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PICO Question
In older adult patients with delirium, does increase rounding as compared to normal rounding decrease fatality from this condition?
P older adult patients with delirium
I increased rounding
C normal rounding
O decrease in fatality
Practice Issue and Scope of the Problem
Older adults are one of the most vulnerable groups in hospital settings as their bodies and minds are subject to a wide range of disorders, conditions, and illnesses. According to Inouye, Westendorp, and Saczynski (2014), delirium is fairly common among this group of patients and constitutes up to 50% of cases in hospitals. Delirium and the symptoms that are associated with it are observed in 80% of older adults in intensive care units. Thus, the scope of the problem is very broad. The symptoms are quite elusive and often seen in post-operation elderly patients. This unpleasant condition affects the cognitive abilities of the brain and can lead to death within 30 days (Fick, Steis, Waller, & Inouye, 2013). The mortality rate that is associated with delirium is also high. Up to 25% of the elderly who were diagnosed with this condition died. Moreover, service for patients having it is enormously high, which speaks further to the urgency of the issue. Thus, there is a strong need for intervention.
Evidence and Rationale
There is extensive empirical evidence that delirium is an acute problem of modern medicine. Inouye et al. (2014) state that it was described 2500 years ago but the notion is still vague. The researchers cite more than one hundred academic sources that describe various aspects of identification, treatment, and management of delirium in patients. They also state that the onset of the symptoms might be prompt (Inouye et al., 2014). Additionally, Yevchak et al. (2012) also note that the symptoms of delirium are often hard to define in practical settings and easy to confuse with similar ones associated with dementia. Therefore, close observation is in order. Intervention such as increased routing could help find symptoms earlier and manage the disease with better success. The authors personal experience is consistent with practical and theoretical findings and suggests that the problem needs to be addressed.
Empirical evidence, especially published in peer-reviewed journals, needs to be used due to the fact that it provides structured, analyzed, and systematized knowledge of many professionals in the sphere. Clinical experience and case studies can also be helpful as they provide a broad range of real-life data and reflect the current situation. However, personal experience cannot be used extensively for the outlined PICO question and the follow-up study, as it does not contain enough data on the topic. Information on service user perspective also has little relevance to the matter as their mental abilities are diminishing and their opinion can doubtfully be used.
Search Terms
The primary data sources are scholarly and peer-reviewed journals containing empirical and clinical evidence. According to the set PICO question, the search will include articles containing words like delirium, acute confusion, rounding, and older adults. The articles also need to be no older than five-six years old to reflect only the relevant and timely information. The search can be narrowed down by combining the keywords and using quotation marks. Additionally, it can be made more precise with the use of collocations and words like hospital setting, ICU, or nursing.
References
Fick, D. M., Steis, M. R., Waller, J. L., & Inouye, S. K. (2013). Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults. Journal of Hospital Medicine, 8(9), 500-505.
Inouye, S. K., Westendorp, R. G., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922.
Yevchak, A., Steis, M., Diehl, T., Hill, N., Kolanowski, A., & Fick, D. (2012). Managing delirium in the acute care setting: A pilot focus group study. International Journal of Older People Nursing, 7(2), 152-162.
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