The effects of a targeted multicomponent delirium intervention on postdischarge outcomes for hospitalized older adults☆
Received 7 November 2001; received in revised form 9 October 2002; accepted 17 October 2002.
Abstract
Purpose
We sought to determine whether a multicomponent hospital-based intervention targeted toward risk factors for delirium had any effect on patient outcomes 6 months later.
Methods
We studied 705 patients aged 70 years or older who had been enrolled in a controlled trial of a multicomponent intervention at an academic medical center and who survived for at least 6 months after hospitalization. Outcomes included self-rated health, functional status, incontinence, depression, cognitive status, delirium, home health visits, homemaker visits, rehospitalization, and nursing home placement.
Results
Overall, there were no differences between the intervention and control groups for any of the 10 outcomes, except that incontinence was slightly less common in the intervention group (30% [103/344] vs. 37% [132/354], P = 0.02). Among high-risk patients, those in the intervention group had better self-rated health (among those with poor/bad self-rated health at baseline, P <0.001) and better functional status (among those with baseline functional impairment, P <0.001). There were no effects in the other six high-risk subgroups, including cognitive and behavioral outcomes (Folstein Mini-Mental State Examination, Geriatric Depression Scale, incontinence, and delirium) and health care utilization.
Conclusion
In the group as a whole, we were unable to identify a lasting beneficial effect of the multicomponent intervention, although further efforts to identify appropriate subgroups for targeted interventions may be worthwhile. Other strategies are needed after hospital discharge to deter deterioration in susceptible elderly people.
aDepartment of Internal Medicine (STB, DA, SKI), Yale University School of Medicine, New Haven, Connecticut, USA
bDepartment of Epidemiology and Public Health (MMD, LLS), Yale University School of Medicine, New Haven, Connecticut, USA
cSheps Center for Health Services Research (CSW), University of North Carolina, Chapel Hill, North Carolina, USA
Requests for reprints should be addressed to Sidney T. Bogardus, Jr, MD, Department of Internal Medicine (Geriatrics), Yale University School of Medicine, 20 York Street, Tompkins 15, New Haven, Connecticut, USA 06504
☆ This research was supported in part by grants from the National Institute on Aging (RO1 AG12551), Bethesda, Maryland, and by the Claude D. Pepper Older Americans Independence Center (P60 AG10469), Yale University. Dr. Bogardus is a recipient of a Pfizer/American Geriatrics Society Postdoctoral Fellowship for Research on Health Outcomes in Geriatrics. Dr. Inouye is a recipient of a Midcareer Award (K24 AG00949) from the National Institute on Aging and a Donaghue Investigator Award (DF98-105) from the Patrick and Catherine Weldon Donaghue Medical Research Foundation, West Hartford, Connecticut.
ABSTRACT
