“You’ve got to keep moving, keep going”: Understanding older patients’ experiences and perceptions of delirium and nonpharmacological delirium prevention strategies in the acute hospital setting

Abstract

Aims and objectives To explore older inpatients’ experiences and perceptions of delirium and nonpharmacological delirium prevention strategies (NDPS). Background Delirium is a distressing and serious complication in hospitalised older adults. NDPS (supporting nutrition, mobility and cognitive participation) have strong supporting evidence. Few studies have explored older inpatients’ perspectives of these strategies. This information may assist staff to better support patient participation in NDPS. Design Qualitative study using an interpretive descriptive (ID) methodological approach to explore older patient's experience of delirium and NDPS. Methods Structured interviews of inpatients aged over 65 years across 6 medical and surgical wards explored patients’ experiences and perceptions of delirium and prevention activities related to nutrition, mobility and cognition; and barriers and enablers to participation. Reporting used COREQ. Results Twenty‐three participants were included (12 male, 11 reported delirium experience). Participants reported a range of physiological, emotional and psychological responses to delirium, hearing about delirium was different to experiencing it. Most participants were aware of the benefits of maintaining nutrition and hydration, physical activity and cognitive engagement in hospital. Barriers included poor symptom control, inflexible routines and inconsistent communication, whilst enablers included access to equipment, family involvement, staff encouragement and individual goals. These were organised into themes: outlook, feeling well enough, hospital environment, feeling informed and listened to, and support networks. Conclusion A more patient‐centred approach to delirium prevention requires consideration of older people's values, needs, preferences and fit within the hospital environment and routines. Feeling informed, listened to and receiving support from staff and family carers can improve older inpatients’ engagement in NPDS to prevent delirium in hospital. Relevance to clinical practice Nurses are ideally placed to improve patient participation in NDPS through holistic assessment and care, addressing symptoms, providing clear information about delirium and delirium prevention, and facilitating family carer support and patient interactions.

Drug-Induced Delirium among Older People

“…The clinical manifestations of delirium and the factors associated with this condition can be confused with elements characteristic of aging, as well as being recognized as only cases of dementia or depression [24,25]. The assessment of delirium superimposed on pre-existing dementia must be part of the differential diagnosis, as it happens in 90% of the cases with hospitalized older people [26]. In addition, hyperactive presentations of delirium can be misdiagnosed as hypomanic episodes [24,25].…”

“…In addition, hyperactive presentations of delirium can be misdiagnosed as hypomanic episodes [24,25]. Estimates indicate that the recognition of delirium in the usual care only happens in 12-35% of the occurrences [26].…”

“…To improve this scenario, there are support strategies and tools for the delirium evaluation. Initially, it is extremely important to be aware of the signs and symptoms, as well as in the early observation of their onset (appearance of disorders and mental fluctuations), to avoid undesirable worsening [18,26]. Therefore, the history of the episode is fundamental, with the record consistency of the steps that resulted in the event and thus it will be possible to carry out a comprehensive assessment of the potential triggering causes [18,26].…”

“…Initially, it is extremely important to be aware of the signs and symptoms, as well as in the early observation of their onset (appearance of disorders and mental fluctuations), to avoid undesirable worsening [18,26]. Therefore, the history of the episode is fundamental, with the record consistency of the steps that resulted in the event and thus it will be possible to carry out a comprehensive assessment of the potential triggering causes [18,26]. Thus, the notoriety of providing instruction for people is justified because, in addition to the health team, family members and/or caregivers will also be crucial for the collection of this information [18].…”

“…Owing to achieve quality and safety attributes at all levels of care for the older people, in addition of taking into account the severity of the complications caused (as poor quality of life, increased hospital stay and risk of death) and the high consecutive costs (from $ 143 to $ 152 billion per year), it is necessary to encourage the training of health professionals enabling them to recognize cases of delirium, as well as risk factors, treatment and prevention [18,26]. The adequate documentation concerning the occurrence of delirium in health services and the initiative to educate the population about this disorder, can greatly contribute to the improvements in the management of this clinical condition [18,26].…”