Abstract
BackgroundAmong potentially modifiable risk factors for delirium, transfers between wards, hospitals and other facilities have been mentioned with low evidence. TRADE (TRAnsport and DElirium in older people) was set up to investigate i) the impact of transfer and/or discharge on the onset of delirium in older adults and ii) feasibility and acceptance of a developed complex intervention targeting caregiver’s participation during and after hospital discharge or transfer on cognition and the onset of delirium in older adults.MethodsThe study is designed according to the guidelines of the UK Medical Research Council (MRC) for development and evaluation of complex interventions and comprises two steps: development and feasibility/piloting. The development phase includes i) a multicenter observational prospective cohort study to assess delirium incidence and cognitive decline associated with transfer and discharge, ii) a systematic review of the literature, iii) stakeholder focus group interviews and iv) an expert workshop followed by a Delphi survey. Based on this information, a complex intervention to better and systematically involve family caregivers in discharge and transport was developed. The intervention will be tested in a pilot study using a stepped wedge design with a detailed process and health economic evaluation. The study is conducted at four acute care hospitals in southwest Germany. Primary endpoints are the delirium incidence and cognitive function. Secondary endpoints include prevalence of caregiver companionship, functional decline, cost and cost effectiveness, quality of discharge management and quality of admission management in admitting hospitals or nursing homes. Data will be collected prior to discharge as well as after 3, 7 and 90 days.DiscussionTRADE will help to evaluate transfer and discharge as a possible risk factor for delirium. In addition, TRADE evaluates the impact and modifiability of caregiver’s participation during patient’s transfer or discharge on delirium incidence and cognitive decline providing the foundation for a confirmatory implementation study.Trial registrationDRKS (Deutsches Register für klinische Studien) DRKS00017828. Registered on 17th September 2019. Retrospectively registered.
Highlights
Among potentially modifiable risk factors for delirium, transfers between wards, hospitals and other facilities have been mentioned with low evidence
TRAnsport and DElirium in older people (TRADE) evaluates the impact and modifiability of caregiver’s participation during patient’s transfer or discharge on delirium incidence and cognitive decline providing the foundation for a confirmatory implementation study
Since both patients and relatives are targeted by the intervention, we focus on the recruitment of either group to identify possible barriers or facilitators in the process [57]
Summary
Among potentially modifiable risk factors for delirium, transfers between wards, hospitals and other facilities have been mentioned with low evidence. Delirium is a growing medical burden especially for hospitalized older adults with incidences of up to one third among those 70 years of age or older [1]. In a meta-analysis with 42 studies delirium in hospital and post-acute care was associated with increased post discharge mortality and institutionalization rates [2]. Risk factors for delirium are multidimensional and include non-modifiable aspects such as age, acute illness or pre-existing dementia [3]. Like major surgery, anesthesia, immobilization during inpatient treatment, drug side effects and several psychological, social and environmental factors are linked to acute hospital care itself and potentially modifiable [4,5,6,7]. Delirium prevention and treatment is, an indicator of patient safety and quality in modern health care settings [8, 9]
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