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

Prevalence and management of delirium in community dwelling older people with dementia referred to a memory clinic

OBJECTIVE

Our aim was to measure the prevalence of delirium, its clinical features, and outcomes in older patients referred to a memory clinic.

METHODS

A retrospective cohort study of 109 older outpatients with delirium referred to a memory clinic with a home care service. Delirium was diagnosed using the confusion assessment method and dementia with the DSM-5 criteria. We collected information on cognitive and functional status, mortality, institutionalization, and hospitalization during 6 months following the delirium episode.

RESULTS

Delirium prevalence was 3.6%, mostly of hyperactive type. Delirium worsened functional (ADL 2.95 ± 1.95 vs. 2.16 ± 1.84) and cognitive (MMSE 13.88 ± 8.96 vs.11.0 ± 9.49) status after 6 months compared to the baseline. The mortality rate was 29.4%, and 28.3% were admitted to a long-term facility after the episode of delirium. Of these patients, more than half were hospitalized during the follow-up. Of the 109 patients with delirium, 85 were managed at home and 24 were hospitalized. Patients who were hospitalized had more severe behavioral symptoms during the delirium episode. There was no difference in mortality and institutionalization according to the home or hospital management.

CONCLUSIONS

This retrospective cohort study adds novel information to the existing literature of an understudied setting and population. The study supports the need to further investigate the feasibility and efficacy of the hospital at home models for the prevention and management of delirium in a high-risk population.

Nurses' experiences of delirium and how to identify delirium-A qualitative study

AIM

Delirium is a serious, acute medical condition which places a heavy burden on the patient, his or her family and healthcare professionals. There have been only a limited number of studies to explore nurses' experiences of delirium and how delirium is identified in community care. The research questions of the study are as follows: "How do community care nurses' experience delirium?" and "How is delirium identified?".

DESIGN

This study has been designed as an explorative and descriptive study.

METHODS

A topic-based interview guide was developed containing questions associated with the Registered Nurses' experiences of their meetings with people with delirium and their identification of delirium.

RESULTS

Nurses working in the community care need to know more about delirium as they play a key role in treatment. Our results also show that the participants have difficulty in establishing whether a patient is suffering from acute confusion/delirium, depression or dementia.

Methodological reporting in feasibility studies: a descriptive review of the nursing intervention research literature

Background

In reaction to weaknesses in feasibility studies reporting, the Consolidated Standards of Reporting Trials (CONSORT) statement published an extension for feasibility studies in 2016.

Aim

The aim of this study was to systematically review and appraise the reporting of feasibility studies in the nursing intervention research literature based on the CONSORT statement extension for feasibility studies.

Method

Papers published prior to January 2018 that described feasibility studies of nursing interventions were retrieved. Components of feasibility studies were coded, and code frequencies were analysed.

Results

The review included 186 papers. Although most papers (n = 142, 76.3%) included the label 'pilot' or 'feasibility' in their title, reporting for other components generally did not adhere to one or several CONSORT recommendations. Most papers reported objectives (n = 116, 62.4%), designs (n = 95, 51%), or rationales for sample size (n = 165, 88.7%) that were incongruent with the purpose of feasibility studies.

Discussion

This review results in two main implications for nursing research. First, we noted that the reporting of feasibility studies is weak. While all papers described feasibility studies, almost half focused exclusively on testing the effectiveness of an intervention. Second, we identified rationales for sample size along with key references that could offer guidance in reporting feasibility studies while being coherent with the CONSORT recommendations.

Management of delirium across an integrated health system

Facilitating throughput with systems thinking.