The effectiveness of nursing management on improving health outcomes for hospitalized older adults with delirium: A systematic review protocol

Abstract

The objective of this systematic review is to identify the best available research evidence related to the effectiveness of nursing management on improving health outcomes for hospitalized older adults with delirium. The specific review questions to be addressed are: What is the effectiveness of nursing interventions on: Ÿ reducing the duration, severity and incidence of delirium? Ÿ reducing the decline in cognitive status and functional status? Ÿ reducing mortality? Ÿ reducing length of hospital stay in hospitalized older adults? Specific nursing interventions include: systematic detection/screening of delirium, systematic geriatric or psychiatric consultation or consultation services by a geriatric nurse specialist, follow-up by a nurse, nursing intervention protocol designed for delirious patients, music therapy, and scheduled pain medication protocol. Inclusion criteria Types of participants Older adults aged 65 or above being admitted into acute care hospitals. Those with communication barriers such as aphasia or delirium due to substance abuse will be excluded. Types of intervention(s) For the purpose of this review, nursing management is defined as any interventions that are coordinated, led or delivered by nursing staff aiming to reduce the duration, severity, incidence, and decline on cognitive and functional status, mortality and length of hospital stay on admitted older patients with delirium. The interventions include: -a systematic screening of all admitted older adults for delirium -an intervention protocol on environmental control, patient orientation, familiarity to the environment, communication with patients and patient activities -a consultation service to geriatric or psychiatric specialist to give advice on individualized care -an alteration on care system from task-oriented to patient oriented -a scheduled pain medication protocol -music therapy according to the patients need throughout their hospitalization. Studies with multi-components or single intervention will be included in the review and a subgroup analysis will be performed. The comparator is the usual care that was done in the hospital. For detection of delirium in a usual care setting, detection of delirium relies on diagnosis by a psychiatrist or physician upon referral when agitation and disorientation are sensed by nurses. The consultation service can only be referred by physicians in-charge. No treatment plan or music therapy was designed. No standardized pain medication protocol was established. Pain medication regimen is different according to the preference of physicians. Types of outcomes The primary outcome for quantifying the effect of the interventions is the duration, severity and incidence of delirious older adults admitted to hospital. Diagnostic criteria according to the DSM-IV-TR will be adopted in evaluating the incidence of delirium. Severity of delirium will be measured by the Delirium index. The secondary outcome of interest is on the cognition and functional status, mortality and the length of hospital stay of the participants. Cognitive status will be measured by using scales such as Mini-Mental State Examination (MMSE). Functional status will be measured by using tools such as and Katz Index of Independence in Activities of Daily Living (ADL) index.