Delirium is one of the oldest forms of mental disorder known in medical history. It is also one of the least understood and recognized, according to Donna Fick, professor of nursing at Penn State. That misunderstanding can result in devastating consequences for elderly hospital patients, particularly those with dementia.
Fick and her colleague Ann Kolanowski, the Elouise Ross Eberly professor of nursing and director of the Hartford Center of Geriatric Nursing Excellence at Penn State, are attempting to shed light on the condition and to better equip hospital nurses to recognize and manage it when it occurs.
In medical terms, delirium is an acute state of confusion that can result from certain diseases, drug reactions and other causes. It is a reversible change in mental status that occurs in more than 40 percent of people with dementia. Though delirium commonly occurs in elderly hospital patients, it often goes undetected by health care professionals. This can lead to overmedication, falls or other complications including, in some cases, death.
When patients with dementia have an acute change in cognition, it may be missed, mislabeled or misattributed to dementia alone, Fick explains.
Fick is leading a five-year, $2.7 million study funded by the National Institutes of Health aimed at improving early nurse detection and care of patients experiencing delirium superimposed on dementia. The goal is to provide hospitals with the tools to better manage this condition and ultimately improve patient outcomes, which could include resolving the delirium in a shorter time, or increasing use of nondrug approaches in patient care.
Ficks study is a clinical trial that involves nursing rounds of carefully selected acute-care patients in the medical-surgical units of three medical centers, including Mount Nittany Medical Center. Led by a unit champion a staff nurse designated to implement and promote the study methods nurses are educated to look for signs of delirium in patients.
Nurses are essential to early detection, as they are at the bedside and are often the first health professionals to observe changes in patients mental status, Fick notes.
Another component of the study is a computerized decision support system with targeted screens for assessment, detection and modules for managing delirium symptoms. These may include enhancing sleep, getting patients out of bed, using sensory devices such as listening amplifiers and providing therapeutic touch and relaxing music.
The first course of action should not be to medicate a delirious patient with a sedative or psychoactive drug if a medical condition, such as pneumonia or infection, is causing the increased confusion, says Fick. Earlier nurse recognition and assessment of the potential causes of delirium are crucial to improving care for these patients.
In another study, Fick and Kolanowski are testing the effectiveness of cognitive stimulation in the form of recreational activities for resolving DSD. That five-year study, funded by a $2.4 million NIH grant, is being conducted in Pennsylvania nursing homes and rehabilitation centers, including Brookline, Centre Crest, Hearthside Rehabilitation and Nursing Center, and Windy Hill Village.
The purpose of the study is to find ways to help those experiencing delirium to recover more quickly, so they regain their health and return to more active lives, Kolanowski explains. We draw on participants inherent mental capacities by engaging them in simple but intellectually stimulating mental tasks. These may include puzzles, word searches, and games such as Name That Tune.
We are trying to find ways to help older adults who experience confusion to return to their homes and routines as soon as possible, Kolanowski says. Besides reducing their risk factors, one of the best ways to do this is to stimulate their minds. This is the kind of collaborative research that has the potential to improve health outcomes for older adults across the nation.
Beverly Molnar is a marketing communications specialist for the School of Nursing at Penn State.