A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

Thai Lian Tan,Mei Sian Chong,Huey Charn Han,Mark Pc Chan,Yew Yoong Ding,Jasmine Kang

doi:10.1186/1471-2318-11-41

Abstract

BackgroundDelirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU) where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care.Methods/DesignGMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors) and undertook satisfaction surveys for caregivers of patients treated in GMU.DiscussionThis study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care, but also improved staff knowledge and satisfaction. The model may then be transposed across various locations and disciplines in the acute hospital where delirious patients could be sited.Trial RegistrationCurrent Controlled Trials ISRCTN52323811

Highlights

Delirium is a common and serious condition, which affects many of our older hospitalised patients
This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care, and improved staff knowledge and satisfaction
Project overview The Geriatric Monitoring Unit (GMU) concept was developed via an evidence-based approach using specific interventions that have been found to be beneficial for delirium care

Summary

Introduction

Delirium is a common and serious condition, which affects many of our older hospitalised patients It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. The prevalence in hospitalised elderly patients is shown to be as high as 50%, with the diagnosis in 11-24% of older patients upon admission and another 5-35% of them developing delirium during admission [1,2] It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment. The Assessing Care of Vulnerable Elders Project has ranked delirium among the top 3 conditions for which the quality of care needs to be improved [10,11].

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