A complex intervention to promote prevention of delirium in older adults by targeting caregiver’s participation during and after hospital discharge – study protocol of the TRAnsport and DElirium in older people (TRADE) project
Creators: name: Leinert, Christoph
name: Brefka, Simone
name: Braisch, Ulrike
name: Denninger, Natascha
name: Müller, Martin
name: Benzinger, Petra
name: Bauer, Jürgen M.
name: Bahrmann, Anke
name: Frey, Norbert
name: Katus, Hugo
name: Geisler, Tobias
name: Eschweiler, Gerhard W.
name: Klaus, Jochen
name: Seufferlein, Thomas
name: Schütze, Konrad
name: Gebhard, Florian
name: Dreyhaupt, Jens
name: Muche, Rainer
name: Pahmeier, Kathrin
name: Biermann-Stallwitz, Janine
name: Wasem, Jürgen
name: Flagmeier, Lena
name: Dallmeier Rojas, Dhayana Elizabeth
name: Denkinger, Michael D.
Publisher: name: Universität Ulm
Year: 2021
Subjects: subject: Complex intervention
subject: Geriatrics
subject: Older adults
subject: CONFUSION ASSESSMENT METHOD
subject: ELDER LIFE PROGRAM
subject: DDC 610 / Medicine &amp; health
subject: Hospitals; Admission and discharge
subject: Older people
subject: Continuity of patient care
subject: Aged
subject: Delirium
subject: Dementia
subject: Patient discharge
subject: Patient safety
subject: Risk factors
subject: Surveys and questionnaires
subject: Caregivers
subject: Krankenhausaufenthalt
subject: Entlassungsplanung
subject: Alter
subject: Demenz

description: Background Among potentially modifiable risk factors for delirium, transfers between wards, hospitals and other facilities have been mentioned with low evidence. TRADE (TRAnsport and DElirium in older people) was set up to investigate i) the impact of transfer and/or discharge on the onset of delirium in older adults and ii) feasibility and acceptance of a developed complex intervention targeting caregiver’s participation during and after hospital discharge or transfer on cognition and the onset of delirium in older adults. Methods The study is designed according to the guidelines of the UK Medical Research Council (MRC) for development and evaluation of complex interventions and comprises two steps: development and feasibility/piloting. The development phase includes i) a multicenter observational prospective cohort study to assess delirium incidence and cognitive decline associated with transfer and discharge, ii) a systematic review of the literature, iii) stakeholder focus group interviews and iv) an expert workshop followed by a Delphi survey. Based on this information, a complex intervention to better and systematically involve family caregivers in discharge and transport was developed. The intervention will be tested in a pilot study using a stepped wedge design with a detailed process and health economic evaluation. The study is conducted at four acute care hospitals in southwest Germany. Primary endpoints are the delirium incidence and cognitive function. Secondary endpoints include prevalence of caregiver companionship, functional decline, cost and cost effectiveness, quality of discharge management and quality of admission management in admitting hospitals or nursing homes. Data will be collected prior to discharge as well as after 3, 7 and 90 days. Discussion TRADE will help to evaluate transfer and discharge as a possible risk factor for delirium. In addition, TRADE evaluates the impact and modifiability of caregiver’s participation during patient’s transfer or discharge on delirium incidence and cognitive decline providing the foundation for a confirmatory implementation study.