Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students), Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study

Abstract

Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards). Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1 : 1 ratio, regarding age, gender, and time of hospitalization), received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males) participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward.

The effect of volunteers’ care and support on the health outcomes of older adults in acute care: A systematic scoping review

“…Donoghue et al () and Giles et al () specified their studies were conducted in aged care wards. There was a variety of participant inclusion criteria across the studies, including participants needing assistance with feeding (Manning et al, ; Roberts et al, ; Robinson et al, ; Walton et al, ), risk of a diagnosis of dementia or delirium (Bateman et al, ; Caplan & Harper, ; Wong et al, ), risk of falls (Donoghue et al, ; Giles et al, ), risk of malnutrition (Huang, Dutkowski, Fuller, & Walton, ), dysphagia (Wright et al, ) and admission for acute conditions (Gorski et al, ).…”

“…The number of volunteers involved in each of the interventions or exposures ranged from 3–128, with three studies providing no information on the number of volunteers (Caplan & Harper, ; Manning et al, ; Wong et al, ). Eight studies provided no information on the type of volunteers used, while the remaining four studies’ volunteers included previous health professionals (Bateman et al, ), student health professionals (Gorski et al, ; Wright et al, ) and college students (Robinson et al, ). The majority of studies reported volunteers were present during weekdays only.…”

“…One study in this review reported a nonsignificant but clinically meaningful trend towards a reduction in falls, despite the lack of a specific mobilisation strategy, and the authors suggested that preventing delirium played a role in fall reduction (Caplan & Harper, ). In contrast, two other studies reported that volunteers accompanied patients during mobilisation and encouraged them in walking (Bateman et al, ; Gorski et al, ). However, in these two studies, there were no significant differences observed in the reduction of falls.…”

“…The incidence of delirium was found to be lower in the intervention group in the first study. The latter study, however, used four surrogate markers for delirium in lieu of standardised delirium assessment tools: length of stay, need for antipsychotic drugs, falls and in‐hospital deaths, and found antipsychotic medications were administered less frequently in the intervention group (Gorski et al, ). While these results indicate a positive association between volunteer assistance and reduced delirium, further studies are required using validated cognitive assessment tools, as employed by Caplan and Harper ().…”

“…Medication use was also identified as a clinical outcome of volunteer programmes for older adult patients. The multicomponent interventions delivered by volunteers in two studies were determined to contribute to modifications in the use of antipsychotics and analgesics in patients (Bateman et al, ; Gorski et al, ). The recognition by volunteers of patients with symptoms that may indicate pain could have contributed to the increased analgesic use.…”