title: Nursing intervention versus usual care to improve delirium among home-dwelling older adults receiving homecare after hospitalization: feasibility and acceptability of a Randomized Controlled Trail.
abstract: BACKGROUND
  Delirium is an acute cognitive impairment among older hospitalized patients. It can persist until discharge and for months after that. Despite proof that evidence-based nursing interventions are effective in preventing delirium in acute hospitals, interventions among home-dwelling older patients is lacking. The aim was to assess feasibility and acceptability of a nursing intervention designed to detect and reduce delirium in older adults after discharge from hospital.
  
  
  METHODS
  Randomized clinical pilot trial with a before/after design was used. One hundred and three older adults were recruited in a home healthcare service in French-speaking Switzerland and randomized into an experimental group (EG, n = 51) and a control group (CG, n = 52). The CG received usual homecare. The EG received usual homecare plus five additional nursing interventions at 48 and 72 h and at 7, 14 and 21 days after discharge. These interventions were tailored for detecting and reducing delirium and were conducted by a geriatric clinical nurse (GCN). All patients were monitored at the start of the study (M1) and throughout the month for symptoms of delirium (M2). This was documented in patients' records after usual homecare using the Confusion Assessment Method (CAM). At one month (M2), symptoms of delirium were measured using the CAM, cognitive status was measured using the Mini-Mental State Examination (MMSE), and functional status was measured using Katz and Lawton Index of activities of daily living (ADL/IADL). At the end of the study, participants in the EG and homecare nurses were interviewed about the acceptability of the nursing interventions and the study itself.
  
  
  RESULTS
  Feasibility and acceptability indicators reported excellent results. Recruitment, retention, randomization, and other procedures were efficient, although some potentially issues were identified. Participants and nurses considered organizational procedures, data collection, intervention content, the dose-effect of the interventions, and methodology all to be feasible. Duration, patient adherence and fidelity were judged acceptable. Nurses, participants and informal caregivers were satisfied with the relevance and safety of the interventions.
  
  
  CONCLUSIONS
  Nursing interventions to detect/improve delirium at home are feasible and acceptable. These results confirm that developing a large-scale randomized controlled trial would be appropriate.
  ISRCTN registry no: 16103589 - 19 February 2016.
authors.affiliation: University of Applied Nursing Sciences, La Source, 30, Avenue Vinet, CH-1004 Lausanne, Switzerland.
authors.forename: Henk
authors.initials: H
authors.lastname: Verloo
authors.affiliation: Faculty of Nursing Science, University of Montreal, Montreal, Canada.
authors.forename: Céline
authors.initials: C
authors.lastname: Goulet
authors.affiliation: Institut Universitaire de Formation et Recherche en Soins (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Lausanne University Hospital, 10, Rte de la Corniche, CH-1010 Lausanne, Switzerland ; Faculty of Nursing Science, Université Laval, Québec, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Morin
authors.affiliation: Department of Psychiatry, Service Universitaire de Psychiatrie de l'Age Avancé (SUPAA), Lausanne University Hospital, CH-1008 Prilly, Switzerland.
authors.forename: Armin
authors.initials: A
authors.lastname: von Gunten
keywords: Acceptability; Delirium; Feasibility; Home-dwelling older adults; Intervention; Prevention