Early Occupational Therapy for Delirium Prevention in Older Patients Admitted to Critical Care Unit
Condition: Delirium; Alteration of Cognitive Function; Incompetence, Functional
MeSH terms: Delirium
Study type: Interventional

Summary: 
      This is a randomized, controlled trial to compare the efficacy of two strategies of
      non-pharmacological prevention of delirium in critically non-ventilated older patients:

        -  standard non-pharmacological prevention

        -  intensive nonpharmacological prevention (standard non-pharmacological prevention plus
           early and intensive occupational therapy).
    

Detailed description: 
      Delirium is a complication in older, with incidences 70-87% in CCU. This increases mortality,
      hospital stay, hospital cost, and cognitive impairment. Occupational Therapy (OT) improves
      independence at discharge, and reduction in delirium in patients undergoing mechanical
      ventilation. This study compares the efficacy of non pharmacological standard prevention
      (control group) versus intensive nonpharmacological prevention (experimental group) in the
      delirium duration in older admitted CCU.
    

Intervention name(s): Early and Intensive Occupational Therapy; Standard non-pharmacological delirium prevention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Intervention group:Standard non-pharmacological prevention plus early and intensive OT. Begin in the first 24 hours in CCU admission. OT areas:1)Multi-sensory stimulation:Intense external stimulation, increase alertness,2)Positioning: Fixtures like dorxi-flexion splints, devices for preventing edema,etc,3)Cognitive Stimulation: Awareness, orientation, attention, memory, calculation, praxis and language,4)Training Activities of Daily Living (ADL): Keep a daily routine and independence in hygiene, grooming and feeding,5)Upper Limb Motor Stimulation (ULMS): Activate functional movement and strength ,6)Family involvement.
General Guidelines for intervention: Visit of an OT twice a day, 40 minutes each time, for 5 days; meeting of family training for promote strategies during the daily visit.; Non-pharmacological strategies are the first line of approach in the prevention of delirium. It is recommended to implement some of these strategies, which are: Reorientation protocol, including information 4 times a day about time, date, place and reason for hospitalization; early mobilization by physical therapist 3 times a day, corrected sensory impairment (use such as eyeglasses, hearing aids); environment management, use clock and calendar in the patient´s room, promote supervision of a professional or family to avoid physical restraints; sleep protocol, like lower light, noise and nighttime drug administration and finally, reduction of any anticholinergic drugs and minimize the use of benzodiazepines.
Other intervention name(s): Active hospital routine; Recommended non-pharmacological treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: older; delirium; cognitive status; occupational therapy; critically ill patients