A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients.
OBJECTIVE
To develop and test the effect of a nurse-led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip-fracture patients.


METHODS
Longitudinal prospective before/after design (sequential design).


METHODS
The emergency room and two traumatological units of an academic medical center located in an urban area in Belgium.


METHODS
60 patients in an intervention cohort (81.7% females, median age = 82, interquartile range (IQR) = 13) and another 60 patients in a usual care/nonintervention cohort (80% females, median age = 80, IQR = 12).


METHODS
(1) Education of nursing staff, (2) systematic cognitive screening, (3) consultative services by a delirium resource nurse, a geriatric nurse specialist, or a psychogeriatrician, and (4) use of a scheduled pain protocol.


METHODS
All patients were monitored for signs of delirium, as measured by the Confusion Assessment Method (CAM). Severity of delirium was assessed using a variant of the CAM. Cognitive and functional status were measured by the Mini-Mental State Examination (MMSE) (including subscales of memory, linguistic ability, concentration, and psychomotor executive skills) and the Katz Index of activities of daily living (ADLs), respectively.


RESULTS
Although there was no significant effect on the incidence of delirium (23.3% in the control vs 20.0% in the intervention cohort; P =.82), duration of delirium was shorter (P =.03) and severity of delirium was less (P =.0049) in the intervention cohort. Further, clinically higher cognitive functioning was observed for the delirious patients in the intervention cohort compared with the nonintervention cohort. Additionally, a trend toward decreased length of stay postoperatively was noted for the delirious patients in the intervention cohort. Despite these positive intervention effects, no effect on ADL rehabilitation was found. Results for risk of mortality were inconclusive.


CONCLUSIONS
This study demonstrated the beneficial effects of an intervention program focusing on early recognition and treatment of delirium in older hip-fracture patients and confirms the reversibility of the syndrome in view of the delirium's duration and severity.
Milisen
K
K
Center for Health Services and Nursing Research, Katholieke Universiteit Leuven and Department of Geriatrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium.
Foreman
M D
MD
Abraham
I L
IL
De Geest
S
S
Godderis
J
J
Vandermeulen
E
E
Fischler
B
B
Delooz
H H
HH
Spiessens
B
B
Broos
P L
PL
D000203:Activities of Daily Living; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D015577:Geriatric Assessment; D005851:Geriatric Nursing / Q000458:organization & administration*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009720:Nurse Clinicians / Q000458:organization & administration*; D015403:Nursing Evaluation Research; D010348:Patient Care Team / Q000458:organization & administration*; D011183:Postoperative Complications / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D015397:Program Evaluation; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index