Caregiver-based Intervention for Persistent Delirium
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DESCRIPTION (provided by applicant): Over one-third of hospitalized elders develop delirium, and in more than half of these cases, delirium is persistent. Persistent delirium is associated with poor patient outcomes, and also leads to substantial caregiver stress and burden. For the past 5 years, we have been conducting an NIH-funded randomized trial of a Delirium Abatement Program in post-acute skilled nursing facilities. Our current proposal builds upon our extensive experience with patients with persistent delirium and their caregivers. We will conduct a 15-month pilot randomized trial of a Caregiver-based Intervention for Persistent Delirium (CIPD) that will enroll 48 patient-caregiver dyads. Patients will be screened for delirium while inpatients, and if delirious, caregivers will be contacted to assess eligibility and provide informed consent. Patients whose delirium persists for 3 days after the initial screening or until hospital discharge will be randomized to CIPD vs. usual care in a 2:1 ratio. Based on Social Cognitive Theory, the CIPD will employ a gerontological nurse practitioner serving as a health coach who will engage caregivers in developing an individualized health action plan for delirium prior to hospital discharge. After hospital discharge, the nurse practitioner will continue to work with the caregiver at weekly intervals for six weeks, including 2 home visits. After this period, there will be at least biweekly contacts over the remainder of the 12-week intervention period. Patient outcomes will be change in delirium symptoms and ADL function, measured 2, 6, and 12 weeks after randomization. Caregiver outcomes will be change in burden, self-efficacy, and health status at the same time points. Our proposed pilot trial has the following Specific Aims: 1) To determine the feasibility of performing a caregiver-based health coach-mediated intervention in patients with persistent delirium, 2) To perform qualitative interviews of all enrolled caregivers to better understand their experience of persistent delirium and to obtain feedback on how to improve our intervention, and 3) To obtain preliminary estimates of accrual rates and effect sizes for patient and caregiver endpoints to enable the design of a definitive randomized controlled trial. If promising, our findings will serve as pilot data for a definitive trial to test this novel strategy to improve the health of a vulnerable population of elders and their caregivers.
