Evidence for Multi-Component NPI Management of Delirium

CARE Volunteers

Trained in delirium prevention and provide additional attention and activities to high-risk older adults in ED
Offer bedside interventions from conversation to short activities to engage and reorient high‐risk, older, unaccompanied individuals in the ED
Provide elders in ED with additional attention needed in an often chaotic, unfamiliar environment, enhancing care, improving satisfaction, and preventing potential decline

Sanon M, et al. J Am Geriatr Soc. 2014;62(2):365–370.

The Care and Respect for Elders with Emergencies (CARE) volunteer initiative is a geriatric‐focused volunteer program developed to help prevent avoidable complications such as falls, delirium, and use of restraints, and functional decline in vulnerable older adults in the ED. Associated with decreased use of inappropriate medications.

The CARE program consists of bedside volunteer interventions ranging from conversation to various short activities designed to engage and reorient high‐risk, older, unaccompanied individuals in the ED.

Educational Interventions for Families

Uses family members to help prevent delirium
Consists of 6 elements
- Education
- Familiar objects
- Clock
- Reorientation
- Avoidance of sensory deprivation
- Extended visitation
Delirium occurred in 5.6% of patients in the intervention group and in 13.3% of patients in the control group

Martinez FT, et al. Age Ageing. 2012;41(5):629–634.

There is a benefit in the nonpharmacologic prevention of delirium using family members, when compared with standard management of patients at risk of developing this condition.

The primary outcome (delirium occurrence) occurred in 5.6% of the patients in the intervention group and in 13.3% of the patients in the control group.

The NPI was performed thoroughly by patient’s family members and consisted of:

Education: brief interviews with each patient’s family members, in which the main aspects regarding the clinical features and prognostic implications of acute confusional syndromes were explained
Provision of a clock (analog or digital as required by the patient) and calendar in the room
Avoidance of sensory deprivation (glasses, dentures, and hearing aids must be available as needed)
Presence of familiar objects in the room (photographs, cushions, and radio)
Reorientation of patient provided by family members (current date and time, recent events)
Extended visitation times (5 h daily)

HELP (Hospital Elder Life Program)

Skilled staff and volunteers implement practical interventions toward evidence-based risk factors
Addresses 6 delirium risk factors and implements standard protocols
- Cognitive impairment
- Immobility
- Sleep deprivation
- Vision impairment
- Dehydration
- Hearing impairment
Prevents cognitive and functional decline in at-risk older patients
Reduces incidence of delirium by 33%

Key Points

In older patients, multicomponent NPIs and some single-components NPIs are effective in reducing the overall incidence, length, or severity of delirium
Use of NPIs to manage delirium has resulted in faster improvement of symptoms and cognition scores without adverse effect on mortality or health-related QoL (level 1)
A relative reduction of 30% in delirium rates was determined when using multicomponent NPI regardless of setting and cognitive decline

Abraha I, et al. PLoS One. 2015;10(6):e0123090.

Chai E, Meier D, Morris J, Goldhirsch S, eds. Geriatric Palliative Care. New York: Oxford University Press; 2014; Chapter 34: Delirium:191.

Inouye SK, et al. N Engl J Med. 1999;340(9):669–676.

Martinez F, et al. Age Ageing. 2015;44(2):196–204.

Pitkala KH, et al. J Gerontol A Biol Sci Med Sci. 2006;61(2):176–181.

References