Date Presented 03/31/2022
Delirium is prevalent among hospitalized older adults. Interest-based activities and environmental cues can increase cognitive stimulation to prevent delirium. OTs have unique skills to create person-centered interventions to promote cognition and participation. The feasibility of providing multicomponent interest-based intervention in the acute care setting was explored. Promising patient engagement and high satisfaction were reported.
Primary Author and Speaker: Qianwen Liu
Contributing Authors: Elena Donoso Brown, Shauni Johnson, Autumn Moss-Corcoran
PURPOSE: To explore the feasibility of integrating a personalized multi-component intervention into an existing protocol for delirium prevention.
DESIGN SETTING: The setting was a delirium prevention program known as the Hospital Elder Life Program (HELP) in four acute care units in Pennsylvania. HELP provides daily volunteer visits for patient needs (i.e., hydration, hearing aids). Participants: Inclusion criteria: 1) age 70 years and older, 2) admitted to a HELP unit, 3) able to communicate verbally or in writing in English, and 4) presence of at least one risk factor for delirium, including impairment in cognition, vision, hearing, activities of daily living or kidney function. Exclusion criteria: 1) delirium diagnosis at admission; 2) coma; 3) mechanical ventilation; 4) aphasia; 5) imminently terminal condition; or 6) profound cognitive impairment. Intervention: This was a 10-week quality improvement (QI) project integrated into the standard HELP protocol. The QI project provided at least one of the following personalized interventions: 1) interest-based activities, 2) family education, and 3) orientation cards. An adapted version of the Modified Interest Checklist was used to initiate communication and to identify activity choices. Patients or caregivers filled out cards to indicate the patients’ identities and routines. Caregivers also received education on delirium prevention strategies such as bringing patients’ family photos to hospital rooms. The QI intervention was implemented by an occupational therapy doctoral student, 5 days a week. Additionally, QI participants received routine HELP visits over the weekends. The QI project was approved by the hospital institutional review board and verbal consent was obtained before delivering the intervention.
DATA COLLECTION: A process evaluation was conducted to determine the protocol’s feasibility. The researchers used daily logs, and discharge satisfaction surveys to collect descriptive information on how the additional components were used. In addition, data from the electronic health record tracked delirium incidence (DI) and falls. Data analysis: Descriptive data analysis was used to describe the participants’ demographic characteristics, activity choices, and satisfaction using Statistical Package for the Social Sciences (SPSS).
RESULTS: Thirty-two patients (mean age = 79.63 years) received at least one component of the QI intervention, among which 26 participants engaged in interest-based activities, 15 participants received personalized orientation cards and family photos, 16 caregivers received education. The most selected interest-based activities were cognitive stimulation activities such as word searches, and reading activities related to instrumental activities of daily living, like gardening. Twenty-five satisfaction surveys were completed. A total of 24 (96%) participants reported that they felt ‘very supported’ by the project. Among surveyed participants who received interest-based activities, 16/21(76.1%) participants reported ‘regularly’ or ‘sometimes’ engaging in the activities. Only two QI participants developed delirium, and none of them had a fall during the hospital stay.
CONCLUSION: Promising engagement rate and high participant satisfaction were reported. The results suggested that it is feasible to implement an interest-based multi-component intervention in the acute care setting. However, further study on the intervention’s impact on preventing delirium is warranted.
IMPACT STATEMENT: This project demonstrated how occupational therapists can play a valuable role in delirium prevention through providing holistic person-centered approaches by utilizing assessments, such as interest checklists, to build rapport and identify motivation.
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