The PiTSTOP study: a feasibility cluster randomized trial of delirium prevention in care homes for older people

Najma Siddiqi, Francine Cheater, Michelle Collinson, Amanda Farrin, Anne Forster, Deepa George, Mary Godfrey, Elizabeth Graham, Jennifer Harrison, Anne Heaven, Peter Heudtlass, Claire Hulme, David Meads, Chris North, Angus Sturrock, John Young

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Abstract

Background and objectives: delirium is a distressing but potentially preventable condition common in older people in long-term care. It is associated with increased morbidity, mortality, functional decline, hospitalization and significant healthcare costs. Multicomponent interventions, addressing delirium risk factors, have been shown to reduce delirium by one-third in hospitals. It is not known whether this approach is also effective in long-term care. In previous work, we designed a bespoke delirium prevention intervention, called ‘Stop Delirium!’ In preparation for a definitive trial of Stop Delirium, we sought to address key aspects of trial design for the particular circumstances of care homes. 

Design: a cluster randomized feasibility study with an embedded process evaluation. 

Setting and participants: residents of 14 care homes for older people in one metropolitan district in the UK. 

Intervention: Stop Delirium!: a 16-month-enhanced educational package to support care home staff to address key delirium risk factors. Control homes received usual care. 

Measurements: we collected data to determine the following: recruitment and attrition; delirium rates and variability between homes; feasibility of measuring delirium, resource use, quality of life, hospital admissions and falls; and intervention implementation and adherence. 

Results: two-thirds (215) of eligible care home residents were recruited. One-month delirium prevalence was 4.0% in intervention and 7.1% in control homes. Proposed outcome measurements were feasible, although our approach appeared to underestimate delirium. Health economic evaluation was feasible using routinely collected data. 

Conclusion: a definitive trial of delirium prevention in long-term care is needed but will require some further design modifications and pilot work. 

Original languageEnglish
Pages (from-to)652-661
JournalAge and Ageing
Volume45
Issue number5
Early online date20 May 2016
DOIs
Publication statusPublished - Sep 2016

Keywords

  • delirium
  • long-term care
  • prevention
  • cluster randomized trial
  • older people

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