Effect of Cognitively Stimulating Activities on Symptom Management of Delirium Superimposed on Dementia

A Randomized Controlled Trial

Ann Kolanowski, Donna Fick, Mark Litaker, Paula Mulhall, Linda Clare, Nikki Hill, Jacqueline Mogle, Malaz Boustani, David Gill, Andrea Yevchak-Sillner

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: To determine whether cognitively stimulating activities would reduce duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care. Design: Single-blind randomized clinical trial. Setting: Eight post-acute care (PAC) facilities. Participants: Community-dwelling older adults with dementia and delirium (N = 283). Intervention: Research staff provided cognitively stimulating activities daily for up to 30 days. Measurements: Primary outcomes were delirium duration (Confusion Assessment Method) and delirium severity (Delirium Rating Scale). Secondary outcomes were cognitive function (Digits Forward, Montreal Cognitive Assessment, CLOX) and physical function (Barthel Index). Results: Mean percentage of delirium-free days (intervention: 64.8%, 95% confidence interval (CI) = 59.6–70.1; control: 68.7%, 95% CI = 63.9–73.6; P =.37, Wilcoxon rank sum test) and delirium severity (range 0–39: intervention: 10.77, 95% CI = 10.10–11.45; control: 11.15, 95% CI = 10.50–11.80; difference 0.37, 95% CI = 0.56–1.31, P =.43) were similar in both groups. Significant differences for secondary outcomes favoring intervention were found (executive function (range 0–15): intervention: 6.58, 95% CI = 6.12–7.04; control: 5.89, 95% CI = 5.45–6.33; difference −0.69, 95% CI = 1.33 to −0.06, P =.03; constructional praxis (range 0–15): intervention: 8.84, 95% CI = 8.83–9.34; control: 7.53, 95% CI = 7.04–8.01; difference −1.31, 95% CI = 2.01 to −0.61, P <.001). After adjusting for baseline constructional praxis, the group comparison was no longer significant. Average length of stay was shorter in the intervention (36.09 days) than the control (53.13 days) group (standard error = 0.15, P =.01, negative binomial regression). Conclusion: Cognitively stimulating activities did not improve delirium but improved executive function and reduced length of stay. Resolution of delirium may require more-intense nonpharmacological management when the individual has dementia.

Original languageEnglish (US)
Pages (from-to)2424-2432
Number of pages9
JournalJournal of the American Geriatrics Society
Volume64
Issue number12
DOIs
StatePublished - Dec 1 2016

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Delirium
Dementia
Randomized Controlled Trials
Confidence Intervals
Executive Function
Nonparametric Statistics
Cognition
Length of Stay
Subacute Care
Independent Living
Confusion

Keywords

  • delirium
  • dementia
  • nonpharmacological intervention
  • postacute care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Effect of Cognitively Stimulating Activities on Symptom Management of Delirium Superimposed on Dementia : A Randomized Controlled Trial. / Kolanowski, Ann; Fick, Donna; Litaker, Mark; Mulhall, Paula; Clare, Linda; Hill, Nikki; Mogle, Jacqueline; Boustani, Malaz; Gill, David; Yevchak-Sillner, Andrea.

In: Journal of the American Geriatrics Society, Vol. 64, No. 12, 01.12.2016, p. 2424-2432.

Research output: Contribution to journalArticle

Kolanowski, A, Fick, D, Litaker, M, Mulhall, P, Clare, L, Hill, N, Mogle, J, Boustani, M, Gill, D & Yevchak-Sillner, A 2016, 'Effect of Cognitively Stimulating Activities on Symptom Management of Delirium Superimposed on Dementia: A Randomized Controlled Trial', Journal of the American Geriatrics Society, vol. 64, no. 12, pp. 2424-2432. https://doi.org/10.1111/jgs.14511
Kolanowski, Ann ; Fick, Donna ; Litaker, Mark ; Mulhall, Paula ; Clare, Linda ; Hill, Nikki ; Mogle, Jacqueline ; Boustani, Malaz ; Gill, David ; Yevchak-Sillner, Andrea. / Effect of Cognitively Stimulating Activities on Symptom Management of Delirium Superimposed on Dementia : A Randomized Controlled Trial. In: Journal of the American Geriatrics Society. 2016 ; Vol. 64, No. 12. pp. 2424-2432.
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abstract = "Objective: To determine whether cognitively stimulating activities would reduce duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care. Design: Single-blind randomized clinical trial. Setting: Eight post-acute care (PAC) facilities. Participants: Community-dwelling older adults with dementia and delirium (N = 283). Intervention: Research staff provided cognitively stimulating activities daily for up to 30 days. Measurements: Primary outcomes were delirium duration (Confusion Assessment Method) and delirium severity (Delirium Rating Scale). Secondary outcomes were cognitive function (Digits Forward, Montreal Cognitive Assessment, CLOX) and physical function (Barthel Index). Results: Mean percentage of delirium-free days (intervention: 64.8{\%}, 95{\%} confidence interval (CI) = 59.6–70.1; control: 68.7{\%}, 95{\%} CI = 63.9–73.6; P =.37, Wilcoxon rank sum test) and delirium severity (range 0–39: intervention: 10.77, 95{\%} CI = 10.10–11.45; control: 11.15, 95{\%} CI = 10.50–11.80; difference 0.37, 95{\%} CI = 0.56–1.31, P =.43) were similar in both groups. Significant differences for secondary outcomes favoring intervention were found (executive function (range 0–15): intervention: 6.58, 95{\%} CI = 6.12–7.04; control: 5.89, 95{\%} CI = 5.45–6.33; difference −0.69, 95{\%} CI = 1.33 to −0.06, P =.03; constructional praxis (range 0–15): intervention: 8.84, 95{\%} CI = 8.83–9.34; control: 7.53, 95{\%} CI = 7.04–8.01; difference −1.31, 95{\%} CI = 2.01 to −0.61, P <.001). After adjusting for baseline constructional praxis, the group comparison was no longer significant. Average length of stay was shorter in the intervention (36.09 days) than the control (53.13 days) group (standard error = 0.15, P =.01, negative binomial regression). Conclusion: Cognitively stimulating activities did not improve delirium but improved executive function and reduced length of stay. Resolution of delirium may require more-intense nonpharmacological management when the individual has dementia.",
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T2 - A Randomized Controlled Trial

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AU - Fick, Donna

AU - Litaker, Mark

AU - Mulhall, Paula

AU - Clare, Linda

AU - Hill, Nikki

AU - Mogle, Jacqueline

AU - Boustani, Malaz

AU - Gill, David

AU - Yevchak-Sillner, Andrea

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N2 - Objective: To determine whether cognitively stimulating activities would reduce duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care. Design: Single-blind randomized clinical trial. Setting: Eight post-acute care (PAC) facilities. Participants: Community-dwelling older adults with dementia and delirium (N = 283). Intervention: Research staff provided cognitively stimulating activities daily for up to 30 days. Measurements: Primary outcomes were delirium duration (Confusion Assessment Method) and delirium severity (Delirium Rating Scale). Secondary outcomes were cognitive function (Digits Forward, Montreal Cognitive Assessment, CLOX) and physical function (Barthel Index). Results: Mean percentage of delirium-free days (intervention: 64.8%, 95% confidence interval (CI) = 59.6–70.1; control: 68.7%, 95% CI = 63.9–73.6; P =.37, Wilcoxon rank sum test) and delirium severity (range 0–39: intervention: 10.77, 95% CI = 10.10–11.45; control: 11.15, 95% CI = 10.50–11.80; difference 0.37, 95% CI = 0.56–1.31, P =.43) were similar in both groups. Significant differences for secondary outcomes favoring intervention were found (executive function (range 0–15): intervention: 6.58, 95% CI = 6.12–7.04; control: 5.89, 95% CI = 5.45–6.33; difference −0.69, 95% CI = 1.33 to −0.06, P =.03; constructional praxis (range 0–15): intervention: 8.84, 95% CI = 8.83–9.34; control: 7.53, 95% CI = 7.04–8.01; difference −1.31, 95% CI = 2.01 to −0.61, P <.001). After adjusting for baseline constructional praxis, the group comparison was no longer significant. Average length of stay was shorter in the intervention (36.09 days) than the control (53.13 days) group (standard error = 0.15, P =.01, negative binomial regression). Conclusion: Cognitively stimulating activities did not improve delirium but improved executive function and reduced length of stay. Resolution of delirium may require more-intense nonpharmacological management when the individual has dementia.

AB - Objective: To determine whether cognitively stimulating activities would reduce duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care. Design: Single-blind randomized clinical trial. Setting: Eight post-acute care (PAC) facilities. Participants: Community-dwelling older adults with dementia and delirium (N = 283). Intervention: Research staff provided cognitively stimulating activities daily for up to 30 days. Measurements: Primary outcomes were delirium duration (Confusion Assessment Method) and delirium severity (Delirium Rating Scale). Secondary outcomes were cognitive function (Digits Forward, Montreal Cognitive Assessment, CLOX) and physical function (Barthel Index). Results: Mean percentage of delirium-free days (intervention: 64.8%, 95% confidence interval (CI) = 59.6–70.1; control: 68.7%, 95% CI = 63.9–73.6; P =.37, Wilcoxon rank sum test) and delirium severity (range 0–39: intervention: 10.77, 95% CI = 10.10–11.45; control: 11.15, 95% CI = 10.50–11.80; difference 0.37, 95% CI = 0.56–1.31, P =.43) were similar in both groups. Significant differences for secondary outcomes favoring intervention were found (executive function (range 0–15): intervention: 6.58, 95% CI = 6.12–7.04; control: 5.89, 95% CI = 5.45–6.33; difference −0.69, 95% CI = 1.33 to −0.06, P =.03; constructional praxis (range 0–15): intervention: 8.84, 95% CI = 8.83–9.34; control: 7.53, 95% CI = 7.04–8.01; difference −1.31, 95% CI = 2.01 to −0.61, P <.001). After adjusting for baseline constructional praxis, the group comparison was no longer significant. Average length of stay was shorter in the intervention (36.09 days) than the control (53.13 days) group (standard error = 0.15, P =.01, negative binomial regression). Conclusion: Cognitively stimulating activities did not improve delirium but improved executive function and reduced length of stay. Resolution of delirium may require more-intense nonpharmacological management when the individual has dementia.

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