Up to 50 percent of hospitalized older adults experience delirium, a state of acute (sudden onset) confusion that may be accompanied by inattention, disorganized thinking, sleep disturbance, and a host of other symptoms. Delirium costs the United States $164 billion annually in health care costs and can lead to physical and mental decline, nursing home placement, and even death. Yet many health care professionals lack the tools to identify and prevent delirium before it becomes costly and deadly.
Supported by $2.4 million from the National Institute on Aging, a new four-year interprofessional project, “Researching Efficient Approaches to Delirium Identification” (READI), aims to improve the care of older adults by developing an identification protocol to detect delirium in hospitalized adults age 70 and older. This new application will build on previous work by Donna Fick, Elouise Ross Eberly Professor of Nursing, whose research team in collaboration with Harvard Medical School developed a two-step bedside tool to quickly identify delirium in hospital patients.
Fick is a multiple principal investigator for the READI team at Penn State. Edward Marcantonio, professor of medicine at Harvard Medical School, is the other multiple principal investigator. The team consists of 14 additional investigators, including Penn State researchers Janice Penrod, professor of nursing, and Doug Leslie, professor of public health in the College of Medicine.
“Delirium is a reversible condition that can be resolved if caught and treated early,” Fick said. “The READI project will give us the tools and knowledge to implement a protocol that is practical, effective and cost efficient.”
Mount Nittany Medical Center in State College, Pa., participated in pilot testing of the bedside tool in 2015. Patients were asked what day of the week it was and to recite the months of the year backward. The screener took a median of 36 seconds to administer, with 100 percent sensitivity for CNAs and nurses and 80 percent for physicians.
A second goal of READI is to generate the evidence base needed to implement the new protocol in a larger future trial to prevent and manage delirium in older adults.
“This ultra-brief screener is a promising approach to improve delirium identification by clinicians,” Fick said.