Clinical trial NCT04737733: Effects of a Dementia-friendly Program
Official title: Effects of a Dementia-friendly Program on Detection and Management of Patients With Cognitive Impairment and Delirium in Acute-care Hospital Units: a Non-equivalent Control Group Design
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Delirium
Cognitive Impairment
Dementia
Lead sponsor: Oslo and Akershus University College
Sponsor class: OTHER
First posted: 2021-02-04
Enrollment: 423
Sex: ALL
Minimum age (years): 75
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: A non-equivalent control group design with a historical control group
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Frail older persons with cognitive impairment are at special risk of experiencing delirium during acute hospitalisation. The purpose of this study was to investigate whether a dementia-friendly hospital program contributes to improved detection and management of patients with cognitive impairment and delirium.

Detailed description: Study design This study, has a non-equivalent control group design and a historical control Group. The Control group received usual care and the experimental group received usual care plus the dementia-friendly program.

One Group received care after implementing the dementia-friendly hospital program. The study is performed at two medical wards at a large acute-care hospital in Norway. A medical pulmonary ward and a cardiac ward participated.

Data Collection:

Demographic data included age, gender, place of residence (home, adapted housing, institution), and family/relative network, and were obtained upon admission to the study.

Medical data included cause of admission, active medical diagnoses, medications and medical treatment, and were obtained both at admission and from their electronic medical records after discharge.

Cognitive Impairment and delirium were assessed with two different screening tools: the Four Assessment Test (4AT) and the Confusion Assessment Method (CAM).

For all patients with a positive 4AT (≥1) or identified cognitive impairment during their hospital stays, a thorough review of the patient's journal was conducted upon discharge to record if, in case of yes, which type of preventive or treatment measures according to the dementia-friendly program, the patients had received during their stays.

Eligibility criteria: Inclusion Criteria:

* Patients ≥75 years
* acute admission to the cardiac or pulmonary wards.
* Patient who has given informed written consent, or proxy consent from relatives for patients who lacked cognitive capacity.

Exclusion Criteria:

* Readmitted patients enrolled in a previous hospital stay.
* Patients who do not have sufficient verbal function or hearing to communicate
* Patients in a coma or too ill to participate
* Patients who are isolated
* Patients who do not wish to participate or relatives who do not want the patient to participate, in the cases where the patient lacked cognitive capacity to consent.

Primary outcomes:
measure: Detection of patients with cognitive impairment
timeFrame: During the stay at the participating wards, assessed from the electronical medical record within 6 months after discharge
measure: Management of patients with cognitive impairment and delirium
timeFrame: During the stay at the participating wards, assessed from the electronical medical record within 6 months after discharge
Secondary outcomes:
measure: Screening within 24 hours
timeFrame: Within 24 hours after admission to the ward
measure: Use of antipsychotics, hypnotics and sedatives
timeFrame: During the stay at the participating wards, assessed from the electronical medical record within 6 months after discharge
measure: Use of medications not recommended for the patient group
timeFrame: During the stay at the participating wards, assessed from the electronical medical record within 6 months after discharge
measure: Departure to rehabilitation or nursing home
timeFrame: Assessed from the electronical medical record, within 6 month after discharge
measure: Length of hospital stay
timeFrame: Assessed from the electronical medical record, within 6 month after discharge
measure: Delirium
timeFrame: Assessed from the electronical medical record, within 6 month after discharge
measure: 30-day readmission to the hospital
timeFrame: Readmissions to the hospital were assessed from the electronical medical record 30 days after discharge.
measure: 30-day mortality
timeFrame: Mortality were assessed from the electronical medical record 30 days after discharge.
Other outcomes:
Locations:
city: Lørenskog
country: Norway
facility: University hospital, Akershus
Study officials:
affiliation: University Hospital, Akershus
name: Nina M Weldingh, Master
role: PRINCIPAL_INVESTIGATOR
References:
citation: Weldingh NM, Mellingsaeter MR, Hegna BW, Benth JS, Einvik G, Juliebo V, Thommessen B, Kirkevold M. Impact of a dementia-friendly program on detection and management of patients with cognitive impairment and delirium in acute-care hospital units: a controlled clinical trial design. BMC Geriatr. 2022 Mar 31;22(1):266. doi: 10.1186/s12877-022-02949-0.