Matching the Environment to Patients with Delirium: Lessons Learned from the Delirium Room, a Restraint-Free Environment for Older Hospitalized Adults with Delirium

Authors

  • Joseph H. Flaherty MD,

    Corresponding author
    1. Geriatric Research, Education and Clinical Center, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
    • Division of Geriatrics, Department of Internal Medicine, School of Medicine, Saint Louis University
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  • Milta O. Little DO

    1. Division of Geriatrics, Department of Internal Medicine, School of Medicine, Saint Louis University
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Address correspondence to Joseph H. Flaherty, 1402 S. Grand Blvd., Room M238, St. Louis, MO 63104. E-mail: flaherty@slu.edu

Abstract

Delirium is associated with several negative outcomes and is not always preventable. Current practices for the management of older hospitalized adults with delirium, such as one-on-one sitters, antipsychotic medications, and physical restraints, have limited effectiveness or potential health risks. An alternative management model, called the Delirium Room (DR), is a four-bed patient room (within an Acute Care for Elders (ACE) Unit) that provides 24-hour nursing care, emphasizes nonpharmacological approaches, and is completely free of physical restraints. This article is based on 13 years of experience at two hospitals. The authors have found that a restraint-free environment can be achieved; “tolerate, anticipate, and don't agitate” (the T-A-DA method) are the core principles of the nonpharmacological approach that go beyond the traditional strategies of management (such as reorientation); based on observational data, it appears that negative outcomes associated with delirium, such as loss of function, longer hospital stay, and greater mortality, can be decreased to levels seen in individuals without delirium; and based on limited data, it appears that the rate of falls is at least not higher in the DR than in the ACE unit overall. The limitations of the DR model include lack of randomized controlled trials and the inability to determine which component of the model provides its benefits.

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