Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long-Term Care Delivered by Certified Nursing Assistants.
Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long-Term Care Delivered by Certified Nursing Assistants.
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DOI：
10.1111/jgs.14091
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发表时间：
2016-05
影响因子：
6.3
通讯作者：
Inouye SK
中科院分区：
文献类型：
--
作者：
Boockvar KS;Teresi JA;Inouye SK
护理之家（NH）患者具有较高的谵妄风险因素患病率，经历2-4次急性医学状况（例如，感染），并且在这些条件下谵妄的发生率与住院的老年人相似。许多伴有谵妄的NH患者的认知功能无法恢复到之前的水平。与那些没有谵妄的人相比，他们更有可能死亡，住院，不太可能出院回家。在NH中对谵妄的预防或治疗的研究仍然有限。本文介绍了一种多组分谵妄预防干预的发展和试点测试的NH设置改编自医院老年生活计划（“帮助-LTC”）。我们开发了适用于功能受损NH患者的谵妄风险降低活动，这些活动在急性疾病治疗和恢复期间提供，这是一种新的患者靶向方法。活动由一名经过专业培训的认证护理助理（CNA）提供，该助理在整个设施中访问患者。我们报告事件谵妄，谵妄缓解，认知和身体功能的变化，住院治疗，死亡与急性医疗条件确定的程序协调员。我们还报告了病人和工作人员对CNA活动的整合和接受情况。在非干预对照组中确定住院和死亡。研究结果支持在对照试验中进行干预测试。潜在的影响是巨大的：在美国大约有140万NH患者，估计有100万患有痴呆或认知障碍，这是一个关键的谵妄风险因素。如果通过预防住院来减少医疗保健费用，从而抵消该计划的CNA费用，那么干预措施将被广泛采用。
Nursing home (NH) patients have a high prevalence of delirium risk factors, experience 2-4 acute medical conditions (e.g., infections) each year, and have an incidence of delirium during these conditions that is similar to that of hospitalized older adults. Many NH patients with delirium do not return to their prior level of cognitive function. As compared to those without delirium, they are more likely to die, be hospitalized, and less likely to be discharged home. Research on the prevention or treatment of delirium in the NH remains limited. This article describes the development and pilot-testing of a multicomponent delirium prevention intervention in the NH setting adapted from the Hospital Elder Life Program (“HELP-LTC”). We developed delirium-risk reducing activities appropriate for functionally-impaired NH patients that were delivered during treatment for and recovery from acute illness, a novel patient targeting approach. Activities were provided by an expertly trained certified nursing assistant (CNA) who visited patients throughout the facility. We report on incident delirium, delirium remission, cognitive and physical function change, hospitalization, and death associated with acute medical conditions as ascertained by a program coordinator. We also report on the integration and acceptance of the CNAs’ activities by patients and staff. Hospitalization and death were ascertained in a non-intervention comparison group. Findings support a test of the intervention in a controlled trial. The potential impact is great: there are approximately 1.4 million NH patients in the U.S. and an estimated 1 million with dementia or cognitive impairment, a key delirium risk factor. An intervention would be broadly adoptable if the cost of the program’s CNAs were offset by a reduction in health care costs through prevention of hospitalization.