Outcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU)

Mei Sian Chong, Mark Chan, Laura Tay, Yew Yoong Ding Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore Objective: Delirium is associated with poor outcomes following acute hospitalization. The Geriatric Monitoring Unit (GMU) is a speciali...

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Autores principales:	Chong MS, Chan M, Tay L, Ding YY
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	delirium function elderly Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/edf6a835913b419e810c4f415662e47d
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spelling	oai:doaj.org-article:edf6a835913b419e810c4f415662e47d2021-12-02T08:19:34ZOutcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU)1178-1998https://doaj.org/article/edf6a835913b419e810c4f415662e47d2014-04-01T00:00:00Zhttps://www.dovepress.com/outcomes-of-an-innovative-model-of-acute-delirium-care-the-geriatric-m-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Mei Sian Chong, Mark Chan, Laura Tay, Yew Yoong Ding Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore Objective: Delirium is associated with poor outcomes following acute hospitalization. The Geriatric Monitoring Unit (GMU) is a specialized five-bedded unit for acute delirium care. It is modeled after the Delirium Room program, with adoption of core interventions from the Hospital Elder Life Program and use of evening light therapy to consolidate circadian rhythms and improve sleep in older inpatients. This study examined whether the GMU program improved outcomes in delirious patients. Method: A total of 320 patients, including 47 pre-GMU, 234 GMU, and 39 concurrent control subjects, were studied. Clinical characteristics, cognitive status, functional status (Modified Barthel Index [MBI]), and chemical restraint-use data were obtained. We also looked at in-hospital complications of falls, pressure ulcers, nosocomial infection rate, and discharge destination. Secondary outcomes of family satisfaction (for the GMU subjects) were collected. Results: There were no significant demographic differences between the three groups. Pre-GMU subjects had longer duration of delirium and length of stay. MBI improvement was most evident in the GMU compared with pre-GMU and control subjects (19.2±18.3, 7.5±11.2, 15.1±18.0, respectively) (P<0.05). The GMU subjects had a zero restraint rate, and pre-GMU subjects had higher antipsychotic dosages. This translated to lower pressure ulcer and nosocomial infection rate in the GMU (4.1% and 10.7%, respectively) and control (1.3% and 7.7%, respectively) subjects compared with the pre-GMU (9.1% and 23.4%, respectively) subjects (P<0.05). No differences were observed in mortality or discharge destination among the three groups. Caregivers of GMU subjects felt the multicomponent intervention to be useful, with scheduled activities voted the most beneficial in patient’s recovery from the delirium episode. Conclusion: This study shows the benefits of a specialized delirium management unit for older persons. The GMU model is thus a relevant system of care for rapidly “graying” nations with high rates of frail elderly hospital admissions, which can be easily transposed across acute care settings. Keywords: delirium, function, elderlyChong MSChan MTay LDing YYDove Medical PressarticledeliriumfunctionelderlyGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 603-612 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	delirium function elderly Geriatrics RC952-954.6
spellingShingle	delirium function elderly Geriatrics RC952-954.6 Chong MS Chan M Tay L Ding YY Outcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU)
description	Mei Sian Chong, Mark Chan, Laura Tay, Yew Yoong Ding Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore Objective: Delirium is associated with poor outcomes following acute hospitalization. The Geriatric Monitoring Unit (GMU) is a specialized five-bedded unit for acute delirium care. It is modeled after the Delirium Room program, with adoption of core interventions from the Hospital Elder Life Program and use of evening light therapy to consolidate circadian rhythms and improve sleep in older inpatients. This study examined whether the GMU program improved outcomes in delirious patients. Method: A total of 320 patients, including 47 pre-GMU, 234 GMU, and 39 concurrent control subjects, were studied. Clinical characteristics, cognitive status, functional status (Modified Barthel Index [MBI]), and chemical restraint-use data were obtained. We also looked at in-hospital complications of falls, pressure ulcers, nosocomial infection rate, and discharge destination. Secondary outcomes of family satisfaction (for the GMU subjects) were collected. Results: There were no significant demographic differences between the three groups. Pre-GMU subjects had longer duration of delirium and length of stay. MBI improvement was most evident in the GMU compared with pre-GMU and control subjects (19.2±18.3, 7.5±11.2, 15.1±18.0, respectively) (P<0.05). The GMU subjects had a zero restraint rate, and pre-GMU subjects had higher antipsychotic dosages. This translated to lower pressure ulcer and nosocomial infection rate in the GMU (4.1% and 10.7%, respectively) and control (1.3% and 7.7%, respectively) subjects compared with the pre-GMU (9.1% and 23.4%, respectively) subjects (P<0.05). No differences were observed in mortality or discharge destination among the three groups. Caregivers of GMU subjects felt the multicomponent intervention to be useful, with scheduled activities voted the most beneficial in patient’s recovery from the delirium episode. Conclusion: This study shows the benefits of a specialized delirium management unit for older persons. The GMU model is thus a relevant system of care for rapidly “graying” nations with high rates of frail elderly hospital admissions, which can be easily transposed across acute care settings. Keywords: delirium, function, elderly
format	article
author	Chong MS Chan M Tay L Ding YY
author_facet	Chong MS Chan M Tay L Ding YY
author_sort	Chong MS
title	Outcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU)
title_short	Outcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU)
title_full	Outcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU)
title_fullStr	Outcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU)
title_full_unstemmed	Outcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU)
title_sort	outcomes of an innovative model of acute delirium care: the geriatric monitoring unit (gmu)
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/edf6a835913b419e810c4f415662e47d
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Outcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU)

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