A Nurse-Led Interdisciplinary Intervention Program for Delirium in Elderly Hip-Fracture Patients

Authors: Milisen, Koen¹; Foreman, Marquis D.²; Abraham, Ivo L.³; De Geest, Sabina⁴; Godderis, Jan⁵; Vandermeulen, Erik⁶; Fischler, Benjamin⁷; Delooz, Herman H.⁸; Spiessens, Bart⁹; Broos, Paul L. O.¹⁰

Source: Journal of the American Geriatrics Society, Volume 49, Number 5, MAY 2001 , pp. 523-532(10)

Publisher: Wiley-Blackwell

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Abstract:

J Am Geriatr Soc 49:523-532, 2001. OBJECTIVES:

To develop and test the effect of a nurse-led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip-fracture patients. DESIGN:

Longitudinal prospective before/after design (sequential design). SETTING:

The emergency room and two traumatological units of an academic medical center located in an urban area in Belgium. PARTICIPANTS:

60 patients in an intervention cohort (81.7% females, median age = 82, interquartile range (IQR) = 13) and another 60 patients in a usual care/nonintervention cohort (80% females, median age = 80, IQR = 12). INTERVENTION:

(1) Education of nursing staff, (2) systematic cognitive screening, (3) consultative services by a delirium resource nurse, a geriatric nurse specialist, or a psychogeriatrician, and (4) use of a scheduled pain protocol. MEASUREMENTS:

All patients were monitored for signs of delirium, as measured by the Confusion Assessment Method (CAM). Severity of delirium was assessed using a variant of the CAM. Cognitive and functional status were measured by the Mini-Mental State Examination (MMSE) (including subscales of memory, linguistic ability, concentration, and psychomotor executive skills) and the Katz Index of activities of daily living (ADLs), respectively. RESULTS:

Although there was no significant effect on the incidence of delirium (23.3% in the control vs 20.0% in the intervention cohort; P = .82), duration of delirium was shorter (P = .03) and severity of delirium was less (P = .0049) in the intervention cohort. Further, clinically higher cognitive functioning was observed for the delirious patients in the intervention cohort compared with the nonintervention cohort. Additionally, a trend toward decreased length of stay postoperatively was noted for the delirious patients in the intervention cohort. Despite these positive intervention effects, no effect on ADL rehabilitation was found. Results for risk of mortality were inconclusive. CONCLUSIONS:

This study demonstrated the beneficial effects of an intervention program focusing on early recognition and treatment of delirium in older hip-fracture patients and confirms the reversibility of the syndrome in view of the delirium's duration and severity.

Keywords: delirium; intervention; older; hip fracture

Document Type: Research article

DOI: http://dx.doi.org/10.1046/j.1532-5415.2001.49109.x

Affiliations: 1: Center for Health Services and Nursing Research, Katholieke Universiteit Leuven and Department of Geriatrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium; 2: Department of Medical-Surgical Nursing, College of Nursing, University of Illinois at Chicago, Chicago, Illinois; 3: The Epsilon Group and University of Virginia, Charlottesville, Virginia and New York University, New York, New York; 4: Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium, and Institute of Nursing Science, University of Basel, Switzerland; 5: Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; 6: Department of Anesthesiology, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium; 7: Department of Psychiatry, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium; 8: Department of Emergency Medicine, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium; 9: Biostatistical Centre, Katholieke Universiteit Leuven, Leuven, Belgium; and 10: Department of Surgery, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium.

Publication date: 2001-05-01

A Nurse-Led Interdisciplinary Intervention Program for Delirium in Elderly Hip-Fracture Patients

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