The Effects of Environmental and Orienting Devices on the Prevalence and Severity of Delirium Superimposed on Dementia in Hospitalized Older Adults

Open Access
- Author:
- DiMeglio, Brittney Christine
- Area of Honors:
- Nursing
- Degree:
- Bachelor of Science
- Document Type:
- Thesis
- Thesis Supervisors:
- Donna Marie Fick, Thesis Supervisor
Donna Marie Fick, Thesis Honors Advisor
Rita Jablonski, Faculty Reader - Keywords:
- delirium
dementia
delirium superimposed on dementia
confusion
mental status
environment
environmental devices
orienting devices - Abstract:
- Delirium superimposed on dementia is common in hospitalized older adults and leads to poor long term outcomes. A few studies have investigated the impact of environmental factors on an episode of delirium, but this research has been sparse and conflicting at times; more research must be done to find the link between these potentially modifiable risk factors and delirium. The purpose of this study was to conduct a secondary data analysis of the association between environmental and orienting devices and the presence and severity of delirium superimposed on dementia in hospitalized older adults. More specifically, to analyze the data related to environmental and orienting devices patients are exposed to while hospitalized and if this has any impact on the prevalence and severity of a delirious episode. Results were analyzed for 143 hospitalized older adults from the parent study who were screened for dementia using the Modified Blessed Dementia Rating Scale (MBDRS) and were assessed daily using an 11-item environmental tool and the Confusion Assessment Model (CAM). The subjects mean age was 83.47 with a mean length of stay of 6.6 days. Forty percent of subjects experienced delirium during hospitalization. Delirium was found to be related to the total environmental score but not individual orienting and environmental devices. The use of highly sensitive instruments in future studies to measure environmental devices such as the amount of noise and light present in a patient’s room may provide more accurate research findings. In addition, nurses and other healthcare professionals can refer to online resources such as the Hospital Elder Life Program (HELP) and ConsultGeriRN.org, which will provide evidence based practice guidelines related to the recognition and prevention of delirium. Nurses using these resources may better address ways to enhance the environment in hospitalized older adults with dementia. Finally, a comprehensive baseline assessment of a patient’s mental status will allow for the detection of changes over time.