Background. Evaluating management of delirium through the implementation of a care modality called a Delirium Room (DR) of an Acute Care for the Elderly (ACE) unit. The DR was created in theory to be a care modality that is to raise the awareness and emphasis on the diagnosis and management of delirium.
Methods. The research studied 168 patients 65 years of age or older who had been admitted to the ACE or DR unit of a suburban hospital and who had at least a 48 hour stay and was evaluated by the geriatric team within this timeframe. The purpose of the study was to return to the naturalistic design and model of research and make quantitative comparisons, based on retrospective data collection, observation, and measurement, of dependent variables (functionality, cognition, and length of stay) among 4 types of patients as a function of delirium status (delirium as opposed to no delirium) and care setting (Delirium Room as opposed to ACE unit). Secondary dependent variables included complications, institutionalization, and mortality. The key elements of the program are multidisciplinary multi-component, and features of the unit include physical environmental changes to promote mobility and function and discourage bed rest. Comprehensive geriatric care team meetings occur daily to identify and address problems that lead to a decline through early identification. A nurse staff is in the room at all times in the care cycle.
Results. Care modality and subclinical delirium status had a statistically significant interactive association with function at discharge. The interaction effect was significant, F(1,128) = 5.1, P < 0.05, such that the effect of subclinical delirium on function (ADL) at discharge depends on whether or not the patient was treated on the DR. Subclinically-delirious patients treated on the DR improved in ADL at discharge, relative to subclinically-delirious patients not treated on the DR. Those patients with greater than or equal to 1 day in the DR and greater than or equal to 1 day of delirium went from 1.9 mean ADL score to 2.4 mean. All other groups declined. The identification of subclinical delirium was significant to predict outcomes for patients with delirium. All other outcomes findings from dependent variables were not significant.
Conclusion. The Delirium Room care modality enhances function among patients with significant symptoms of delirium, so that they are more functionally independent when they leave the hospital (relative to those who are not treated on the DR). The DR moderated outcomes for patients with subclinical delirium, patients spending some time in the DR improved in function at discharge.
|School:||University of Phoenix|
|School Location:||United States -- Arizona|
|Source:||DAI-B 70/04, Dissertation Abstracts International|
|Subjects:||Gerontology, Public health, Health care management|
|Keywords:||Acute care, Acute care for elderly, Delirium, Delirium room, Elderly, Function, length of stay, mortality, and delirium, Health outcomes and delirium, Subsyndromal delirium|
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