The New Jewish Home, New York, New York, USA.
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Am Geriatr Soc. 2020 Oct;68(10):2329-2335. doi: 10.1111/jgs.16695. Epub 2020 Jul 25.
BACKGROUND/OBJECTIVES: The Hospital Elder Life Program (HELP) has been shown to prevent delirium in hospitalized older adults. The objective of this study was to test the efficacy of HELP adapted to long-term care (HELP-LTC).
Cluster randomized controlled trial.
A 514-bed academic urban nursing home.
A total of 219 long-term nursing home residents who developed an acute illness or change in condition were randomly assigned to HELP-LTC (n = 105) or usual care (n = 114) by unit.
HELP-LTC is a multicomponent intervention targeting delirium risk factors of cognitive impairment, immobility, dehydration, and malnutrition. Two certified nursing assistants (CNAs) delivered HELP-LTC components twice daily 7 days per week. In addition, recommendations were given to primary providers to reduce medications associated with delirium.
Delirium (primary outcome) and delirium severity were ascertained each weekday by a research assistant blinded to group assignment, using the Confusion Assessment Method (CAM) and CAM severity score (CAM-S), respectively. Cognitive function was determined using the Cognitive Performance Scale (CPS). Hospitalization was ascertained by chart review.
Participants were 81.7 years of age on average and 65.3% female. At baseline, usual care group participants had better cognitive function than intervention group participants (CPS = 1.33 vs 2.25; P = .004). Delirium symptoms declined over the course of the episode (mean CAM-S = 3.63 at start vs 3.27 at end). Overall, 33.8% of the total sample experienced incident delirium. After adjusting for baseline cognitive function, no significant differences were found in delirium or delirium severity between intervention and usual care groups. Hospitalization was not significantly different between groups.
An intervention targeting delirium risk in long-term nursing home residents did not prevent delirium or reduce delirium symptoms. Baseline differences in cognitive function between groups, greater than expected improvements in both groups, quality-enhancing practices such as consistent assignments delivered to both groups, and adaptations of the intervention may have biased results toward null. J Am Geriatr Soc 68:2329-2335, 2020.
背景/目的：医院老年人生活计划（HELP）已被证明可预防住院老年人的谵妄。本研究的目的是测试适用于长期护理的 HELP（HELP-LTC）的疗效。
集群随机对照试验。
一个拥有 514 张床位的城市学术型养老院。
共有 219 名患有急性疾病或病情变化的长期养老院居民被随机分配到 HELP-LTC（n = 105）或常规护理（n = 114）组。
HELP-LTC 是一种针对认知障碍、活动能力下降、脱水和营养不良等谵妄危险因素的多组分干预措施。两名认证的护理助理（CNA）每周 7 天每天 2 次提供 HELP-LTC 成分。此外，还向主要提供者提出了减少与谵妄相关的药物的建议。
使用研究助理对组分配进行盲法评估，每周 5 天每天评估一次谵妄（主要结局）和谵妄严重程度，使用意识混乱评估方法（CAM）和 CAM 严重程度评分（CAM-S）。认知功能通过认知表现量表（CPS）确定。通过病历回顾确定住院情况。
参与者的平均年龄为 81.7 岁，65.3%为女性。在基线时，常规护理组参与者的认知功能优于干预组参与者（CPS = 1.33 比 2.25；P =.004）。在整个过程中，谵妄症状逐渐缓解（平均 CAM-S = 3.63 在开始时比 3.27 在结束时）。总的来说，总样本中有 33.8%发生了谵妄。调整基线认知功能后，干预组与常规护理组在谵妄或谵妄严重程度方面无显著差异。两组间的住院情况无显著差异。
针对长期养老院居民谵妄风险的干预措施并未预防谵妄或减轻谵妄症状。组间基线认知功能的差异，两组中超出预期的改善，以及向两组提供的一致分配等质量增强实践，以及干预措施的调整可能使结果偏向于无效。J Am Geriatr Soc 68:2329-2335, 2020.
