The PREvention Program for Alzheimer's RElated Delirium (PREPARED) cluster randomized trial: a study protocol

Area of Science:

• Gerontology
• Clinical Nursing
• Public Health

Background:

• Delirium significantly increases morbidity and mortality in older adults in acute and long-term care facilities (LTCFs).
• Multicomponent interventions effectively reduce delirium in acute care settings, but their application in LTCFs is underexplored.
• Targeting modifiable risk factors is key to preventing delirium in vulnerable elderly populations.

Purpose of the Study:

• To assess the PREPARED Trial's effectiveness in reducing delirium incidence, severity, duration, and frequency among cognitively impaired LTCF residents.
• To evaluate a multicomponent intervention designed for delirium prevention in the long-term care setting.

Main Methods:

• A 4-year, cluster randomized trial involving 45-50 LTCFs in Montreal, Canada, with 400-600 residents aged 65+ with cognitive impairment.
• Intervention group received the PREPARED Trial program (decision tree, manual, training, toolkit); control group received usual care.
• Outcomes assessed weekly; functional autonomy and cognition assessed at baseline and end; data on risk factors, consultations, and transfers collected retrospectively.

Main Results:

• Primary outcomes (incidence, severity, duration, frequency of delirium) will be reported at the intervention assignment level.
• Functional autonomy and cognitive levels will be compared pre- and post-intervention.
• Data on modifiable risk factors, medical consultations, and transfers will be analyzed retrospectively.

Conclusions:

• This study is the first large-scale evaluation of a multicomponent delirium prevention program implemented in LTC clinical practice.
• Findings will inform evidence-based clinical guidelines for delirium prevention in frail elderly populations residing in LTCFs.
• The PREPARED Trial intervention has the potential to significantly improve care and outcomes for LTCF residents at risk of delirium.