Monitoring Delirium in the Hospitalized Elderly

Wednesday, 19 July 2006
9:30 AM - 10:00 AM
Wednesday, 19 July 2006
2:30 PM - 3:00 PM

This presentation is part of : Poster Presentations I

Sonia Sandhaus, MS, RN, CRNP¹, Margarete Lieb Zalon, PhD, RN, APRN, BC², Faith Harrell¹, and Donna Valenti, RNC¹. (1) Hospital Elder Life Program, Moses Taylor Hospital, Scranton, PA, USA, (2) Department of Nursing, University of Scranton, Scranton, PA, USA

Delirium is a complex problem in the hospitalized elderly that is associated with increased mortality. Research has demonstrated that a program using volunteers, the Hospital Elder Life Program (HELP), is effective in reducing the incidence of delirium in the hospitalized elderly (Inouye, et al., 1999). The translation of research findings by implementing a HELP program presents a challenge for community hospitals with limited resources. Furthermore, once such a program is started, it is difficult to determine which outcomes might be directly associated with the intervention. The purpose is to illustrate the evaluation of health outcomes when monitoring the hospitalized elderly for delirium. Specifically, a marker for delirium, intravenous haloperidol and lorazepam use, in relation to patient enrollment in the HELP program will be used to illustrate the complexities of systematic outcome evaluation.

Patients aged 70 years and older are enrolled into the HELP program upon nurse or physician request. The HELP program consists of skilled interdisciplinary staff with geriatric expertise and trained volunteers who carry out interventions addressing special needs of older adults. Volunteers perform therapeutic activities which include communication/comfort, relaxation, meal assistance and recreation. This will be a retrospective analysis of parenteral use of haloperidol and lorazepam in relation to patient participation in the HELP program.

The sample will consist of patients aged 70 years and older admitted to one of three medical-surgical units over a four-month period (N = 1117) at a community hospital.

The results will report differences in psychoactive medication use among patients enrolled or not enrolled in the HELP program. Potential confounding variables will be reported.

Implications for ongoing evaluation of patient outcomes will be described. Detection of differences in delirium between enrolled and non-enrolled patients may be compounded by referral to the HELP program after delirium onset.

Learning Objective #1: describe the relationships among intravenous psychoactive medication use, a volunteer program designed to preserve cognitive function and delirium in the hospitalized elderly.
Learning Objective #2: describe the complexities of evaluating patient outcomes within the context of a program designed to translate delirium prevention research into practice.