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The effects of a targeted multicomponent delirium intervention on postdischarge outcomes for hospitalized older
Sidney T Bogardus1, Mayur M Desai, Christianna S Williams
1Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06504, USA. bogardus@ynhh.org
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.
