Occupational Therapy for Establishing a Morning Routine to Prevent Delirium After Hip Fracture Surgery: A Randomised...

Area of Science:

• Geriatric Medicine
• Orthopedic Surgery
• Rehabilitation Therapy

Background:

• Older patients undergoing hip fracture surgery face a high risk of postoperative delirium.
• Multicomponent, non-pharmacological interventions are recommended for delirium prevention, but specific components lack consensus.
• An occupational therapy program to establish a morning routine (OT-EMR) was developed based on Cochrane review recommendations.

Purpose of the Study:

• To assess the feasibility of the OT-EMR program in patients aged 80 years and older following acute hip fracture surgery.
• To evaluate the impact of OT-EMR on delirium incidence and quality of life (QOL) in this patient population.

Main Methods:

• A randomized controlled feasibility trial compared OT-EMR with usual occupational therapy.
• Interventions included daily morning activities of daily living support and group therapy sessions.
• Primary outcomes were delirium occurrence within 14 days and QOL at 7 and 14 days post-operation.

Main Results:

• The study enrolled 49 patients (51% recruitment rate); 45 completed.
• Delirium incidence was 45.5% with OT-EMR vs. 56.5% in controls; median delirium duration was 1.5 vs. 3.0 days.
• Mean QOL scores were higher in the OT-EMR group, but effect sizes were small across all outcomes.

Conclusions:

• The OT-EMR program demonstrated feasibility in older hip fracture patients.
• The program showed small effects on reducing delirium incidence and improving QOL.
• Further refinements in program implementation and research methodology are necessary for future studies.