Delirium in older patients

Reducing harm in older inpatients with and at risk of delirium

Delirium is a serious condition where a person experiences a disturbance in attention, perception, awareness and cognition. It is a common complication in older hospitalised patients, affecting 25–40% of inpatients aged 65 and older, and often leads to a need for longer hospital stays, including inpatient rehabilitation. Caring for people with active or resolving delirium requires particular skills in communication and care.  

This project piloted a combination of a staff education program called A View From Here and a comprehensive ward-based improvement program called Eat Walk Engage in a rehabilitation ward at Redcliffe hospital.

A View From Here is a modular online program developed by Dementia Training Australia which helps nurses and other health professionals understand the care experience from the viewpoint of the person with cognitive impairment (dementia or delirium). Eat Walk Engage helps the ward multidisciplinary team to improve care for their older patients. It has been demonstrated to significantly reduce delirium and can enhance functional recovery in acute care wards.

The project aimed to test the feasibility and acceptability of this model to improve staff skills and improve evidence-based care practices which prevent and manage delirium to improve patient outcomes in the rehabilitation setting.

Outcomes

Results showed that:

• Eat Walk Engage is feasible and acceptable in a rehabilitation setting, with both qualitative and quantitative data evidencing its effectiveness.
• The education component for clinicians is feasible and acceptable, but only if staff are specifically allocated time to complete the training
• Clinical outcomes of the combined intervention showed promising improvements in functional recovery and more patients discharged home.

The findings can inform future trials of this combined intervention in the rehabilitation setting to demonstrate cost impact and create a case for future funding and sustainable implementation.

Project investigators

Project investigators engage with and draw on the expertise of partners within universities, research institutes, and hospital and health services around Queensland.

• Professor Alison Mudge, The University of Queensland and  Royal Brisbane and Women’s Hospital, Metro North Health (Lead)
• Professor Len Gray, The University of Queensland Centre for Health Services Research
• Professor Ruth Hubbard, The University of Queensland Centre for Research in Geriatric Medicine
• Professor Elizabeth Beattie, Queensland University of Technology School of Nursing
• Ms Prue McRae, Statewide Program Manager Eat Walk Engage, Royal Brisbane and Women’s Hospital, Metro North
• Ms Sandra Jeavons Dementia Training Australia Centre Manager, Queensland University of Technology

Additional Resources

Clinical Excellence Queensland, Eat Walk Engage

AHRA, Improving the rehabilitation experience for older people and staff