[This article first appeared in: Dementia: the Latest Evidence Newsletter (RWHT) Volume 1 Issue 5 December 2010].
Delirium is an often unrecognised, but very common, complication of hospitalisation in elderly people, affecting about one third of older patients admitted to medical wards. Delirium is associated with mortality rates of 25% – 33%, increased morbidity, functional decline and the need for institutional care. There is evidence that delirium could be prevented in about one third of patients, but these interventions are not yet routinely available in the NHS.
This research programme is conducted by academics at the University of Leeds and clinicians at Bradford Teaching Hospitals NHS Foundation Trust. It aims to develop, embed and evaluate a delirium prevention system of care for older people admitted to NHS acute hospitals.
The foundations of this research draw on the Hospital Elder Life Program, developed in the United States over 10 years ago and the recently published NICE Delirium Guideline which encapsulates current best evidence. The planned phases of this research project may be summarised as follows:
Project 1: December 2009 to May 2011
The research team is working alongside acute hospital staff at all levels in addition to volunteers and patient and carer representatives from three local trusts in Yorkshire. The aim is to produce a delirium prevention system of care which involves staff, volunteers and relatives that may be integrated into routine care delivery.
Currently they are over half way through Project 1 and have conducted workshops, interviews and focus groups with managers, staff, volunteers and patient and carer representatives. Early indications show considerable enthusiasm for volunteer involvement in enhancing patient care in specific aspects of delirium prevention (namely orientation, communication and engaging with patients). The research team has also identified knowledge, practice & organisational barriers to delirium prevention; upon which the intervention system and implementation strategies will focus.
Project 2: June 2011 to November 2013
The team plans to implement the draft delirium prevention system of care in wards in three different hospitals so that it may be tested for acceptability and feasibility.
Project 3: December 2013 to November 2015
The team plans to explore the effectiveness and cost-effectiveness of the delirium prevention system of care, versus standard care practice, by undertaking a cluster randomised controlled feasibility study in 6 hospitals.
The Research Unit and Team
Professor John Young, an elderly care consultant physician and Professor of Elderly Care Medicine, is head of the Academic Unit of Elderly Care and Rehabilitation (at the Bradford Institute for Health Research). The prime focus of the unit is on clinically relevant health services research directly addressing the national priorities of elderly care and stroke.
The Delirium Prevention Research Programme, led by Professor John Young, is being carried out by a core team of three researchers: John Green (Project Manager), Mary Godfrey (Senior Qualitative Researcher) and Jane Smith (Research Fellow).
Pre-Existing Initiatives and Resources
1) HELP: The Hospital Elder Life Program (HELP) is a US multi-component delirium prevention system of care developed by Professor Sharon Inouye and colleagues in Boston. Although successfully evaluated and adopted in North America and Australia, HELP has not been used in the UK. An innovative aspect of HELP is the use of hospital volunteers in addressing delirium prevention for older people in hospital.
2) NICE Delirium Guidelines: The Delirium Guideline was published in July 2010.
NICE clinical guideline CG103. Delirium: diagnosis, prevention and management. London: National Institute for Health and Clinical Excellence, 2010.
2b) NICE has developed tools to help organisations implement this guidance:
2c) Professor John Young and his colleagues at the Academic Unit of Elderly Care and Rehabilitation have written an overview of this guideline:
Young, J. Murthy, L. [and] Westby, M. [et al] (2010). Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ, July 28th 2010, Vol.341, c3704.