title: Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long-Term Care Delivered by Certified Nursing Assistants.
abstract: Nursing home (NH) residents have a high prevalence of delirium risk factors, experience two to four acute medical conditions (e.g., infections) each year, and have an incidence of delirium during these conditions similar to that of hospitalized older adults. Many NH residents with delirium do not return to their prior level of cognitive function. They are more likely to die, be hospitalized, and less likely to be discharged home than those without delirium. Research on the prevention or treatment of delirium in NHs is limited. This article describes the development and pilot testing of a multicomponent delirium prevention intervention in the NH setting adapted from the Hospital Elder Life Program (HELP-LTC). Activities to reduce the risk of delirium that were appropriate for functionally impaired NH residents were developed and delivered during treatment for and recovery from acute illness, a novel resident-targeting approach. Expertly trained certified nursing assistants (CNAs - a total of 1.4 full-time equivalent (FTE) positions-) visited residents throughout the facility and delivered the activities. The current study reports on incident delirium, delirium remission, cognitive and physical function change, hospitalization, and death associated with acute medical conditions as ascertained by a program coordinator. The integration and acceptance of the CNAs' activities by residents and staff are also reported on. Hospitalization and death were ascertained in a nonintervention comparison group. Findings support a test of the intervention in a controlled trial. The potential effect is great; there are approximately 1.4 million NH residents in the United States and an estimated 1 million with dementia or cognitive impairment, an important delirium risk factor. An intervention would be broadly adoptable if a reduction in healthcare costs through prevention of hospitalization offset the cost of the program's CNAs.
authors.affiliation: The New Jewish Home, New York, New York.|Icahn School of Medicine at Mount Sinai, New York, New York.|James J. Peters Veterans Affairs Medical Center, Bronx, New York.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Boockvar
authors.affiliation: Research Division, Hebrew Home at Riverdale, Bronx, New York.|Stroud Center at New York State Psychiatric Institute, Columbia University, New York, New York.|Weill Cornell Division of Geriatrics and Palliative Care, New York, New York.
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Teresi
authors.affiliation: Aging Brain Center, Hebrew SeniorLife, Boston, Massachusetts.|Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D002568:Certification; D003693:Delirium / Q000451:nursing* / Q000517:prevention & control*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009730:Nursing Assessment; D009728:Nursing Assistants; D009735:Nursing Homes; D010865:Pilot Projects; D016730:Program Development; D018570:Risk Assessment; D012307:Risk Factors; D000078329:Workforce
keywords: delirium; intervention; nosocomial infection; nursing homes