• Ann Kolanowski, Donna Fick, Mark Litaker, Paula Mulhall, Linda Clare, Nikki Hill, Jacqueline Mogle, Malaz Boustani, David Gill, and Andrea Yevchak-Sillner.
• College of Nursing, Pennsylvania State University, University Park, Pennsylvania.
• J Am Geriatr Soc. 2016 Dec 1; 64 (12): 2424-2432.

ObjectiveTo determine whether cognitively stimulating activities would reduce duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care.DesignSingle-blind randomized clinical trial.SettingEight post-acute care (PAC) facilities.ParticipantsCommunity-dwelling older adults with dementia and delirium (N = 283).InterventionResearch staff provided cognitively stimulating activities daily for up to 30 days.MeasurementsPrimary outcomes were delirium duration (Confusion Assessment Method) and delirium severity (Delirium Rating Scale). Secondary outcomes were cognitive function (Digits Forward, Montreal Cognitive Assessment, CLOX) and physical function (Barthel Index).ResultsMean percentage of delirium-free days (intervention: 64.8%, 95% confidence interval (CI) = 59.6-70.1; control: 68.7%, 95% CI = 63.9-73.6; P = .37, Wilcoxon rank sum test) and delirium severity (range 0-39: intervention: 10.77, 95% CI = 10.10-11.45; control: 11.15, 95% CI = 10.50-11.80; difference 0.37, 95% CI = 0.56-1.31, P = .43) were similar in both groups. Significant differences for secondary outcomes favoring intervention were found (executive function (range 0-15): intervention: 6.58, 95% CI = 6.12-7.04; control: 5.89, 95% CI = 5.45-6.33; difference -0.69, 95% CI = 1.33 to -0.06, P = .03; constructional praxis (range 0-15): intervention: 8.84, 95% CI = 8.83-9.34; control: 7.53, 95% CI = 7.04-8.01; difference -1.31, 95% CI = 2.01 to -0.61, P < .001). After adjusting for baseline constructional praxis, the group comparison was no longer significant. Average length of stay was shorter in the intervention (36.09 days) than the control (53.13 days) group (standard error = 0.15, P = .01, negative binomial regression).ConclusionCognitively stimulating activities did not improve delirium but improved executive function and reduced length of stay. Resolution of delirium may require more-intense nonpharmacological management when the individual has dementia.© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

23 keywords...

hide…