OBJECTIVES:

To improve outcomes for cognitively impaired and delirious older adults.

DESIGN:

Pretest, posttest.

SETTING:

A university-affiliated hospital.

PARTICIPANTS:

Physicians and nurses in the emergency department (ED) and on an acute geriatric unit (AGU).

INTERVENTION:

Multifactorial and targeted to the processes of care for cognitively impaired and delirious older adults admitted to medicine service from the ED.

MEASUREMENTS:

Prevalence of delirium, admission to AGU, psychotropic medication use, hospital length of stay.

RESULTS:

Patient characteristics did not differ between baseline and the two outcome cohorts 4 and 9 months postintervention. Prevalence of delirium was 40.9% at baseline, 22.7% at 4 months (P<.002), and 19.1% at 9 months (P<.001). More delirious patients were admitted to the AGU than to non-AGU units at 4 months (P<.01) and 9 months (P<.01). Postintervention medication use in the hospital differed from baseline. Antidepressant use was greater at 4 months (P<.05). Benzodiazepine and antihistamine use were lower at 9 months (P>.01). Antidepressant and neuroleptic use were higher (P<.02) and antihistamine use was lower (P<.02) at 4 months on the AGU than for the baseline group. Benzodiazepine (P<.01) and antihistamine (P<.05) use were lower at 9 months. Each case of delirium prevented saved a mean of 3.42 hospital days.

CONCLUSION:

A multifactorial intervention designed to reduce delirium in older adults was associated with improved psychotropic medication use, less delirium, and hospital savings.