Less delirium with focus on mobility, nutrition, and cognitive engagement for older hospitalized patients (CHERISH)

Référence

Mudge AM, McRae P, Banks M, et al. Effect of a ward-based program on hospital-associated complications and length of stay for older inpatients: the cluster randomized CHERISH trial. JAMA Intern Med 2022;182(3):274-282.

Sommaire

These investigators evaluated a ward-based program focused on older adults admitted to acute medical and surgical wards in 4 hospitals in Australia. The “Eat Walk Engage” program prioritized delivery of nutrition, hydration, mobility, and cognitive engagement to hospitalized patients. On each of 4 study wards, a site facilitator assembled a multidisciplinary working group to implement structured interventions. Examples of interventions included assisting patients to sit in chairs for meals, encouraging patients to walk, providing patients with opportunities for small group activities, and giving patients access to puzzles, games, and books. The 4 control wards provided usual care. Patients 65 years and older admitted to the hospital for 3 or more days were eligible for the study (n = 265 in the intervention group, n = 274 in the control group). Those with terminal illness and severe cognitive impairment without a surrogate decision-maker were excluded. The primary outcomes were length of stay and any hospital-associated complications of older people (HAC-OP), defined as a composite measure of delirium, hospital-associated disability, incontinence, falls, or pressure injuries. At baseline, the intervention group was younger, less frail, and had less functional and cognitive impairment. After adjusting for these and other factors, no significant differences were detected in length of stay (6 days in the intervention group vs 7 days in the control group) or in the incidence of HAC-OPs (46% in the intervention group vs 52% in the control group; adjusted odds ratio [OR] 1.07; 95% CI 0.71 - 1.61). However, when looking at the individual outcome of delirium, the intervention group fared better (16% vs 31%, adjusted OR 0.53; 0.31 - 0.90). Other secondary outcomes including the other individual components of HAC-OP, discharge to a facility, mortality, and readmissions were similar in the 2 groups.