Award for delirium research

Research led by a HammondCare doctor which found good clinical and nursing care for patients with delirium was better than using antipsychotic medication has won an American Geriatrics Society (AGS) award.

The clinical trial, for which Braeside Hospital was a key site, compared the efficacy of risperidone and haloperidol in a placebo controlled study, exploring their ability to control specific delirium symptoms relating to communication, behaviour and/or perceptual disturbances in palliative care patients.Braeside Hospital Director of Palliative Care, Associate Professor Meera Agar, led an international team in conducting a clinical trial of delirium medications, with a poster addressing the outcomes winning the 2015 AGS Presidential Poster award in the clinical trials category.

HammondCare is involved in wide-ranging research across health and aged care include palliative care, rehabilitation, dementia, aged care practice and pain. 

Importance of identifying, treating delirium

A/Prof Agar, who also holds positions with Flinders University the University of New South Wales and Liverpool Hospital’s Ingham Institute, told the ehospice news website that the core finding of the study was that good clinical and nursing care for patients with delirium was actually better than using antipsychotic medication.

“This study has highlighted the importance of identifying delirium and individualising its management,” A/Prof Agar said.

“Many health professionals don’t realise that delirium is often reversible in people with advanced illness, even in specialist palliative care inpatient units. The key is to keep an open mind about what may or may not be burdensome to the patient, and not just jump to the conclusion that the person is at the end of their life and nothing can or should be done."

Explanation for patient and family, training for nurses

A/Prof Agar said, “Often families think a loved one has developed a psychiatric disorder because many don’t know what delirium is. This trial has reinforced how critical timely diagnosis is. There also the need for as comprehensive an explanation as possible to the patient and family about this highly distressing state and how it can be managed.”

Delirium will be the subject of an advanced symptom management workshop hosted by the Palliative Care Nurses Association (PCNA) and the Palliative Care Clinical Studies Collaborative (PaCCSC) at the Australian Palliative Care Conference in Melbourne on Tuesday, September 1.

The session will give delegates an overview of the burden of delirium in palliative care, and present the results from several recently completed Australian studies exploring delirium care, including the clinical trial led by A/Prof Agar.

”All of these highlight the importance of nursing care in improving patient outcomes," she said.

Strategies for better care

A/Prof Agar will co-host the workshop with Professor Jane Phillips and Ms Annmarie Hosie. It will include information ranging from strategies and tools to assist attendees personally and allow them to take back to their clinical domain.

The workshop will employ a typical case study to help educate participants while using and experimenting with delirium screening tools and discussing how to handle clinical scenarios they have encountered.

"It will give delegates hands on experience in the nuances in these type of assessments using examples that people would have seen in their clinical practice,” A/Prof Agar said.

More from the researcher 

How did a clinical trial find that good clinical and nursing care was better than using anti-psychotics?

MA: All patients received individualised clinical management of the medical causes of delirium and the trials nurses worked with ward clinical teams to help support them in implementing good non-pharmacological management - for example ensuring patients had their glasses and hearing aids, considering if a family member could be present, trying to keep the ward environment calm. The patients on the placebo arm of the trial received this care but without adding a drug - and they had a better outcome with less symptoms after three days. We also found the trial ensured the family were given a good explanation of what delirium is and how it can be managed so this also may have helped.

How will we seek to implement the research findings?

MA: The results are quite new but some response would be:

1.It is important all our staff know what delirium is and how to detect it.

2.We need to have procedures in place to screen for delirium and act quickly if it occurs.

3.We need to ensure all families (and patients) receive a good explanation of what delirium is and are supported.

4.We need to ensure our clinical environments value, foster and can support non-pharmacological therapies - and we continue to pay attention to essential elements of care (hydration, ensuring vision and hearing is maximised, encouraging mobilisation) and help with orientation (clocks, and calendars) and sleep (not noisy, low lighting at night).

"It sometimes seems simpler and quicker to jump to using medication when someone is agitated, but we need to value sitting quietly with that person, providing reassurance and orientation to assist with symptoms."