News | Published December 10, 2012

Research provides effective tools for bringing “mom” back to baseline and back to her life

Let's say your 80 year-old mother, who lives in an assisted living home, has been admitted to a hospital due to an infection. She has been pretty successful in her living arrangement so far, even though she has dementia. Caretakers have been able to help her with any problems. But, now you are worried because mom has been acting really different ever since she came to the hospital.

She is suddenly agitated. Although she had been showing signs of dementia for several years, especially with her limited short-term memory, she is now very, very confused. Some days she thinks she is back home on the farm of her youth! You wonder if mom will be able to go back to the assisted living home when she is discharged.

The above scenario is actually fairly common. The condition that "mom" is experiencing in the hospital is "delirium superimposed on dementia." Delirium occurs in 40 percent of hospitalized older adults with dementia.

Delirium typically comes on suddenly and can often be traced to one or more contributing factors, such as a severe or chronic medical illness, medication, infection, surgery, or drug or alcohol abuse.

The symptoms of delirium and dementia can be similar, and input from a family member or caregiver may be important for a doctor to make an accurate diagnosis. Nurses are key to recognizing the condition.

Failure to recognize delirium can result in a decline in health, the need for institutionalization or hospital re-admittance, or mortality.

Mount Nittany Medical Center is participating in a National Institutes of Health-funded trial to improve the care of older adults by giving nurses a computerized decision support tool, which is part of the nursing portion of the electronic health record. Computerized decision support tools improve both nurse assessment and detection of delirium and non-pharmacological management of the problem.

The principal investigator is Donna Fick, PhD, GCNS-BC, FGSA, FAAN, and professor of nursing at The Pennsylvania State University. At the 2012 State of Science Congress on Nursing Research sponsored by The Council for the Advancement of Nursing Sciences in Washington, D.C. in September, data from the study was presented through a poster presentation titled, "Integrating language processes in a multi-site study with different electronic health records."

When the computerized decision support tool indicates the presence of dementia, nurses on the floor are able to administer a non-pharmacological intervention, after prompts indicate the necessity. Adult Cognitive Education Boxes (ACE) have proven to be an effective intervention and treatment.

Contents of the ACE box helps patients cope with the anxiety and confusion by providing a mental focus. Tactile stimulation of stuffed animals can provide comfort, old photographs can bring back memories and spark interesting conversation, and puzzles and games can occupy the mind. The goal is to provide a link between provider and patient in an effort to get the patient back to baseline and decrease the length of the hospital stay.

The poster presentation gave national recognition to a very important study that has the potential to impact patient care on a large scale. "If you look at this poster, you can see that we are keeping good company," said Joyce Walls, MSN, RN, director of information services, Mount Nittany Health. Although too small to see at this size, the partners on the poster are Vanderbilt University, Penn State University, Harvard Medical School and Mount Nittany Health.

The bottom line is this - as a result of this research - "mom" will receive the best care possible through proven methods and specific tools designed to get her back to baseline, back home, and back to life!