Prevention of delirium in an acute geriatric care unit

Purpose. - Delirium is the most common complication of hospitalization in frail elderly. The prognosis is poor with increased mortality and morbidity. Confusion results from one or several precipitating factors in patients at risk. In a randomized study, a preventive multicomponent intervention reduced the incidence of delirium by 40%. The aim of our study was to evaluate the efficacy of such a preventive strategy, in the setting of an acute geriatric care unit. Methods. - The study was conducted in a French 26-bed geriatric acute care ward. The primary outcome was the comparison of the incidence of delirium among patients aged 75 years and older, before and after the implementation of a preventive strategy. The overall adherence of the ward staff to the prevention procedures was also determined. Results. - Before intervention, 367 patients were admitted (mean age: 80.6 years). The incidence of delirium was of 8.99%. In the subgroup of 123 demented patients, the incidence of delirium was of 15.4%. After intervention, 372 patients were admitted (mean age 84.9). The incidence of delirium was of 2.4% (relative risk reduction of 73%, P = 0.001). In the subgroup of 133 demented patients, the incidence of delirium was 5.3% (relative risk reduction of 66%, P = 0.01). The ward staff applied the prevention procedures in 96% of the 10 230 patients-day during the study period. Conclusion. - This study shows that it is possible to apply the results of clinical research in clinical practice to prevent delirium in frail elderly hospitalized in an acute geriatric care unit. Such an easy preventive strategy could be applied in medical units admitting old patients at risk, in the context of a quality procedure. (c) 2007 Elsevier Masson SAS. Tous droits reserves.