Male gender influences response to an educational package for delirium prevention among older people: a stratified analysis.

BACKGROUND: Increasing evidence is pointing towards the efficacy of intervention programmes in decreasing the incidence of delirium among older people admitted to hospital. We have previously shown that an educational package directed at doctors and nurses significantly decreased the point prevalence of delirium among older people on a general medical ward. It is not yet established whether specific and 'fixed' patients' characteristics influence the rate of response to such an intervention. METHODS: A secondary, exploratory stratified analysis was carried out to determine whether age, sex and presence of dementia might influence the effect of the intervention through a delirium educational package. This information is important in order to increase the effectiveness of preventive measures across various patients' subgroups. RESULTS: Male gender (OR 0.17, 0.05-0.65) significantly (p = 0.030) and positively influence the response to the educational package compared to female gender (OR 1.04, 0.38-2.81). Neither age nor the presence of underlying dementia was associated with a significant influence on the rate of response to the delirium prevention package. CONCLUSION: Staff may be more likely to implement an earlier and more effective intervention for males who are perceived as presenting a higher risk to themselves and others. The results reported highlight the need to increase staff's vigilance to female patients whose prodromal symptoms of delirium may be underemphasised. Understanding different sub-group responses to preventive educational packages for delirium is an important consideration if these are to be applied widely.

An educational intervention can prevent delirium on acute medical wards.

BACKGROUND: Delirium is a common disorder in hospitalised older people and established cases may have a poor outcome that is not readily improved by intervention. Prevention of cases through education of medical and nursing staff has not been fully studied. OBJECTIVES: To test the hypothesis that an educational package for medical and nursing staff would both reduce the number of incident cases of delirium and increase recognition of cases of delirium within an acute medical admissions ward. DESIGN: Single-blind case-control study. SETTING: Two acute admissions wards in a busy inner-city teaching hospital. SUBJECTS: 250 acute admissions over the age of 70 years. METHODS: An educational package for staff on one ward consisting of a 1 hour formal presentation and group discussion, written management guidelines and follow-up sessions. The follow-up sessions, which were based on one-to-one and group discussions, aimed at providing continuous support of staff through emphasising learning and testing knowledge. Diagnosis and management of some discharged delirium patients were also discussed to allow staff to learn from previous experience. The main outcome measures are point prevalence of delirium established by researchers, and recognition and case-note documentation of delirium by clinical staff. RESULTS: The point prevalence of delirium was significantly reduced on the intervention compared to the control ward (9.8% versus 19.5%, P < 0.05) and clinical staff recognised significantly more delirium cases that had been detected by research staff on the ward where the educational package had been delivered. CONCLUSION: A focused and inexpensive educational programme can decrease the prevalence of delirium among older inpatients.