third arm of the study will explore preliminary estimates of effectiveness and cost-effectiveness of the modified version of the POD system of care in older patients at risk of developing delirium.

Sixteen elderly care medicine and orthopedic/trauma wards in eight National Health Service acute hospitals will be randomized to receive the POD or usual care. The recruitment of 720 patients was completed in February 2015 and the last follow-up took place this past June. Analysis is underway and the results will be available later this year.