Effects of a Dementia-friendly Program on Detection and Management of Patients With Cognitive Impairment and Delirium in Acute-care Hospital Units: a Non-equivalent Control Group Design
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Delirium
- Sponsor
- University Hospital, Akershus
- Enrollment
- 423
- Locations
- 1
- Primary Endpoint
- Detection of patients with cognitive impairment
- Status
- Completed
- Last Updated
- 5 years ago
Overview
Brief Summary
Frail older persons with cognitive impairment are at special risk of experiencing delirium during acute hospitalisation. The purpose of this study was to investigate whether a dementia-friendly hospital program contributes to improved detection and management of patients with cognitive impairment and delirium.
Detailed Description
Study design This study, has a non-equivalent control group design and a historical control Group. The Control group received usual care and the experimental group received usual care plus the dementia-friendly program. One Group received care after implementing the dementia-friendly hospital program. The study is performed at two medical wards at a large acute-care hospital in Norway. A medical pulmonary ward and a cardiac ward participated. Data Collection: Demographic data included age, gender, place of residence (home, adapted housing, institution), and family/relative network, and were obtained upon admission to the study. Medical data included cause of admission, active medical diagnoses, medications and medical treatment, and were obtained both at admission and from their electronic medical records after discharge. Cognitive Impairment and delirium were assessed with two different screening tools: the Four Assessment Test (4AT) and the Confusion Assessment Method (CAM). For all patients with a positive 4AT (≥1) or identified cognitive impairment during their hospital stays, a thorough review of the patient's journal was conducted upon discharge to record if, in case of yes, which type of preventive or treatment measures according to the dementia-friendly program, the patients had received during their stays.
Investigators
Nina Mickelson Weldingh
Prinsipal Investigator
University Hospital, Akershus
Eligibility Criteria
Inclusion Criteria
- •Patients ≥75 years
- •acute admission to the cardiac or pulmonary wards.
- •Patient who has given informed written consent, or proxy consent from relatives for patients who lacked cognitive capacity.
Exclusion Criteria
- •Readmitted patients enrolled in a previous hospital stay.
- •Patients who do not have sufficient verbal function or hearing to communicate
- •Patients in a coma or too ill to participate
- •Patients who are isolated
- •Patients who do not wish to participate or relatives who do not want the patient to participate, in the cases where the patient lacked cognitive capacity to consent.
Outcomes
Primary Outcomes
Detection of patients with cognitive impairment
Time Frame: During the stay at the participating wards, assessed from the electronical medical record within 6 months after discharge
Proportion of patients identified with cognitive impairment during the hospital stay, documented in the electronic Medical record. Difference between the control group and the intervention group. Patients were assessed with The Four Assessment Test at admission and during the stay at the participating wards. Furthermore, documentation of cognitive impairment in the electronic medical journal during the stay were assessed after discharge.
Management of patients with cognitive impairment and delirium
Time Frame: During the stay at the participating wards, assessed from the electronical medical record within 6 months after discharge
Proportion of patients identified with cognitive impairment, delirium or at risk of delirium who has documented interventions to prevent and/or treat delirium, according to the implemented dementia-friendly program.Differences between the control group and the intervention group.
Secondary Outcomes
- Delirium(Assessed from the electronical medical record, within 6 month after discharge)
- Use of medications not recommended for the patient group(During the stay at the participating wards, assessed from the electronical medical record within 6 months after discharge)
- Length of hospital stay(Assessed from the electronical medical record, within 6 month after discharge)
- 30-day mortality(Mortality were assessed from the electronical medical record 30 days after discharge.)
- Screening within 24 hours(Within 24 hours after admission to the ward)
- 30-day readmission to the hospital(Readmissions to the hospital were assessed from the electronical medical record 30 days after discharge.)
- Use of antipsychotics, hypnotics and sedatives(During the stay at the participating wards, assessed from the electronical medical record within 6 months after discharge)
- Departure to rehabilitation or nursing home(Assessed from the electronical medical record, within 6 month after discharge)