Simple, non-expensive strategies prevent
delirium, improve quality of care

According to a study in the Journal of the American Geriatrics Society, researchers in Europe have developed a program that successfully prevents delirium in elders, and improves quality of care. The program is easy to implement, requires no extra staff and is no cost.

What is delirium?

Delirium is the most common life-threatening complication in elders who are in, or have been recently discharged from, the hospital.

That’s why preventing it is important, particularly if the elder belongs to one of the categories at risk.

These include patients with dementia, vision loss, dehydration, or a severe acute illness, such as worsening COPD (chronic obstructive pulmonary disease), urinary infection and heart failure.

How the program works

Now, researchers at Gregorio Marañón University General Hospital, Madrid, Spain, have developed a program that reduces the occurrence of delirium, by simply encouraging nursing staff to use – every day – the following easy-to-implement, inexpensive strategies.

• Encouraging elders to get out of bed and take short walks in the ward corridor. Even a few steps around the room will do the job, if the person feels too weak to do more.
• Ensuring they wear clean and not scratched current prescription glasses, and hearing aids in good working order.
• Giving reminders of the current date and time, and of where they are and why.
• Avoiding disrupting the person’s sleep; for example, by avoiding administering medications during the night.
• Changing position of bedbound patients every three hours.
• Removing urinary catheters that are not necessary.
• Ensuring good fluid intake (at least four glasses of water).
• Avoiding drugs known to be associated with increased risk of delirium, like sedatives, whenever possible.

Successfully reduces delirium

The program has been proven effective in a study the researchers conducted on 542 hospitalized elders aged 70 and
over at risk of delirium. Of these, 170 were enrolled in the program and 372 received usual care.

Nursing staff, who cared for elders on the program, had been informed about strategies they needed to implement during a series of educational sessions.

In addition, they could refer to posters and quick-reference cards, which also explained the various delirium prevention strategies. When the researchers compared
the number of cases of delirium occurred in the two groups over a period of 12 months, they found that elders who were on the program had a 37% lower risk of delirium than those who were not.

Improves quality of care

The program also led to significant improvements in quality of care, as shown by the fact that, during its implementation, participating elders were

• better able to carry out activities of daily living, such as bathing, dressing, toileting and eating;
• less likely to stay in bed for more than 48 hours;
• more keen to walk around the ward, and wear their glasses and/or hearing aids (importantly, this increase
in mobility was not associated with falls); and
• less likely to require the use of restraints.

Advantages

As the lead researcher, Dr. Maria Vidán, points out: “Other programs have proven effective at reducing the incidence of delirium, but the complexity
of the interventions was lower in this program.” What’s more, “the usual team can implement this protocol as part of the routine practice, without the need for extra
staff” or resources. The study was published online, September 15, 2009, in the Early View section of the journal.