Background: Delirium is an acute cognitive impairment among older hospitalized patients. It can persist until\ndischarge and for months after that. Despite proof that evidence-based nursing interventions are effective in\npreventing delirium in acute hospitals, interventions among home-dwelling older patients is lacking. The aim\nwas to assess feasibility and acceptability of a nursing intervention designed to detect and reduce delirium in\nolder adults after discharge from hospital.\nMethods: Randomized clinical pilot trial with a before/after design was used. One hundred and three older\nadults were recruited in a home healthcare service in French-speaking Switzerland and randomized into an\nexperimental group (EG, n = 51) and a control group (CG, n = 52). The CG received usual homecare. The EG\nreceived usual homecare plus five additional nursing interventions at 48 and 72 h and at 7, 14 and 21 days\nafter discharge. These interventions were tailored for detecting and reducing delirium and were conducted by\na geriatric clinical nurse (GCN). All patients were monitored at the start of the study (M1) and throughout the\nmonth for symptoms of delirium (M2). This was documented in patients� records after usual homecare using\nthe Confusion Assessment Method (CAM). At one month (M2), symptoms of delirium were measured using\nthe CAM, cognitive status was measured using the Mini-Mental State Examination (MMSE), and functional\nstatus was measured using Katz and Lawton Index of activities of daily living (ADL/IADL). At the end of the\nstudy, participants in the EG and homecare nurses were interviewed about the acceptability of the nursing\ninterventions and the study itself.\nResults: Feasibility and acceptability indicators reported excellent results. Recruitment, retention, randomization, and\nother procedures were efficient, although some potentially issues were identified. Participants and nurses considered\norganizational procedures, data collection, intervention content, the dose-effect of the interventions, and methodology\nall to be feasible. Duration, patient adherence and fidelity were judged acceptable. Nurses, participants and informal\ncaregivers were satisfied with the relevance and safety of the interventions.\nConclusions: Nursing interventions to detect/improve delirium at home are feasible and acceptable. These results\nconfirm that developing a large-scale randomized controlled trial would be appropriate.
Loading....