A Model for Managing Delirious Older Inpatients

Abstract

Although multiple models of care exist to prevent the development of delirium in hospitalized patients, models for the management of patients for whom delirium is unpreventable or who already have delirium on admission to the hospital are needed. This article describes the development, management, and economics of a new model of care for patients with delirium, called the Delirium Room (DR). The DR is a specialized 4-bed unit that provides 24-hour intensive nursing care and is completely free of physical restraints. Another important feature of the 4-bed DR is that it is an integral part of a 22-bed acute care for the elderly (ACE) unit. As such, patients in the DR benefit from features of the ACE unit: a change in the physical environment of the medical floor to promote mobility and function and discourage bedrest, comprehensive geriatric care that identifies and addresses problems that can lead to a decline in function, and use of a daily multidisciplinary team meeting. This article also presents descriptive data on a group of delirious patients managed in the DR with the intention of giving baseline data for other ACE units that are considering opening a DR or for future prospective studies in this area.

Educating staff working in long-term care about delirium: The Trojan horse for improving quality of care?

“…We also examined key documents, existing guidelines and training packages [39][40][41], and various models of relevance to the organisation and delivery of delirium care [42][43][44]. As the strongest evidence is for delirium prevention through addressing common risk factors [32][33][34], this was chosen as the focus of the intervention.…”

Cultivating Responsive Systems for the Care of Acutely and Critically Ill Older Adults

“…Delirium may be dynamic and rapidly varying throughout the course of hospitalization, with subtle presentations that may be misdiagnosed. Reported rates of delirium among hospitalized older adults range from 12% to as high as 60% [18]. Acute delirium is associated with poor functional recovery [19] and when unrecognized or misdiagnosed, the effect on function can be profound [20].…”

“…Acute delirium is associated with poor functional recovery [19] and when unrecognized or misdiagnosed, the effect on function can be profound [20]. Multiple studies have found delirium associated with higher mortality [18] as well as poorer functional status and mobility decline [19].…”

Geriatrics in the 21st century

“…Geriatricians will play a key role in enhancing care for older persons with hip fractures (37)(38)(39)(40), trauma (41,42), delirium, utilizing Delirium Intensive Care Units and other techniques (43)(44)(45)(46), and stroke patients (47,48). Working with dietitians they will have a specific role on preventing and treating undernutrition and cachexia in the hospital setting (49)(50)(51)(52)(53).…”