Early and intensive occupational therapy in prevention of delirium in older adults admitted to critical patient unit. randomized clinical trial: preliminary results

Abstract

Objective: To compare the efficacy of standard non pharmacological prevention of delirium versus intensified prevention of delirium (standard prevention plus early and intensive Occupational Therapy) in the incidence of delirium in older adults (OA) admitted to critical patient unit (CPU). Desing: Randomized control trial, blinded to outcome evaluator, in the CPU of Hospital Clinico Universidad de Chile. Subjects: 70 patients aged 60 years or older, admitted to CPU between April and October of 2011, with need for admission to CPU for monitoring, acute or decompensated chronic illness, without cognitive impairment\xa0 and consent by patient or family member. Materials and Methods: Standard prevention group consisted in: reorienting, early mobilization, correction of sensory deficit, environmental management, protocol of sleep and reduction of drugs, and intensified prevention based on standard measured plus early and intensive Occupational Therapy: multisensory stimulation, positioning, cognitive stimulation, training in activities of daily living, motor stimulation of the upper extremities and family participation, twice a day for 5 days. Delirium was evaluated (twice a day for 5 days) with CAM and severity with DRS. Primary outcome was delirium incidence, and secondarily were functional independence (FIM), cognitive status (MMSE) and strength of grip with Jamar dynamometer at leaving. Results: Early intervention and intensive occupational therapy is associated with lower incidence of delirium, affecting 16.1% of non-pharmacological standard prevention group and 3.1% of intensified prevention group, as well as fewer days of hospitalization (20, 6 days versus 10,4, p= 0,009). The functional independence at leaving keeps in cognitive (32.5 versus 32.9) and is increases significantly in motor aspects (46.5 versus 58.3 l, P =. 03). Conclusion: Standard prevention plus early intensive intervention of Occupational Therapy is effective in preventing delirium in hospitalized OA, reduces their stay and increases levels of functional independence at leaving.