Feasibility of the Age-Friendly Health System in Acute Cardiac Care Units for Delirium Detection and Management

Abstract

Background Optimal delirium care requires a multicomponent approach. However, implementation of such comprehensive care in a fast-paced specialized unit like acute cardiac care unit is challenging. The Age-Friendly Health System (AFHS) 4Ms initiative focuses on four key components, What Matters, Medication, Mentation, and Mobility, and provides a simple but comprehensive framework for optimal delirium care. However, studies reporting the application of AFHS 4Ms focusing on delirium care are lacking. Objective We aimed to evaluate the feasibility of the AFHS 4Ms on delirium detection and management among older adults in acute cardiac care units. Methods We conducted a quality improvement (QI) project using the AFHS 4Ms framework and implemented specific strategies for each M in the acute cardiac care units at a tertiary teaching hospital. Then, we assessed the changes in the rates of delirium screening and the rates of positive screening results during the QI project period using Cochran-Armitage test, and compared the percentages of older adults who received delirium-related orders before and after the initiative using Fisher’s exact test. Results The overall rate of delirium screening was 79.5% (68.3% in August, 81.0% in September, 87.2% in October, 87.9% in November, and 72.9% in December). The overall rate of positive delirium screening results was 9.3% (6.3% in August, 10.8% in September, 8.5% in October, 6.0% in November, and 5.0% in December). The utilization of all of the delirium-related orders was reduced, 2.4% to 1.9% for haloperidol, 6.9% to 5.1% for lorazepam, 6.5% to 3.0% for a physical restraint order, and 4.1% to 2.6% for a sitter order, before and after the initiative. However, all of the decreasing trends were not statistically significant. Conclusion We showed that it is feasible to apply AFHS 4Ms for delirium detection and management in acute cardiac care units. Future prospective studies are needed.