Annals of Long Term Care

Effect of an In-Home Occupational and Physical Therapy Intervention on Reducing Mortality in Functionally Vulnerable Older People: Preliminary Findings

Laura N. Gitlin, PhD, Walter W. Hauck, PhD, Laraine Winter, PhD, Marie P. Dennis, PhD, EdM, and Richard Schulz, PhD

Objectives: To evaluate the effect of a multicomponent intervention on mortality and the role of control-oriented strategy use as the change mechanism.

Design: Two-group randomized design with survivorship followed for 14 months. Participants were randomized to intervention or a no-treatment control group.

Setting: Urban, community-living older people.

Participants: Three hundred nineteen people aged 70 and older with functional difficulties.

Intervention: Occupational therapy and physical therapy sessions involving home modifications, problem solving, and training in energy conservation, safe performance, balance, muscle strength, and fall recovery techniques.

Measurements: Survival time was number of days between baseline interview and date of death or final interview if date unknown. Control-oriented strategy use was measured using eight items.

Results: Intervention participants exhibited a 1% rate of mortality, compared with a 10% rate for no-treatment control participants (P=.003, 95% confidence interval=2.4–15.04%). At baseline, those who subsequently died had more days hospitalized and lower control-oriented strategy use 6 months before study enrollment than survivors. No intervention participants with previous days hospitalized (n=31) died, whereas 21% of control group counterparts did (n=35; P=.001). Although intervention participants with low and high baseline control strategy use had lower mortality risk than control participants, mortality risk was lower for intervention participants with low strategy use at baseline (P=.007).

Conclusion: An occupational and physical therapy intervention to ameliorate functional difficulties may reduce mortality risk in community-dwelling older people overall and benefit those most compromised. Instruction in control-oriented strategies may account for the intervention's protective effects on survivorship. J Am Geriatr Soc 2006;54(6):950-955.

NURSING
Detection of Delirium by Bedside Nurses Using the Confusion Assessment Method

Joke Lemiengre, RN, MSN, Tine Nelis, RN, MSN, Etienne Joosten, MD, PhD, Tom Braes, RN, MSN, Marquis Foreman, RN, PhD, FAAN, Chris Gastmans, PhD, and Koen Milisen, RN, PhD

A prospective, descriptive study was used to assess the diagnostic validity of the Confusion Assessment Method (CAM) administered at the bedside by nurses in daily practice. Two different scoring methods of the CAM (the specific (SPEC) and sensitive (SENS) methods) were compared with a criterion standard (CAM completed by trained research nurses). During a 5-month period, all patients consecutively admitted to an acute geriatric ward of the University Hospitals of Leuven (Belgium) were enrolled in the study. The 258 elderly inpatients who were included underwent 641 paired but independent ratings of delirium by bedside and trained research nurses.

Delirium was identified in 36 of the 258 patients (14%) or in 42 of the 641 paired observations (6.5%). The SENS method of the CAM algorithm as administered by bedside nurses had the greatest diagnostic accuracy, with 66.7% sensitivity and 90.7% specificity; the SPEC method had 23.8% sensitivity and 97.7% specificity. Bedside nurses had difficulties recognizing the features of acute onset, fluctuation, and altered level of consciousness.

For both scoring methods, bedside nurses had difficulties with the identification of elderly patients with delirium but succeeded in diagnosing correctly those patients without delirium in more than 90% of observations.