A daily 30-minute regimen designed to help elderly surgery patients stay oriented can cut the rate of postoperative delirium in half and help them return home sooner, according to a test among 377 volunteers in Taipei.
After they were moved out of an intensive care unit, 15.1 percent given conventional treatment experienced delirium. But when hospital workers got patients moving faster, helped them brush their teeth, gave them facial exercises and talked to them in ways to help them understand what was happening, the delirium rate was just 6.6 percent.
And while the patients who didn’t get the intervention typically stayed in the hospital for 14 days, those who did were discharged an average two days sooner.
The study “draws needed attention to delirium,” which can cause problems when confused patients, for example, try to extricate themselves from the tubes and equipment needed to recover, said Lillian Kao, acute care surgery chief for McGovern Medical School at the University of Texas Health Science Center in Houston, who wasn’t involved with the study.
Estimates of delirium’s prevalence vary widely, ranging from 13 percent to 50 percent among people who have non-heart surgery, according to an editorial accompanying the study, which appears in JAMA Surgery.
People 65 and older are particularly vulnerable. Delirium is believed to cost the U.S. health-care system more than $164 billion a year, yet up to 40 percent of cases could be preventable, the researchers write.
In the new study, all 377 patients were hospitalized for abdominal surgeries, about 90 percent of them involving removal of a malignant tumor. They ranged in age from about 69 to 80 years old, and half were randomly assigned to receive the usual care and half to receive the interventional strategy used in the study, known as mHELP.
Specially trained nurses started visiting the mHELP patients as soon as they were moved to the inpatient ward from the ICU. The nurse asked each patient about events of the past days to try to orient them or simply to get them talking on a subject that interested them. They also had patients practice exercises involved in eating and oral health. The patients were also encouraged to stretch, stand and start walking as quickly as possible.
Another pair of trained nurses, unaware of which experimental group a patient was in, assessed all of the study participants daily for delirium. The patients were considered to be delirious if they couldn’t pay attention and if they experienced either an altered state of consciousness or disorganized thinking.
Cheryl Chia-Hui Chen, professor of nursing at National Taiwan University, and her colleagues estimated that for every dozen people treated with mHELP, one case of delirium would be prevented.