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Waszynski CM, Milner KA, Staff I, et al. Using simulated family presence to decrease agitation in older hospitalized delirious patients: A randomized controlled trial. Int J Nurs Stud. 2018 Jan;77:154-161. doi: 10.1016/j.ijnurstu.2017.09.018. Epub 2017 Oct 7. (Original)

RCT: In hospitalized patients with hyperactive or mixed delirium, a family video message or a nature video briefly reduced agitation more than usual care.

BACKGROUND: Simulated family presence has been shown to be an effective nonpharmacological intervention to reduce agitation in persons with dementia in nursing homes. Hyperactive or mixed delirium is a common and serious complication experienced by hospitalized patients, a key feature of which is agitation. Effective nonpharmacological interventions to manage delirium are needed.

OBJECTIVES: To examine the effect of simulated family presence through pre-recorded video messages on the agitation level of hospitalized, delirious, acutely agitated patients.

DESIGN: Single site randomized control trial, 3 groupsx4 time points mixed factorial design conducted from July 2015 to March 2016.

SETTING: Acute care level one trauma center in an inner city of the state of Connecticut, USA.

PARTICIPANTS: Hospitalized patients experiencing hyperactive or mixed delirium and receiving continuous observation were consecutively enrolled (n=126), with 111 participants completing the study. Most were older, male, Caucasian, spouseless, with a pre-existing dementia.

METHODS: Participants were randomized to one of the following study arms: view a one minute family video message, view a one minute nature video, or usual care. Participants in experimental groups also received usual care. The Agitated Behavior Scale was used to measure the level of agitation prior to, during, immediately following, and 30min following the intervention.

RESULTS: Both the family video and nature video groups displayed a significant change in median agitation scores over the four time periods (p<0.001), whereas the control group did not. The family video group had significantly lower median agitation scores during the intervention period (p<0.001) and a significantly greater proportion (94%) of participants experiencing a reduction in agitation from the pre-intervention to during intervention (p<0.001) than those viewing the nature video (70%) or those in usual care only (30%). The median agitation scores for the three groups were not significantly different at either of the post intervention time measurements. When comparing the proportion of participants experiencing a reduction in agitation from baseline to post intervention, there remained a statistically significant difference (p=0.001) between family video(60%) and usual care (35.1%) immediately following the intervention

CONCLUSION: This work provides preliminary support for the use of family video messaging as a nonpharmacological intervention that may decrease agitation in selected hospitalized delirious patients. Further studies are necessary to determine the efficacy of the intervention as part of a multi-component intervention as well as among younger delirious patients without baseline dementia.
Clinical Rater Comments (3)
Geriatrics
Although this is an interesting study, it has a very very small sample size with very short selective intervention. It needs more data to be sure how much potential use this might provide in the future.
Geriatrics
Unfortunately, as a geriatrician, I see many patients with delirium either post op or during hospitalization for an infection. Managing these patients is a nightmare not only for doctors but also for the families and nursing staff. Pharmacotherapy rarely works. Add to that the increased morbidity, hospital stay and mortality and it becomes evident that any intervention that makes the task easier is welcome. The use of video contact with the patient is a welcome idea as the patient family cannot stay around the clock with him or her.
Intensivist/Critical Care
Well conducted but more importantly this is a low-cost potentially effective treatment. The question is what does a 24-hour visitation policy have on delirium versus restricted visitation, and also 24-hour visitation versus playing a video of a family member, as was done in the article.


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DisciplinesRelNews
Geriatrics7/75/7
Hospital Doctor/Hospitalists6/76/7
Intensivist/Critical Care6/76/7
Internal Medicine6/76/7