Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long‐Term Care Delivered by Certified Nursing Assistants

Abstract

Nursing home (NH) patients have a high prevalence of delirium risk factors, experience 2-4 acute medical conditions (e.g., infections) each year, and have an incidence of delirium during these conditions that is similar to that of hospitalized older adults. Many NH patients with delirium do not return to their prior level of cognitive function. As compared to those without delirium, they are more likely to die, be hospitalized, and less likely to be discharged home. Research on the prevention or treatment of delirium in the NH remains limited. This article describes the development and pilot-testing of a multicomponent delirium prevention intervention in the NH setting adapted from the Hospital Elder Life Program (“HELP-LTC”). We developed delirium-risk reducing activities appropriate for functionally-impaired NH patients that were delivered during treatment for and recovery from acute illness, a novel patient targeting approach. Activities were provided by an expertly trained certified nursing assistant (CNA) who visited patients throughout the facility. We report on incident delirium, delirium remission, cognitive and physical function change, hospitalization, and death associated with acute medical conditions as ascertained by a program coordinator. We also report on the integration and acceptance of the CNAs’ activities by patients and staff. Hospitalization and death were ascertained in a non-intervention comparison group. Findings support a test of the intervention in a controlled trial. The potential impact is great: there are approximately 1.4 million NH patients in the U.S. and an estimated 1 million with dementia or cognitive impairment, a key delirium risk factor. An intervention would be broadly adoptable if the cost of the program’s CNAs were offset by a reduction in health care costs through prevention of hospitalization.

Delirium in Older Persons

“…However, further testing of the intervention will be needed in a clinical trial. 89 A recent clinical trial using daily therapeutic activities such as reminiscence activities for cognitive stimulation in the postacute care setting for delirium superimposed on dementia found no benefit on delirium duration or severity but did demonstrate significantly improved executive function and decreased length of stay. 90 Other studies have focused on specialized delirium rooms or improving sleep to treat delirium with use of earplugs, bright light therapy, and sleep protocols – but with varying and limited results.…”

Wie können postoperativ ein Delir und eine neurokognitive Störung verhindert werden?

“…Zu diesen summieren sich präzipitierende Faktoren, also Faktoren, die durch den aktuellen Krankheitsverlauf und dessen Behandlung entstehen (diagnostische Maßnahmen, Operationen, zusätzliche Medikamente, Bluttransfusionen, Sedierung, Behandlung von Infektionen, Nahrungs-und Flüssigkeitskarenz vor bzw. nach diagnostischen oder operativen Eingriffen) [8,9,12,13]. Ist in der Gesamtschau der prädisponierenden und präzipitierenden Faktoren eine individuelle Risikoschwelle überschritten, kommt es zur Ausbildung von PND.…”

Abordaje de los sintomas neurológicosdesde la perspectiva de los cuidados paliativos

“…Acompañada de terapias complementarias para reducir la ansiedad y la percepción del dolor, se considera necesario inducir la relajación y promover la comodidad y el bienestar en vista de que la agitación puede ser incluso una manifestación del delirio terminal 35 . En este sentido, autores como Boockvar, et al 51 , mencionan el uso de terapias táctiles, a través del toque estructurado, como el uso de las energías del cuerpo para sanar usando las manos aunque estas no necesariamente hagan contacto físico con el paciente. Este tipo de técnicas puede aplicarse en cualquier entorno y es particularmente útil para pacientes al final de la vida.…”