A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients
A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients
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DOI：
10.1046/j.1532-5415.2001.49109.x
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发表时间：
2001-05-01
影响因子：
6.3
通讯作者：
Broos, PLO
中科院分区：
文献类型：
--
作者：
Milisen, K;Foreman, MD;Broos, PLO
目的：开发和测试由护士主导的跨学科谵妄干预计划对老年髋部骨折患者谵妄的发生率和病程（严重程度和持续时间）、认知功能、功能康复、死亡率和住院时间的影响。设计：前后纵向前瞻性设计（序贯设计）。地点：位于一个学术医疗中心的急诊室和两个创伤科单位。 参与者：干预队列中的 60 名患者（81.7% 女性，中位年龄 = 82，四分位距 (IQR) = 13）和常规护理/非干预队列中的另外 60 名患者（80% 女性，中位年龄 = 80，IQR = 12）。干预：(1) 护理人员的教育，(2) 系统认知筛查，(3) 由谵妄资源护士、老年护理专家或老年心理科医生提供的咨询服务，以及 (4) 使用预定的疼痛方案。 测量：通过混乱评估方法 (CAM) 测量，对所有患者进行谵妄体征监测。使用 CAM 的变体评估谵妄的严重程度。认知和功能状态分别通过简易精神状态检查 (MMSE)（包括记忆、语言能力、注意力和精神运动执行技能分量表）和卡茨日常生活活动指数 (ADL) 来测量。 结果：虽然对谵妄发生率没有显着影响（对照组为 23.3%，干预组为 20.0%；P = .82），但持续时间 干预队列中谵妄发生时间较短 (P = .03)，谵妄严重程度较低 (P = .0049)。此外，与非干预队列相比，干预队列中的神志不清患者的临床认知功能更高。此外，干预队列中神志不清的患者术后住院时间有缩短的趋势。尽管有这些积极的干预效果，但没有发现对 ADL 康复有影响。死亡风险的结果尚无定论。结论：这项研究证明了针对老年髋部骨折患者谵妄的早期识别和治疗的干预计划的有益效果，并根据谵妄的持续时间和严重程度证实了该综合征的可逆性。
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/non-intervention 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.