Penn State Improving Treatment of Delirium, Dementia

July 21, 2010

Penn State researchers are helping nurses more accurately detect and alleviate symptoms of delirium in persons with dementia, which will improve health outcomes in patients. The project seeks to improve assessment skills and reduce the use of drugs to treat delirium and dementia. The five-year study, a collaboration between several universities being led by Dr. Donna Fick, professor of nursing, received a $2.7-million grant from the National Institute of Nursing Research.

Delirium and dementia present similar symptoms—decline in cognitive abilities such as memory, attention, and problem solving—but they have radically different causes and treatments. Dementia is a chronic, progressive condition that increases with age. Delirium, in contrast, is an acute condition that has a rapid onset and results from multiple insults to the body, such as dehydration, infection, or a drug side effect.

“Delirium is reversible, preventable, and treatable,” says Fick.

Many patients with dementia—about 40 percent, says Fick—also develop bouts of delirium, a condition known as “Delirium Superimposed on Dementia” (DSD). DSD “substantially worsens outcomes in a population who are already burdened by functional decline,” says Fick.

Sifting through the various shades of cognitive decline is no easy task. To make matters worse, some doctors and nurses automatically opt for a drug treatment, which can lead to further problems such as falls or worsened delirium.

Fick found in past research that nurses are common initiators of drug treatments, so educating nurses is the most efficient way to address the medication issues. A survey she conducted in nurses who dealt with patients with dementia and delirium showed that 32 percent of nurses would call a physician to ask for medication in a patient with DSD before trying other non-drug approaches to the problem.

“Not recognizing and treating these conditions efficiently can result in people being put in nursing homes quicker, higher health care costs, and in the worst-case scenario early death,” says Fick.

Fick’s solution is a multifaceted training approach that she will be implementing and testing in three hospitals, one located in an urban region of Tennessee and the other two in rural areas of Pennsylvania. She and her colleagues will be integrating the use of electronic medical records as one component of the training. They are testing a new approach that will provide decision-making support and integrate reminders to check for certain symptoms. This approach is already being used to assess problems such as fall injuries and skin ulcers or breakdown.

The project will establish a nursing opinion leader on the staff who will encourage the use of evidence-based practices to treat delirium and dementia. These leaders will also be a reliable source of information for nurses.
The training also incorporates a weekly feedback session for nurses and the use of continued education in the form of live media (as opposed to printed information).

In addition to assessing whether or not this training helps nurses decipher delirium from dementia and pick non-drug treatment options, the study will be finding out how effectively this approach improves the health of patients.

Other researchers on the project include Dr. Ann Kolanowski, the Elouise Ross Eberly Professor in the School of Nursing, Penn State; Dr. Dee McGonigle,  associate professor of nursing and information sciences and technology, Penn State; Dr. Sharon Inouye, the Milton and Shirley F. Levy Family chair in alzheimer’s disease and professor of medicine, Harvard Medical School; Dr. Lorraine Mion, independence foundation professor of nursing, Vanderbilt University;  Dr. Jennifer Waller, associate professor of biostatics, Medical College of Georgia; and Dr. Malaz A. Boustani, associate professor, Indiana University Center for Aging Research.

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Editors: Donna Fick can be reached at dmf21@psu.edu. For additional information, please contact the College of Health and Human Development Office of College Relations at 814-865-3831 or healthhd@psu.edu.