Caregiver-based Intervention for Persistent Delirium

描述（申请人提供）：超过三分之一的住院老年人出现谵妄，其中一半以上的病例谵妄持续存在。持续性谵妄与患者预后不良相关，并且还导致大量护理人员压力和负担。在过去的5年里，我们一直在进行一项由NIH资助的随机试验，在急性后熟练护理机构中进行谵妄减轻计划。我们目前的建议建立在我们对持续性谵妄患者及其护理人员的广泛经验基础上。我们将进行一项为期15个月的持续性谵妄（CIPD）基于护理人员的干预的试点随机试验，该试验将招募48名患者-护理人员。在住院期间，将对患者进行谵妄筛查，如果出现谵妄，将联系护理人员以评估合格性并提供知情同意书。初始筛选后或出院前谵妄持续3天的患者将以2：1的比例随机分配至CIPD组与常规治疗组。根据社会认知理论，CIPD将聘请一名老年学护士作为健康教练，在出院前让护理人员制定一个针对谵妄的个性化健康行动计划。出院后，执业护士将继续与护理人员一起工作，每周一次，持续6周，包括2次家访。在此之后，在12周干预期的剩余时间内，至少每两周进行一次接触。患者结局将是随机化后2、6和12周测量的谵妄症状和ADL功能的变化。照顾者的结果将是在同一时间点的负担，自我效能和健康状况的变化。我们拟议的试点试验有以下具体目标：1）确定对持续性谵妄患者进行基于康复者的健康教练介导的干预的可行性，2）对所有登记的护理人员进行定性访谈，以更好地了解他们对持续性谵妄的经历，并获得有关如何改善我们干预的反馈，获得患者和护理者终点的累积率和效应量的初步估计，以设计确定性随机对照试验。如果有希望的话，我们的研究结果将作为一项确定性试验的试点数据，以测试这种改善老年人及其照顾者弱势群体健康的新策略。

DESCRIPTION (provided by applicant): Over one-third of hospitalized elders develop delirium, and in more than half of these cases, delirium is persistent. Persistent delirium is associated with poor patient outcomes, and also leads to substantial caregiver stress and burden. For the past 5 years, we have been conducting an NIH-funded randomized trial of a Delirium Abatement Program in post-acute skilled nursing facilities. Our current proposal builds upon our extensive experience with patients with persistent delirium and their caregivers. We will conduct a 15-month pilot randomized trial of a Caregiver-based Intervention for Persistent Delirium (CIPD) that will enroll 48 patient-caregiver dyads. Patients will be screened for delirium while inpatients, and if delirious, caregivers will be contacted to assess eligibility and provide informed consent. Patients whose delirium persists for 3 days after the initial screening or until hospital discharge will be randomized to CIPD vs. usual care in a 2:1 ratio. Based on Social Cognitive Theory, the CIPD will employ a gerontological nurse practitioner serving as a health coach who will engage caregivers in developing an individualized health action plan for delirium prior to hospital discharge. After hospital discharge, the nurse practitioner will continue to work with the caregiver at weekly intervals for six weeks, including 2 home visits. After this period, there will be at least biweekly contacts over the remainder of the 12-week intervention period. Patient outcomes will be change in delirium symptoms and ADL function, measured 2, 6, and 12 weeks after randomization. Caregiver outcomes will be change in burden, self-efficacy, and health status at the same time points. Our proposed pilot trial has the following Specific Aims: 1) To determine the feasibility of performing a caregiver-based health coach-mediated intervention in patients with persistent delirium, 2) To perform qualitative interviews of all enrolled caregivers to better understand their experience of persistent delirium and to obtain feedback on how to improve our intervention, and 3) To obtain preliminary estimates of accrual rates and effect sizes for patient and caregiver endpoints to enable the design of a definitive randomized controlled trial. If promising, our findings will serve as pilot data for a definitive trial to test this novel strategy to improve the health of a vulnerable population of elders and their caregivers.