A Multifactorial Intervention to Reduce Prevalence of Delirium and Shorten Hospital Length of Stay

Abstract

To improve outcomes for cognitively impaired and delirious older adults. Pretest, posttest. A university-affiliated hospital. Physicians and nurses in the emergency department (ED) and on an acute geriatric unit (AGU). Multifactorial and targeted to the processes of care for cognitively impaired and delirious older adults admitted to medicine service from the ED. Prevalence of delirium, admission to AGU, psychotropic medication use, hospital length of stay. Patient characteristics did not differ between baseline and the two outcome cohorts 4 and 9 months postintervention. Prevalence of delirium was 40.9% at baseline, 22.7% at 4 months (P<.002), and 19.1% at 9 months (P<.001). More delirious patients were admitted to the AGU than to non-AGU units at 4 months (P<.01) and 9 months (P<.01). Postintervention medication use in the hospital differed from baseline. Antidepressant use was greater at 4 months (P<.05). Benzodiazepine and antihistamine use were lower at 9 months (P>.01). Antidepressant and neuroleptic use were higher (P<.02) and antihistamine use was lower (P<.02) at 4 months on the AGU than for the baseline group. Benzodiazepine (P<.01) and antihistamine (P<.05) use were lower at 9 months. Each case of delirium prevented saved a mean of 3.42 hospital days. A multifactorial intervention designed to reduce delirium in older adults was associated with improved psychotropic medication use, less delirium, and hospital savings.