Single-bed rooms in a geriatric ward prevent delirium in older patients.

BACKGROUND: Few studies have investigated treatment environment risk factors for delirium in geriatric patients. In March 2017, a geriatric department was moved from old hospital buildings with multiple-bed rooms (old wards) to a new hospital with single-bed rooms (new wards), with no changes regarding uptake area, staff and admission criteria. AIMS: The aim of this study was to investigate the risk of delirium among patients in single-bed rooms compared with multiple-bed rooms. METHODS: An observational prospective study included patients aged ≥ 75 years admitted between 15 September 2016 and 19 March 2017 to the old wards and between 20 March and 19 December 2017 to the new wards. Exclusion criteria were terminal illness, somnolence at admission and inability to communicate in Danish. Delirium was assessed by trained nurses, nurse assistants, occupational therapists and physiotherapists every morning and evening using the Confusion Assessment Method (CAM). RESULTS: We included 1014 patients. Patients' characteristics were similar between patients admitted to the old wards and to the new wards. Delirium was present at admission in 105 patients, with no significant difference between the old and new wards. Patients in the new wards had a significantly reduced incidence of delirium during hospital stay compared with patients in the old wards; hazard ratio 0.66 (95% CI 0.48-0.93, p < 0.02). No difference between the old and the new wards was observed in the duration of the first delirium episode. CONCLUSION: We found evidence that the risk of delirium is reduced in single-bed rooms compared with multiple-bed rooms in geriatric wards.

Analgesic and psychoactive medications and the risk of falls in relation to delirium in single-bed rooms compared to multiple-bed rooms in geriatric inpatients.

BACKGROUND: Previously, we demonstrated a substantial reduction of delirium incidence among geriatric patients after relocating from old hospital buildings with multiple-bed rooms to a new hospital with single-bed rooms. AIMS: To investigate whether (1) the reduced incidence of delirium in single-bed rooms was associated with a simultaneous change in medication use, (2) the relocation had affected the incidence of falls, (3) the use of analgesics and psychoactive medications was associated with the risk of delirium and falls. METHODS: We included 461 admissions to the old wards and 553 admissions to the new wards. Delirium was assessed by the Confusion Assessment Method. Data on drug use and falls during hospitalization were extracted from medical records. RESULTS: There was no difference in drug use between the wards. In the new wards, patients who had experienced delirium had a much higher risk of falls than patients without delirium, while in the old wards this contrast was small. The risk of delirium was increased among patients who received antipsychotic drugs and anti-dementia drugs, Patients who received these drugs had an insignificantly increased risk of falls. CONCLUSION: Medication of analgesics and psychoactive drugs was similar in the old and new wards. In single-bed rooms, but not in multiple-bed rooms there was a much higher risk of falls among inpatients that developed delirium than among other patients. Patients who had used antipsychotics and anti-dementia drugs during hospitalization had increased risk of developing delirium and an insignificantly higher risk of falls.

Blood transfusion strategy and risk of postoperative delirium in nursing homes residents with hip fracture. A post hoc analysis based on the TRIFE randomized controlled trial.

OBJECTIVES: To investigate whether a liberal blood transfusion strategy [Hb levels ≥11.3 g/dL (7 mmol/L)] reduces the risk of postoperative delirium (POD) on day 10, among nursing home residents with hip fracture, compared to a restrictive transfusion strategy [Hb levels ≥9.7 g/dL (6 mmol/L)]. Furthermore, to investigate whether POD influences mortality within 90 days after hip surgery. METHODS: This is a post hoc analysis based on The TRIFE - a randomized controlled trial. Frail anemic patients from the Orthopedic Surgical Ward at Aarhus University Hospital were enrolled consecutively between January 18, 2010 and June 6, 2013. These patients (aged ≥65 years) had been admitted from nursing homes for unilateral hip fracture surgery. After surgery, 179 patients were included in this study. On the first day of hospitalization, all enrolled patients were examined for cognitive impairment (assessed by MMSE) and delirium (assessed by CAM). Delirium was also assessed on the tenth postoperative day. RESULTS: The prevalence of delirium was 10 % in patients allocated to a liberal blood transfusion strategy (LB) and 21 % in the group with a restrictive blood transfusion strategy (RB). LB prevents development of delirium on day 10, compared to RB, odds ratio 0.41 (95 % CI 0.17-0.96), p = 0.04. Development of POD on day 10 increased the risk of 90-day death, hazard ratio 3.14 (95 % CI 1.72-5.78), p < 0.001. CONCLUSION: In nursing home residents undergoing surgery for hip fracture, maintaining hemoglobin level above 11.3 g/dL reduces the rate of POD on day 10 compared to a RB. Development of POD is associated with increased mortality.

Use of single-bed rooms may decrease the incidence of hospital-acquired infections in geriatric patients: A retrospective cohort study in Central Denmark region.

OBJECTIVE: Patients accommodated in single-bed rooms may have a reduced risk of hospital-acquired infections (HAIs) compared to those in multi-bed rooms. This study aimed to examine the effect of single-bed accommodation on HAIs in older patients admitted to a geriatric ward. METHODS: A retrospective cohort study of patients admitted to geriatric wards in a university hospital in Central Denmark Region linked to a move to a newly built hospital, involving all consecutively admitted patients aged 65 years and over from 15 September to 19 December 2016 and a similar cohort admitted in the same three months in 2017. We compared the incidence of HAIs in patients in single-bed accommodation to those in multi-bed accommodation using retrospective review of electronic patient records, with all infections verified microbiologically or by X-ray with onset between 48 hours after admission to 48 hours after discharge from hospital. RESULTS: In total 446 patients were included. The incidence of HAIs in multi-bed accommodation was 30% compared to 20% in single-bed accommodation. The hazard ratio was 0.62 (95% Confidence Interval 0.43-0.91, p = 0.01) for single-bed accommodation. This finding remained robust after adjustment for age, sex, infection at admission, risk of sepsis, use of catheter, treatment with prednisone or methotrexate, and comorbidity index. CONCLUSION: Accommodation in single-bed rooms appeared to reduce HAIs compared to multi-bed rooms in two geriatric wards. This finding should be considered as hypothesis-generating and be examined further using an experimental design.