Nursing Assistant Intervention to Prevent Delirium in Nursing Homes
| Status: | Completed |
|---|---|
| Conditions: | Neurology, Psychiatric |
| Therapuetic Areas: | Neurology, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/1/2019 |
| Start Date: | November 2016 |
| End Date: | August 28, 2018 |
Multicomponent Intervention to Prevent Delirium in Nursing Homes
Delirium is an acute confusion that occurs in one third of hospitalized older adults. As
compared to those without delirium, hospitalized patients with delirium have longer hospital
stays, higher mortality, and increased risk of nursing home utilization. Substantial
attention has been paid to developing, testing, and disseminating interventions to prevent
delirium in the hospital but, to date, not in the nursing home setting. In a previous study
we used known information on delirium risk factors to develop an intervention that can be
delivered at onset of acute illness in nursing home patients. The current study is designed
to test the effect of this intervention in a single-site clinical trial. Objectives: 1) to
determine, as compared to control, the effect of a multicomponent intervention targeting
delirium risk factors on delirium frequency, delirium severity, cognitive and physical
function decline, and hospitalization in nursing home patients with acute illness, and 2) to
identify features of the intervention associated with occurrence of delirium and other
outcomes. Approach: We will screen nursing home patients on 17 long-term care units at a
large, urban nursing home who experience onset of a change in condition according to
established criteria, and enroll and assign them to intervention or control in a 1:1 ratio.
Those assigned to intervention will receive daily visits from an Elder Life Specialist, a
mobile Certified Nursing Assistant trained to provide services to counter risks for delirium,
including dehydration, immobility, cognitive impairment, undernutrition, and sleep problems,
for the duration of the acute illness and for 1 week following. Patients assigned to control
will receive usual care from the unit-based nurses and the patient's primary team. Delirium
will be assessed 5 days a week by a research assistant. Cognitive and physical function
decline and hospital transfer will be ascertained during a 1 month follow-up period. We will
compare outcomes between intervention and control, as well as examine associations between
outcomes and intervention features such as number and duration of visits.
compared to those without delirium, hospitalized patients with delirium have longer hospital
stays, higher mortality, and increased risk of nursing home utilization. Substantial
attention has been paid to developing, testing, and disseminating interventions to prevent
delirium in the hospital but, to date, not in the nursing home setting. In a previous study
we used known information on delirium risk factors to develop an intervention that can be
delivered at onset of acute illness in nursing home patients. The current study is designed
to test the effect of this intervention in a single-site clinical trial. Objectives: 1) to
determine, as compared to control, the effect of a multicomponent intervention targeting
delirium risk factors on delirium frequency, delirium severity, cognitive and physical
function decline, and hospitalization in nursing home patients with acute illness, and 2) to
identify features of the intervention associated with occurrence of delirium and other
outcomes. Approach: We will screen nursing home patients on 17 long-term care units at a
large, urban nursing home who experience onset of a change in condition according to
established criteria, and enroll and assign them to intervention or control in a 1:1 ratio.
Those assigned to intervention will receive daily visits from an Elder Life Specialist, a
mobile Certified Nursing Assistant trained to provide services to counter risks for delirium,
including dehydration, immobility, cognitive impairment, undernutrition, and sleep problems,
for the duration of the acute illness and for 1 week following. Patients assigned to control
will receive usual care from the unit-based nurses and the patient's primary team. Delirium
will be assessed 5 days a week by a research assistant. Cognitive and physical function
decline and hospital transfer will be ascertained during a 1 month follow-up period. We will
compare outcomes between intervention and control, as well as examine associations between
outcomes and intervention features such as number and duration of visits.
Delirium is an acute cognitive disorder with features of inattention, disorganized thinking,
and disordered consciousness that occurs in one third of hospitalized older adults. As
compared to those without delirium, hospitalized patients with delirium have longer hospital
stays, higher mortality, and increased risk of nursing home utilization. Substantial
attention has been paid to developing, testing, and disseminating interventions to prevent
delirium in the hospital but, to date, not in the nursing home setting. In a previous study
we used known information on delirium risk factors to develop a multicomponent intervention
that can be delivered at onset of acute illness in nursing home patients. We demonstrated the
intervention's feasibility, adherence, and acceptance by patients and staff. The current
study is designed to test the efficacy of this intervention in a single-site
cluster-randomized trial. Objectives: 1) to determine, as compared to control, the effect of
a multicomponent intervention targeting delirium risk factors (immobility, cognitive
impairment, dehydration, undernutrition, sleep, and medication use) on the primary outcome of
delirium frequency in nursing home patients with acute illness, and the secondary outcomes of
delirium severity, cognitive and physical function decline, and hospitalization associated
with acute illness, and 2) to identify features of the intervention, including "dose" and
components, associated with occurrence of delirium and its severity, cognitive and physical
function decline, and hospitalization associated with acute illness. Approach: We will screen
nursing home patients on 17 long-term care units at a large, urban nursing home who
experience onset of an acute change in condition according to established criteria, and
enroll and assign them to intervention or control in a 1:1 ratio. Those assigned to
intervention will receive daily visits from an Elder Life Specialist, a mobile Certified
Nursing Assistant trained to provide services to counter risks for delirium, including
dehydration, immobility, cognitive impairment, undernutrition, and sleep problems, for the
duration of the acute illness and for 1 week following, in collaboration with the patient's
primary medical and nursing team. Patients assigned to control will receive usual care from
the unit-based nurses and the patient's primary team. Delirium will be assessed 5 days a week
by a research assistant blinded to study hypotheses and group assignment. Cognitive and
physical function decline and hospital transfer will be ascertained during a 1 month
follow-up period. We will conduct analyses to compare outcomes between intervention and
control, as well as examine associations between outcomes and intervention features such as
number and duration of visits.
and disordered consciousness that occurs in one third of hospitalized older adults. As
compared to those without delirium, hospitalized patients with delirium have longer hospital
stays, higher mortality, and increased risk of nursing home utilization. Substantial
attention has been paid to developing, testing, and disseminating interventions to prevent
delirium in the hospital but, to date, not in the nursing home setting. In a previous study
we used known information on delirium risk factors to develop a multicomponent intervention
that can be delivered at onset of acute illness in nursing home patients. We demonstrated the
intervention's feasibility, adherence, and acceptance by patients and staff. The current
study is designed to test the efficacy of this intervention in a single-site
cluster-randomized trial. Objectives: 1) to determine, as compared to control, the effect of
a multicomponent intervention targeting delirium risk factors (immobility, cognitive
impairment, dehydration, undernutrition, sleep, and medication use) on the primary outcome of
delirium frequency in nursing home patients with acute illness, and the secondary outcomes of
delirium severity, cognitive and physical function decline, and hospitalization associated
with acute illness, and 2) to identify features of the intervention, including "dose" and
components, associated with occurrence of delirium and its severity, cognitive and physical
function decline, and hospitalization associated with acute illness. Approach: We will screen
nursing home patients on 17 long-term care units at a large, urban nursing home who
experience onset of an acute change in condition according to established criteria, and
enroll and assign them to intervention or control in a 1:1 ratio. Those assigned to
intervention will receive daily visits from an Elder Life Specialist, a mobile Certified
Nursing Assistant trained to provide services to counter risks for delirium, including
dehydration, immobility, cognitive impairment, undernutrition, and sleep problems, for the
duration of the acute illness and for 1 week following, in collaboration with the patient's
primary medical and nursing team. Patients assigned to control will receive usual care from
the unit-based nurses and the patient's primary team. Delirium will be assessed 5 days a week
by a research assistant blinded to study hypotheses and group assignment. Cognitive and
physical function decline and hospital transfer will be ascertained during a 1 month
follow-up period. We will conduct analyses to compare outcomes between intervention and
control, as well as examine associations between outcomes and intervention features such as
number and duration of visits.
Inclusion Criteria
- Long-term care nursing home resident at The New Jewish Home
- Acute change in condition or just returned from the hospital
- Assent to participate in study
Exclusion Criteria
- Discharge or death expected before 2 months
- Nonverbal or unable to follow simple commands
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