A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients

Koen Milisen, Marquis D. Foreman, Ivo L Abraham, Sabina De Geest, Jan Godderis, Erik Vandermeulen, Benjamin Fischler, Herman H. Delooz, Bart Spiessens, Paul L O Broos

Research output: Contribution to journalArticle

275 Citations (Scopus)

Abstract

OBJECTIVES: To develop and test the effect of a nurse-led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip-fracture patients. DESIGN: Longitudinal prospective before/after design (sequential design). SETTING: The emergency room and two traumatological units of an academic medical center located in an urban area in Belgium. PARTICIPANTS: 60 patients in an intervention cohort (81.7% females, median age = 82, interquartile range (IQR) = 13) and another 60 patients in a usual care/nonintervention cohort (80% females, median age = 80, IQR = 12). INTERVENTION: (1) Education of nursing staff, (2) systematic cognitive screening, (3) consultative services by a delirium resource nurse, a geriatric nurse specialist, or a psychogeriatrician, and (4) use of a scheduled pain protocol. MEASUREMENTS: All patients were monitored for signs of delirium, as measured by the Confusion Assessment Method (CAM). Severity of delirium was assessed using a variant of the CAM. Cognitive and functional status were measured by the Mini-Mental State Examination (MMSE) (including subscales of memory, linguistic ability, concentration, and psychomotor executive skills) and the Katz Index of activities of daily living (ADLs), respectively. RESULTS: Although there was no significant effect on the incidence of delirium (23.3% in the control vs 20.0% in the intervention cohort; P = .82), duration of delirium was shorter (P = .03) and severity of delirium was less (P = .0049) in the intervention cohort. Further, clinically higher cognitive functioning was observed for the delirious patients in the intervention cohort compared with the nonintervention cohort. Additionally, a trend toward decreased length of stay postoperatively was noted for the delirious patients in the intervention cohort. Despite these positive intervention effects, no effect on ADL rehabilitation was found. Results for risk of mortality were inconclusive. CONCLUSIONS: This study demonstrated the beneficial effects of an intervention program focusing on early recognition and treatment of delirium in older hip-fracture patients and confirms the reversibility of the syndrome in view of the delirium's duration and severity.

Original languageEnglish (US)
Pages (from-to)523-532
Number of pages10
JournalJournal of the American Geriatrics Society
Volume49
Issue number5
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Delirium
Hip Fractures
Nurses
Confusion
Activities of Daily Living
Length of Stay
Rehabilitation
Aptitude
Mortality
Nursing Staff
Belgium
Incidence
Linguistics
Geriatrics
Hospital Emergency Service
Education
Pain

Keywords

  • Delirium
  • Hip fracture
  • Intervention
  • Older

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients. / Milisen, Koen; Foreman, Marquis D.; Abraham, Ivo L; De Geest, Sabina; Godderis, Jan; Vandermeulen, Erik; Fischler, Benjamin; Delooz, Herman H.; Spiessens, Bart; Broos, Paul L O.

In: Journal of the American Geriatrics Society, Vol. 49, No. 5, 2001, p. 523-532.

Research output: Contribution to journalArticle

Milisen, K, Foreman, MD, Abraham, IL, De Geest, S, Godderis, J, Vandermeulen, E, Fischler, B, Delooz, HH, Spiessens, B & Broos, PLO 2001, 'A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients', Journal of the American Geriatrics Society, vol. 49, no. 5, pp. 523-532. https://doi.org/10.1046/j.1532-5415.2001.49109.x
Milisen, Koen ; Foreman, Marquis D. ; Abraham, Ivo L ; De Geest, Sabina ; Godderis, Jan ; Vandermeulen, Erik ; Fischler, Benjamin ; Delooz, Herman H. ; Spiessens, Bart ; Broos, Paul L O. / A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients. In: Journal of the American Geriatrics Society. 2001 ; Vol. 49, No. 5. pp. 523-532.
@article{25b2b444d99a40b4b80b742523da5170,
title = "A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients",
abstract = "OBJECTIVES: To develop and test the effect of a nurse-led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip-fracture patients. DESIGN: Longitudinal prospective before/after design (sequential design). SETTING: The emergency room and two traumatological units of an academic medical center located in an urban area in Belgium. PARTICIPANTS: 60 patients in an intervention cohort (81.7{\%} females, median age = 82, interquartile range (IQR) = 13) and another 60 patients in a usual care/nonintervention cohort (80{\%} females, median age = 80, IQR = 12). INTERVENTION: (1) Education of nursing staff, (2) systematic cognitive screening, (3) consultative services by a delirium resource nurse, a geriatric nurse specialist, or a psychogeriatrician, and (4) use of a scheduled pain protocol. MEASUREMENTS: All patients were monitored for signs of delirium, as measured by the Confusion Assessment Method (CAM). Severity of delirium was assessed using a variant of the CAM. Cognitive and functional status were measured by the Mini-Mental State Examination (MMSE) (including subscales of memory, linguistic ability, concentration, and psychomotor executive skills) and the Katz Index of activities of daily living (ADLs), respectively. RESULTS: Although there was no significant effect on the incidence of delirium (23.3{\%} in the control vs 20.0{\%} in the intervention cohort; P = .82), duration of delirium was shorter (P = .03) and severity of delirium was less (P = .0049) in the intervention cohort. Further, clinically higher cognitive functioning was observed for the delirious patients in the intervention cohort compared with the nonintervention cohort. Additionally, a trend toward decreased length of stay postoperatively was noted for the delirious patients in the intervention cohort. Despite these positive intervention effects, no effect on ADL rehabilitation was found. Results for risk of mortality were inconclusive. CONCLUSIONS: This study demonstrated the beneficial effects of an intervention program focusing on early recognition and treatment of delirium in older hip-fracture patients and confirms the reversibility of the syndrome in view of the delirium's duration and severity.",
keywords = "Delirium, Hip fracture, Intervention, Older",
author = "Koen Milisen and Foreman, {Marquis D.} and Abraham, {Ivo L} and {De Geest}, Sabina and Jan Godderis and Erik Vandermeulen and Benjamin Fischler and Delooz, {Herman H.} and Bart Spiessens and Broos, {Paul L O}",
year = "2001",
doi = "10.1046/j.1532-5415.2001.49109.x",
language = "English (US)",
volume = "49",
pages = "523--532",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients

AU - Milisen, Koen

AU - Foreman, Marquis D.

AU - Abraham, Ivo L

AU - De Geest, Sabina

AU - Godderis, Jan

AU - Vandermeulen, Erik

AU - Fischler, Benjamin

AU - Delooz, Herman H.

AU - Spiessens, Bart

AU - Broos, Paul L O

PY - 2001

Y1 - 2001

N2 - OBJECTIVES: To develop and test the effect of a nurse-led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip-fracture patients. DESIGN: Longitudinal prospective before/after design (sequential design). SETTING: The emergency room and two traumatological units of an academic medical center located in an urban area in Belgium. PARTICIPANTS: 60 patients in an intervention cohort (81.7% females, median age = 82, interquartile range (IQR) = 13) and another 60 patients in a usual care/nonintervention cohort (80% females, median age = 80, IQR = 12). INTERVENTION: (1) Education of nursing staff, (2) systematic cognitive screening, (3) consultative services by a delirium resource nurse, a geriatric nurse specialist, or a psychogeriatrician, and (4) use of a scheduled pain protocol. MEASUREMENTS: All patients were monitored for signs of delirium, as measured by the Confusion Assessment Method (CAM). Severity of delirium was assessed using a variant of the CAM. Cognitive and functional status were measured by the Mini-Mental State Examination (MMSE) (including subscales of memory, linguistic ability, concentration, and psychomotor executive skills) and the Katz Index of activities of daily living (ADLs), respectively. RESULTS: Although there was no significant effect on the incidence of delirium (23.3% in the control vs 20.0% in the intervention cohort; P = .82), duration of delirium was shorter (P = .03) and severity of delirium was less (P = .0049) in the intervention cohort. Further, clinically higher cognitive functioning was observed for the delirious patients in the intervention cohort compared with the nonintervention cohort. Additionally, a trend toward decreased length of stay postoperatively was noted for the delirious patients in the intervention cohort. Despite these positive intervention effects, no effect on ADL rehabilitation was found. Results for risk of mortality were inconclusive. CONCLUSIONS: This study demonstrated the beneficial effects of an intervention program focusing on early recognition and treatment of delirium in older hip-fracture patients and confirms the reversibility of the syndrome in view of the delirium's duration and severity.

AB - OBJECTIVES: To develop and test the effect of a nurse-led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip-fracture patients. DESIGN: Longitudinal prospective before/after design (sequential design). SETTING: The emergency room and two traumatological units of an academic medical center located in an urban area in Belgium. PARTICIPANTS: 60 patients in an intervention cohort (81.7% females, median age = 82, interquartile range (IQR) = 13) and another 60 patients in a usual care/nonintervention cohort (80% females, median age = 80, IQR = 12). INTERVENTION: (1) Education of nursing staff, (2) systematic cognitive screening, (3) consultative services by a delirium resource nurse, a geriatric nurse specialist, or a psychogeriatrician, and (4) use of a scheduled pain protocol. MEASUREMENTS: All patients were monitored for signs of delirium, as measured by the Confusion Assessment Method (CAM). Severity of delirium was assessed using a variant of the CAM. Cognitive and functional status were measured by the Mini-Mental State Examination (MMSE) (including subscales of memory, linguistic ability, concentration, and psychomotor executive skills) and the Katz Index of activities of daily living (ADLs), respectively. RESULTS: Although there was no significant effect on the incidence of delirium (23.3% in the control vs 20.0% in the intervention cohort; P = .82), duration of delirium was shorter (P = .03) and severity of delirium was less (P = .0049) in the intervention cohort. Further, clinically higher cognitive functioning was observed for the delirious patients in the intervention cohort compared with the nonintervention cohort. Additionally, a trend toward decreased length of stay postoperatively was noted for the delirious patients in the intervention cohort. Despite these positive intervention effects, no effect on ADL rehabilitation was found. Results for risk of mortality were inconclusive. CONCLUSIONS: This study demonstrated the beneficial effects of an intervention program focusing on early recognition and treatment of delirium in older hip-fracture patients and confirms the reversibility of the syndrome in view of the delirium's duration and severity.

KW - Delirium

KW - Hip fracture

KW - Intervention

KW - Older

UR - http://www.scopus.com/inward/record.url?scp=0035015872&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035015872&partnerID=8YFLogxK

U2 - 10.1046/j.1532-5415.2001.49109.x

DO - 10.1046/j.1532-5415.2001.49109.x

M3 - Article

C2 - 11380743

AN - SCOPUS:0035015872

VL - 49

SP - 523

EP - 532

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 5

ER -