A program involving family members reduces postoperative delirium in elderly patients

Référence

Wang Y, Yue J, Xie D, et al. Effect of the tailored, family-involved hospital elder life program on postoperative delirium and function in older adults. JAMA Intern Med 2020;180(1):17-25.

Sommaire

POD is a common condition in elderly patients. The Hospital Elder Life Program has been shown to reduce delirium in older, hospitalized patients, but its implementation can be difficult because of cost and the need for staffing. In this trial based in a hospital in China, investigators studied the Tailored, Family-Involved, Hospital Elder Life Program (t-HELP), which used family members and caregivers to provide the program's interventions. Investigators enrolled patients 70 years and older who were admitted to 1 of 24 nursing units on 6 surgical floors after an elective surgery with an anticipated length of stay of more than 2 days. Each of the 24 units were randomized to provide either t-HELP (n = 152) or usual care (n = 129). The t-HELP program consisted of 3 universal protocols and 8 targeted protocols. The universal protocols were orientation, therapeutic activities, and early mobilization. The targeted protocols were based on a patient's individual delirium risk factors and included pain management, sleep enhancement, nutrition assistance, fluid repletion/prevention of constipation, vision and hearing enhancement, hypoxia improvement, and prevention of catheter-associated urinary tract infections. Family members were educated on delirium prevention and they assisted in providing the t-HELP interventions. Patients in the study had a mean age of 75 years and 61% were men. Overall, POD within 7 days from surgery occurred at a rate of 19.4% in the usual care group as compared with 2.6% in the t-HELP group (relative risk 0.13; 95% CI 0.05 - 0.38; number needed to treat = 6). The t-HELP group also had decreased incidence of severe delirium (9.6% vs 1.5%; P = .008) and shorter length of stay (16.4 days vs 12.2 days; P <.001). Additionally, patients in the t-HELP group had less decline in physical and cognitive function at discharge than the usual care group.