4.7 Article

Impact of a dementia-friendly program on detection and management of patients with cognitive impairment and delirium in acute-care hospital units: a controlled clinical trial design

Journal

BMC GERIATRICS
Volume 22, Issue 1, Pages -

Publisher

BMC
DOI: 10.1186/s12877-022-02949-0

Keywords

Cognitive impairment; Delirium; Dementia-friendly hospital; Delirium screening; Delirium prevention; Delirium treatment measures; Delirium detection; Implementation

Funding

  1. National Association for Public Health [32]

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The study investigated whether a dementia-friendly hospital program improved detection and management of patients with cognitive impairment and risk of delirium at an acute-care hospital. Although the program did not significantly increase identification of patients with cognitive impairment, there was an increase in 4AT screening within 24 hours, implementation of non-pharmacological interventions, and a reduction in prescription of certain medications.
Background: Frail older persons with cognitive impairment (CI) are at special risk of experiencing delirium during acute hospitalisation. The purpose of this study was to investigate whether a dementia-friendly hospital program contributes to improved detection and management of patients with CI and risk of delirium at an acute-care hospital in Norway. Furthermore, we aimed to explore whether the program affected the detection of delirium, pharmacological treatment, 30-day re-hospitalisation, 30-day mortality and institutionalisation afterwards. Methods: This study was part of a larger quality improvement project aiming at developing and implementing a new program for early screening and management of patients with CI. This study, evaluating the program are designed as a controlled clinical trial with a historical control group. It was conducted at two different medical wards at a large acute-care hospital in Norway from September 2018 to December 2019. A total of 423 acute hospitalised patients 75 years of age or older were included in the study. Delirium screening and cognitive tests were recorded by research staff with the 4'A's Test (4AT) and the Confusion Assessment Measure (CAM), while demographic and medical information was recorded from the electronic medical records (EMR). Results: Implementation of the dementia-friendly hospital program did not show any significant changes in the identification of patients with CI. However, the share of patients screened with 4AT within 24 h increased from 0% to 35.5% (P < .001). The proportion of the patients with CI identified by the clinical staff, who received measures to promote dementia-friendlycare and reduce the risk for delirium increased by 32.2% (P<.001), compared to the control group. Furthermore, the number of patients with CI who were prescribed antipsychotic, hypnotic or sedative medications was reduced by 24.5% (P<.001). There were no differences in delirium detection, 30-day readmission or 30-day mortality. Conclusions: A model for early screening and multifactorial non-pharmacological interventions for patients with CI and delirium may improve management of this patient group, and reduce prescriptions of antipsychotic, hypnotic and sedative medications. The implementation in clinical practice of early screening using quality improvement methodology deserves attention.

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