Journal: Age and Ageing

Abbreviation

Age & ageing

Publisher

Oxford University Press

Journal Volumes

ISSN

0002-0729
1468-2834

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2012 - 201922020 - 20241
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Publications 1 - 3 of 3
  • Benefits of an automated postoperative delirium risk prediction tool combined with non-pharmacological delirium prevention on delirium incidence and length of stay: a before-after analysis based on a quality improvement project
    Item type: Journal Article
    Dodsworth, Benjamin T.; Reeve, Kelly A.; Zozman, Martin; et al. (2024)
    Age and Ageing
    Background: Postoperative delirium (POD) significantly impacts older surgical patients, necessitating effective prevention strategies. Objective: To assess the effectiveness of the Pre-Interventional Preventive Risk Assessment (PIPRA) automated delirium risk prediction tool alongside non-pharmacological prevention strategies on POD incidence, hospital length of stay (LOS) and nursing time. Methods: This quality improvement project, set in a 335-bed Swiss private hospital, employed a before–after design to evaluate the impact of PIPRA and preventive measures on POD, LOS and nursing time in non-cardiac and non-intracranial surgery inpatients aged 60 or older. The control phase focused on enhancing POD screening, whilst the intervention phase incorporated PIPRA for risk assessment and staff training to enable targeted non-pharmacological prevention in patients at risk. Results: A total of 866 patients were included; 299 control and 567 intervention. The odds ratio of POD, comparing the intervention group to the control, was 0.71 [95% confidence interval (CI) 0.44–1.16] when adjusting for baseline patient characteristics. The intervention was associated with an LOS 0.94 (95% CI 0.85–1.05) and nursing time 0.96 (95% CI 0.86–1.07) times that of the control, adjusted for baseline patient characteristics. Medium risk patients (21.6% of patients) had an LOS 0.74 (95% CI 0.59–0.92) and required nursing time 0.79 (95% CI from 0.62–1.00) times the control, adjusted for baseline patient characteristics, equivalent to an LOS reduction of 1.36 days and nursing time saving of 19.3 hours per patient. Conclusions: Medium risk patients in the intervention group had shorter LOS and nursing time compared to the control group, underscoring the importance of targeted prevention.
  • Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail
    Item type: Journal Article
    Loizeau, Andrea; Theill, Nathan; Cohen, Simon M.; et al. (2019)
    Age and Ageing
    Background: fact Boxes are decision support tools that can inform about treatment effects. Objectives: to test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia. Design: randomized controlled trial. Setting: Swiss-German region of Switzerland. Subjects: two hundred thirty-two participants (64 physicians, 100 relatives of dementia patients, 68 professional guardians) randomly allocated to intervention (N = 114) or control (N = 118). Intervention: two-page Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia (at 1-month). Methods: participants were mailed questionnaires at baseline and one month later that asked questions about treatments based on hypothetical scenarios. The primary outcome was change in decisional conflict (DCS-D; range 0 < 100) about treatment decisions. Secondary outcomes included knowledge about treatments (range 0 < 7) and preferences to forego treatments. Results: participants were: mean age, 55.6 years; female, 62.8%. Relative to control participants, intervention participants experienced less decisional conflict about using antibiotics (unstandardized beta (b) = −8.35, 95% Confidence Interval (CI), −12.43, −4.28) and artificial hydration (b = −6.02, 95% CI, −9.84, −2.20) at 1-month compared to baseline. Intervention participants displayed greater knowledge about the use of antibiotics (b = 2.24, 95% CI, 1.79, 2.68) and artificial hydration (b = 3.01, 95% CI, 2.53, 3.49), and were significantly more likely to prefer to forego antibiotics (odds ratio, 2.29, 95% CI, 1.08, 4.84) but not artificial hydration. Conclusions: fact Box decision support tools reduced decisional conflict, increased knowledge and promoted preferences to forego antibiotics in advanced dementia among various decision-makers. Trial registration: FORSbase (12091).
  • Towards standardised evaluation tools
    Item type: Other Journal Item
    de Bruin, Eling (2012)
    Age and Ageing
Publications 1 - 3 of 3