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.