• Maria Lundström, Agneta Edlund, Stig Karlsson, Benny Brännström, Gösta Bucht, and Yngve Gustafson.
• Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87 Umeå, Sweden. maria.lundstrom@germed.umu.se
• J Am Geriatr Soc. 2005 Apr 1;53(4):622-8.

ObjectivesTo investigate whether an education program and a reorganization of nursing and medical care improved the outcome for older delirious patients.DesignProspective intervention study.SettingDepartment of General Internal Medicine, Sundsvall Hospital, Sweden.ParticipantsFour hundred patients, aged 70 and older, consecutively admitted to an intervention or a control ward.InterventionThe intervention consisted of staff education focusing on the assessment, prevention, and treatment of delirium and on caregiver-patient interaction. Reorganization from a task-allocation care system to a patient-allocation system with individualized care.MeasurementsThe patients were assessed using the Organic Brain Syndrome Scale and the Mini-Mental State Examination on Days 1, 3, and 7 after admission. Delirium was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.ResultsDelirium was equally common on the day of admission at the two wards, but fewer patients remained delirious on Day 7 on the intervention ward (n=19/63, 30.2% vs 37/62, 59.7%, P=.001). The mean length of hospital stay+/-standard deviation was significantly lower on the intervention ward then on the control ward (9.4+/-8.2 vs 13.4+/-12.3 days, P<.001) especially for the delirious patients (10.8+/-8.3 vs 20.5+/-17.2 days, P<.001). Two delirious patients in the intervention ward and nine in the control ward died during hospitalization (P=.03).ConclusionThis study shows that a multifactorial intervention program reduces the duration of delirium, length of hospital stay, and mortality in delirious patients.

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