A Model for Managing Delirious Older Inpatients

Authors

  • Joseph H. Flaherty MD,

    1. Geriatric Research, Education and Clinical Center, St. Louis VA Medical Center, St. Louis, Missouri;
    2. Department of Internal Medicine and Division of Geriatrics , Saint Louis University School of Medicine, St. Louis, Missouri;
    Search for more papers by this author
  • Syed H. Tariq MD,

    1. Geriatric Research, Education and Clinical Center, St. Louis VA Medical Center, St. Louis, Missouri;
    2. Department of Internal Medicine and Division of Geriatrics , Saint Louis University School of Medicine, St. Louis, Missouri;
    Search for more papers by this author
  • Srinivasan Raghavan MD,

    1. Department of Internal Medicine and Division of Geriatrics , Saint Louis University School of Medicine, St. Louis, Missouri;
    Search for more papers by this author
  • Sanjeev Bakshi MD,

    1. Washoe Senior Medical Group, Reno, Nevada;
    Search for more papers by this author
  • Asif Moinuddin MD,

    1. Mallinckrodt
      Institute of Radiology, Washington University, St. Louis, Missouri.
    Search for more papers by this author
  • John E. Morley MBBCh

    1. Geriatric Research, Education and Clinical Center, St. Louis VA Medical Center, St. Louis, Missouri;
    2. Department of Internal Medicine and Division of Geriatrics , Saint Louis University School of Medicine, St. Louis, Missouri;
    Search for more papers by this author

Address correspondence to Joseph H. Flaherty, MD, 1402 S. Grand Blvd., Room M238, St. Louis, MO, 63104. E-mail: Flaherty@SLU.edu

Abstract

Although multiple models of care exist to prevent the development of delirium in hospitalized patients, models for the management of patients for whom delirium is unpreventable or who already have delirium on admission to the hospital are needed.

This article describes the development, management, and economics of a new model of care for patients with delirium, called the Delirium Room (DR). The DR is a specialized 4-bed unit that provides 24-hour intensive nursing care and is completely free of physical restraints. Another important feature of the 4-bed DR is that it is an integral part of a 22-bed acute care for the elderly (ACE) unit. As such, patients in the DR benefit from features of the ACE unit: a change in the physical environment of the medical floor to promote mobility and function and discourage bedrest, comprehensive geriatric care that identifies and addresses problems that can lead to a decline in function, and use of a daily multidisciplinary team meeting.

This article also presents descriptive data on a group of delirious patients managed in the DR with the intention of giving baseline data for other ACE units that are considering opening a DR or for future prospective studies in this area.

Ancillary