132A Cluster, Randomised Feasibility Study Of The Prevention Of Delirium (POD) Programme For Elderly Patients Admitted To Hospital

Abstract

Introduction: Delirium is a common consequence of acute hospital admission for older people. There is a strong evidence base, supported by single centre, proof of concept studies mainly delivered by people with expertise in delirium, for the effectiveness of multi‐component interventions to prevent delirium. NICE has recommended widespread adoption by the NHS of multi‐component delirium prevention interventions. We previously devised and pilot tested the Prevention of Delirium (POD) Programme prior to undertaking a feasibility trial to investigate preliminary estimates of effectiveness and to gather data to inform a future larger study. Methods: A pragmatic, multi‐centre, cluster randomised, controlled, feasibility study. Elderly care and trauma/surgical orthopaedic wards were randomised one‐to‐one to the POD Programme or usual care. Patients aged 65 years and over admitted to the wards were eligible. Exclusion criteria were: prevalent delirium; planned discharge within 48 hours of ward admission; not screened within 24 hours of ward admission; end of life care; outlying from another ward. Researchers screened participants in hospital daily for delirium for up to 10 days and at 30 days using the Confusion Assessment Method (CAM). Quality of life measures were undertaken by researchers at baseline and 30 days and by post at 3 months. We aimed to recruit 16 wards and 720 participants. Results: We recruited 16 wards. 4,449 patients were screened on admission to the wards; 3,274 were eligible for the study; 713 were recruited. 5,065 CAMs were conducted (89.7% of the 5,644 expected). 24 patients (7.0%) in the intervention group and 33 (8.9%) in the control group had a positive CAM screen within 10 days of ward admission (odds ratio [95%CI]: 0.68 [0.37, 1.26]). 33 (4.6%) participants withdrew and 104 (14.6%) died. Conclusions: Conducting a multi‐centre cluster randomised trial to investigate delirium prevention in this frail, older group of patients is feasible.