Often elderly patients develop delirium during hospitalization. Delirium is waxing and waning cognitive function and often manifests as memory lapses, agitation, unable to understand care being provided, and limited cooperation in the provision of care.
One of the reasons offered for the possible causation of delirium is an unfamiliar environment and people (in addition to the underlying illness). However, while this is plausible, it has not been rigorously studied.
A recent study published in the JAMA is trying to address the ‘casualty question’ in addition to the therapeutic effect of family presence. What investigators wanted to see was that if there is a difference in the incidence of delirium between patients who get frequent family visitation versus those who did not. To increase family visitation, investigators relaxed family visitation hours to some intensive care units while other units continue to have their usual visitation hours. Overall, the number of hours a family member visited patient increased significantly in the intervention arm (4.8 hours versus 1.4 hours); almost three times increase.
Investigators did not find a statistically significant difference between the two groups although there appears to be a somewhat decreased incidence of delirium in patients admitted to ICUs in the intervention arm (18.9 vs 20.1%).
These findings are important and while do not reject the hypothesis that unfamiliar environment may play a causal role in delirium, it does question its validity. Future studies are likely to address this question further.
