How Does Delirium Impact Allied Health Therapy After Stroke?
BRENDAN CUTTS
C A N D I D AT E F O R M A S T E R O F C L I N I C A L R E H A B I L I TAT IO N ( N E U R O L O GI C A L P H Y S I O T H E R A P Y )
Post-stroke Delirium
• Delirium is a neuropsychiatric syndrome with fluctuating symptoms of altered attention, perception and
consciousness
• Delirium affects around one third of stroke survivors (Turco et al., 2013)
• Many risk factors for delirium are more prevalent in stroke survivors
• Delirium raises risk of mortality and admission to Residential Aged Care by up to 6 times (Miu & Yeung, 2012)
• Delirium can last from 2 days to many months (Siddiqi et al., 2016)
• Often overlaps the most critical period for rehabilitation
• People in delirium typically receive less therapy
• Strategies have been found to reduce the incidence and severity of delirium (Inouye et al., 2000)
• Very limited research on optimal therapeutic models for patients with delirium
Therapy and Delirium
• Can delirious stroke patients participate in allied health therapy?
• Are there session characteristics that improve engagement?
Aims
• Prospective observational study, January – May 2018
• Up to the first 4 weeks post stroke
• Convenience sample of all patients admitted with a diagnosis of stroke across acute and subacute wards
• PT, OT and SP completed a brief survey after each session
• Confusion Assessment Method completed daily (Inouye et al., 1990)
Methods
• Data collection is complete and analysis is underway. Final report to be submitted in June 2018.
• At time of writing 35 patients had been recruited with over 300 therapy sessions recorded.
Results…
Thank you
A C K N O W L E D G E M E N T S :
A / P r o f C h r i s B a r r, F l i n d e r s U n i v e r s i t y
A / P r o f A n n a Wo n g S h e e , B a l l a r a t H e a l t h S e r v i c e s
Inouye, S. K., Bogardus Jr, S. T., Baker, D. I., Leo-Summers, L., & Cooney Jr, L. M. (2000).
The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. Journal of the American Geriatrics Society, 48(12), 1697-1706.
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P., & Horwitz, R. I. (1990).
Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Annals of internal medicine, 113(12), 941-948.
Miu, D. K., & Yeung, J. C. (2013). Incidence of post-stroke delirium and 1-year outcome.
Geriatr Gerontol Int, 13(1), 123-129. doi:10.1111/j.1447-0594.2012.00871.x
Siddiqi, N., Harrison, J. K., Clegg, A., Teale, E. A., Young, J., Taylor, J., & Simpkins, S. A.
(2016). Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev, 3, CD005563. doi:10.1002/14651858.CD005563.pub3
Turco, R., Bellelli, G., Morandi, A., Gentile, S., & Trabucchi, M. (2013). The effect of poststroke delirium on short-term outcomes of elderly patients undergoing rehabilitation. Journal of
geriatric psychiatry and neurology, 26(2), 63-68.
