TRIAL TO REDUCE DELIRIUM IN AGED POST ACUTE PATIENTS
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Common, morbid, and costly, delirium affects one third of hospitalized elders, and plays a central role in the cascade of adverse events that leads to functional decline and loss of independence. Moreover, as acute care stays continue to shorten and evidence mounts that delirium may persist for many weeks, concern about delirium can no longer be confined to the hospital. Preliminary data from our own work and others suggest that 25 percent of elders admitted to post-acute care facilities are delirious, and that two-thirds of these remain delirious one month later. It is our hypothesis that persistent delirium exerts a significant negative influence on functional recovery in post-acute care. To test this, we propose a randomized controlled interventional trial involving 500 subjects admitted with delirium at four post-acute facilities. A Delirium Abatement Program (DAP) will be developed using specialized protocols for: 1) diagnosing delirium, 2) treating common causes of delirium, 3) preventing complications of delirium, and 4) restoring function. The DAP will be implemented at two intervention facilities under the supervision of Drs. Marcantonio and Murphy. Two additional facilities, matched by demographic, facility, and clinical characteristics to the intervention sites, will serve as controls. To assess the effectiveness of the DAP, subjects will undergo blinded assessments of delirium, cognitive, and functional status at intake, weekly while in the post-acute facilities, and at one, three, and six months after admission. Using bivariable, multivariable, and longitudinal analyses, we will assess the impact of the DAP on the prevalence and severity of delirium, and the rate of ADL functional improvement two weeks and one month after post-acute admission. We will also assess the long term impact of our intervention on ADL functional recovery three and six months after post-acute admission. This study will be the first to examine the natural history and impact of persistent delirium in-the post-acute setting. If the DAP is successful in reducing delirium and improving functional recovery, our findings will serve as a model of a targeted approach to improve the care of elders in the post-acute setting.
