2020 aarp delirium and brain health survey: healthcare ... · laura mehegan, aarp research...

AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED DOI: AARP RESEARCH

March 2020

https://doi.org/10.26419/res.00376.002

2020 AARP DELIRIUM AND BRAIN

HEALTH SURVEY: HEALTHCARE

PROVIDERS

https://doi.org/10.26419/res.00376.002

AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH 2

Key Findings 3

Detailed Results:

Knowledge of and Experience with Delirium 5

Detailed Results:

Prevention and Treatment Strategies 11

Implications 15

Methodology 17

Appendix: Sample Demographics 20

Contact 24

Table of Contents


KEY FINDINGS

AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH

Key FindingsDelirium is a complication that sometimes occurs during a hospitalization. It can happen when individuals undergo a surgical procedure or are hospitalized for an illness or medical condition.1 This survey explored the awareness and incidence of delirium with physicians and affiliated healthcare workers as well as healthcare professionals' attitudes and opinions on effective strategies to prevent delirium.

Healthcare professionals are familiar with delirium, patients are not. Few healthcare providers say their patients who are hospitalized or undergo surgical procedures ask about delirium.

Healthcare professionals believe noninvasive efforts help combat delirium. Healthcare providers say having a loved one or friend stay at the hospital as much as possible is an effective way to treat delirium.

Contrary to recent studies, a majority of healthcare professionals also believe antipsychotic medications are effective. The vast majority say the use of antipsychotic medication is at least somewhat effective in the treatment of delirium. Based on recent research studies, the Global Council on Brain Health (GCBH) advises that these medications can have serious side effects and are NOT helpful to treat delirium. Over medication – either inappropriate and/or multiple medications given at the same time -- is one of the most common contributors to delirium.1

Healthcare professionals support standardized measures to address possible delirium symptoms. They support measures such as employing standard practices and screenings as well as providing patients with related information prior to hospitalization or surgical procedures.

4

1Global Council on Brain Health (2019). “Preserving Your Brain Health During Illness or Surgery: GCBH Recommendations to Prevent and Treat Delirium.” Available at

www.GlobalCouncilOnBrainHealth.org; DOI: https://doi.org/10.26419/pia.00101.001

A second delirium and brain health survey among adults

age 50-plus was fielded in conjunction with this survey.

Those results can be found in the document entitled

“2020 AARP Delirium and Brain Health Survey: Adults

Age 50+” at https://doi.org/10.26419/res.00376.001

http://www.globalcouncilonbrainhealth.org/

https://doi.org/10.26419/pia.00101.001

https://doi.org/10.26419/res.00376.001


DETAILED RESULTS:

KNOWLEDGE OF AND EXPERIENCE WITH DELIRIUM


According to healthcare professionals, a majority of patients are

not familiar with delirium

6

Q6: Thinking about your patients who are hospitalized or undergo surgical procedures, how familiar do they tend to be with delirium (i.e., do they or their families ask about it)? Extremely familiar,

Very familiar, Somewhat familiar, Not very familiar, Not at all familiar

Only about one third of healthcare providers say their patients who are hospitalized or undergo surgical procedures are

familiar with delirium. A parallel survey of adults age 50-plus confirms limited awareness with only about a quarter at

least somewhat familiar with delirium and over half (52%) not at all familiar with delirium.2

3%8%

21%

56%

13%

Extremly familiar Very familiar Somwhat familiar Not very familiar Not at all familiar

Patients’ familiarity with delirium according to healthcare providers

32%

2Mehegan, L.L. and Rainville, G.A. (2020). “2020 AARP Delirium, and Brain Health Survey: Adults Age 50+.” https://doi.org/10.26419/res.00376.001

https://doi.org/10.26419/res.00376.001


Most healthcare providers say a percentage of patients have

experienced delirium from hospitalization or surgery

10%

49%

31%

8%

1%2%

42%39%

13%

3%

None Less than 25% 25% to less than50%

50% to less than75%

75% or more

Percent of patients have experienced delirium from hospitalization or surgery

All patients Patients age 50+

7

Q1: How many of your patients, if any, have experienced delirium from a hospitalization or surgery?

Q2: Thinking about patients who are age 50 or older, approximately what percentage of your patients, if any, have experienced delirium from a hospitalization or surgery? Base = Those who have had patients who experienced delirium

Q8: How many of your patients, if any, experience long-term effects from delirium (e.g., ongoing cognitive impairments in memory)? Base = Those who have had patients who experienced delirium

According to the Global Council on Brain Health (GCBH), as many as half of adults age 65-plus experience delirium following a hospital

admission.3 Results from this survey show that most healthcare providers say at least a quarter of their patients across all age groups

have experienced delirium. One in five say at least a quarter of their patients have experienced long-term effects of delirium.

21%

58%

17%

3%1%

None Less than25%

25% to lessthan 50%

50% to lessthan 75%

75% or more

Percent of patients who have experienced long-term effects from delirium

21%

3Global Council on Brain Health (2019). “Preserving Your Brain Health During Illness or Surgery: GCBH Recommendations to Prevent and Treat Delirium.” Available at www.GlobalCouncilOnBrainHealth.org; DOI:

https://doi.org/10.26419/pia.00101.001


https://doi.org/10.26419/pia.00101.001


Q7: Thinking about your patients who have experienced delirium, how frequently did each of the following cause or contribute to the delirium? Base = Those who have had patients who experienced

delirium

Surgery/anesthesia contribute to delirium for 50% or more patients

Among patients who have experienced delirium, healthcare providers say the top four contributing factors are surgery

or anesthesia, narcotic pain medication, the hospital environment, and current medical conditions. Surgery or

anesthesia contribute to delirium for 50% or more patients.

Percent of healthcare providers indicating frequency of cause/contribution to

delirium experienced by patients

Cause of delirium or contributing

factor to deliriumNone < 25%

25% to

<50%

50%

to

<75%

75% or

more

Surgery/anesthesia 2% 16% 29% 33% 20%

Narcotic pain medication 2% 14% 37% 31% 16%

The hospital environment itself 2% 20% 33% 27% 17%

Current medical condition(s) 2% 20% 33% 32% 12%

Being left in the bed for prolonged periods of time 5% 24% 31% 27% 11%

The use of anticholinergics such as diphenhydramine

or oxybutynin5% 38% 34% 18% 4%

Anti-anxiety medication 6% 33% 38% 19% 4%

Current regular medication(s) 13% 48% 25% 11% 2%


Healthcare providers are familiar with all of the symptoms of delirium

9

For nearly all of the symptoms of delirium, a majority of healthcare providers say they are extremely/very familiar with

each. Nearly all healthcare providers are at least somewhat familiar with each symptom.

Q3: How familiar are you, if at all, with the following symptoms of delirium?

72%

73%

74%

74%

76%

76%

76%

22%

22%

22%

20%

20%

18%

20%

7%

5%

4%

6%

4%

6%

4%

Changes in personality

Confusion about daily routines

Confusion about who people are

Becoming stressed, anxious, or hyper

Difficulty understanding what is happening

Confusion about daily events

Saying things that do not make sense

Extremely/Very familiar Somewhat familiar Not very/Not at all familiar


Some healthcare providers are not as familiar with selected

delirium symptoms

10

While most healthcare providers say they are familiar with a patient delirium symptom of becoming overly sleepy or

compliant, one in five say they are not familiar with this symptom. One in six are not familiar with the patient delirium

symptom of becoming quiet and withdrawn.

Q3: How familiar are you, if at all, with the following symptoms of delirium?

49%

51%

56%

59%

60%

65%

67%

34%

28%

29%

27%

28%

24%

23%

17%

21%

15%

14%

12%

11%

10%

Becoming quiet and withdrawn

Becoming overly sleepy or compliant

Change in eating habits

Thinking people are trying to hurt them

Long-term problems with thinking that resemble dementia

Seeing or hearing things that are not there (hallucinations)

Change in sleep habits

Extremely/Very familiar Somewhat familiar Not very/Not at all familiar


DETAILED RESULTS:

PREVENTION AND TREATMENT STRATEGIES


Having a loved one near is believed to be effective in the treatment

of delirium

12

Patient comfort factors are cited most often as an effective strategy to prevent or treat delirium. Nearly all healthcare

providers believe having a loved one or friend stay at the hospital as much as possible is an effective way to prevent or

treat delirium along with bringing glasses and hearing aids to the hospital.

Q4: Please indicate how effective, if at all, you feel each strategy is in the prevention and/or treatment of delirium. Extremely effective, Very effective, Somewhat effective, Not very effective, Not at

all effective

70%

72%

72%

74%

75%

76%

79%

81%

27%

25%

27%

24%

21%

18%

18%

19%

3%

3%

2%

2%

3%

6%

3%

1%

Periodic and frequent orientation to the day and time

Provide simple instructions, one at a time

Discontinuation of risky medications like sedatives andBenadryl

Immediately notify the medical personnel if symptoms ofdelirium are noticed

Getting patient out of bed daily, standing, and walking asable

Glasses should be brought to the hospital

Hearing aids should be brought to the hospital

A loved one or friend staying at the hospital as much aspossible

Extremely/Very effective Somewhat effective Not very/Not at all effective

In a companion survey

of adults age 50-plus,

the most common

strategy to manage or

treat an episode of

delirium cited by those

who experienced or

witnessed delirium was

for someone familiar

to the patient to stay

with them as much as

possible.4

4Mehegan, L.L. and Rainville, G.A. (2020). “2020 AARP Delirium, and Brain Health Survey: Adults Age 50+.” https://doi.org/10.26419/res.00376.001

https://doi.org/10.26419/res.00376.001


While most say antipsychotic medication is an effective treatment

for delirium, GCBH advises caution

13

While four in five healthcare providers say the use of antipsychotic medication is at least somewhat effective in the treatment of delirium

(and one-third say it is extremely/very effective), the GCBH suggests recent studies indicate other strategies such as getting patients

up and moving may work just as well with less risk of side effects.5

Q4: Please indicate how effective, if at all, you feel each strategy is in the prevention and/or treatment of delirium. Extremely effective, Very effective, Somewhat effective, Not very effective, Not at

all effective

16%

32%

53%

61%

65%

67%

44%

50%

33%

33%

28%

29%

40%

18%

14%

6%

7%

5%

Massage

Administering antipsychotic medication

Dentures should be brought to the hospital

Familiar objects from home should be broughtto the hospital

Exposure to daylight

Periodic and frequent orientation to where theyare, why they are there

Extremely/Very effective Somewhat effective Not very/Not at all effective

5Global Council on Brain Health (2019). “Preserving Your Brain Health During Illness or Surgery: GCBH Recommendations to Prevent and Treat Delirium.” Available at www.GlobalCouncilOnBrainHealth.org; DOI:

https://doi.org/10.26419/pia.00101.001


https://doi.org/10.26419/pia.00101.001


Providers agree that strategies to prevent delirium should be

standard practice in hospitals

14

Nearly eight in ten (78%) healthcare providers say delirium is a serious complication of a hospitalization or surgery and

the vast majority agree with measures designed to address possible delirium symptoms during hospitalization or

surgical procedures. These measure include employing standard prevention practices and screenings as well as

providing patients with related information prior to hospitalization or surgical procedures.

Q5: Please indicate your level of agreement with each of the following statements. Strongly agree, Somewhat agree, Neither agree nor disagree, Somewhat disagree, Strongly disagree

79%

79%

82%

83%

84%

92%

All patients should be screened for delirium during a hospital stay.

All patients age 50 and older should be screened for delirium during ahospital stay.

Hospitalized patients should be made aware of the symptoms of delirium.

Delirium should be mentioned in consent forms for procedures that requiresedation and immobilization.

The possibility of delirium should be discussed with patients prior to ahospitalization or surgical procedure.

The strategies to prevent delirium should be standard practice in hospitals.

% Agree (Strongly or Somewhat)


IMPLICATIONS


ImplicationsThere is a dangerous knowledge gap that can be

addressed. While healthcare professionals are keenly aware

of delirium, its symptoms, and strategies to prevent it, most

adults are not. Bridging this knowledge gap is key. Knowing the

risk of delirium prior to a hospitalization and taking steps to

prevent or treat delirium can avoid the long-term consequences

of this potential complication.

Standardized protocols can help abate the knowledge gap.

Healthcare professionals agree with instituting nationwide

measures designed to address possible delirium symptoms

during hospitalization or surgical procedures. A concerted effort

to better inform the public together with standardized protocols

can lead to more effective management of delirium related

hospitalization or surgical procedures.

16


METHODOLOGY


Methodology

• Objectives: The study evaluates the awareness and incidence of

post-operative delirium with physicians and affiliated healthcare

workers.

• Methodology: Online probability-based survey via Ipsos

KnowledgePanel®.

• Qualifications: Physicians, physician assistants, nurse practitioners,

registered nurses and therapist (speech, occupational, physical)

• Sample: Ipsos KnowledgePanel® & an Opt-in panel, n=556.

• Interviewing Dates: November 14 – 27, 2019.

• Weighting: Employed multi-level weighting protocol including

poststratified weighting to geodemographic characteristics of the

corresponding cohort & raking to KnowledgePanel® benchmarks for

the cohorts.

• Questionnaire length: 5 minutes (median).

• Confidence Interval: Total sample: ± 5.5 percentage points.

18


About AARPAARP is the nation’s largest nonprofit, nonpartisan organization dedicated to empowering Americans 50 and older to

choose how they live as they age. With nearly 38 million members and offices in every state, the District of Columbia,

Puerto Rico, and the U.S. Virgin Islands, AARP works to strengthen communities and advocate for what matters most

to families with a focus on health security, financial stability and personal fulfillment. AARP also works for individuals in

the marketplace by sparking new solutions and allowing carefully chosen, high-quality products and services to carry

the AARP name. As a trusted source for news and information, AARP produces the nation's largest circulation

publications, AARP The Magazine and AARP Bulletin. To learn more, visit www.aarp.org or follow @AARP and

@AARPadvocates on social media.

http://www.aarp.org/


APPENDIX:

SAMPLE DEMOGRAPHICS


Sample Demographics: Profession & Activities

21

55%

23%

14%

4% 4%

RegisteredNurse

Physician Therapist(speech,

occupational,physical)

NursePractitioner

PhysicianAssistant

Primary profession

QS1: What is your primary profession?

QS2. What percent of your professional time do you spend in each of the following areas?

92%

7% 8%2%

5%

Direct PatientCare

Administration Teaching Research Other

Percentage of time in listed areas*

*Percentages shown are the mean numbers


Sample Demographics: Practice and Specialty

22

1%

3%

5%

5%

13%

23%

52%

Transition care

Direct care in patient homes

Skilled nursing care

Rehabilitation care

Ambulatory care

Physician office

Hospital acute care

Primary practice care setting

QS3: Please select the option that best describes the care setting in which you primarily practice?

QS5: Please indicate your current medical specialty or area of practice.

Current medical specialty

Allergy/immunology 1%

Anesthesiology 1%

Cardiology 9%

Emergency medicine 5%

Endocrinology 2%

Family medicine(all types)

11%

Gastroenterology 2%

Geriatrics 5%


Internal medicine 8%

Nephrology 1%

Neurology 3%

OB-GYN 4%

Occupational therapy 1%

Oncology (all types) 8%

Orthopedics 2%

Physical therapy 10%


Podiatry 1%

Psychiatry 4%

Pulmonology 2%

Radiology (all types) 2%

Surgery (all types except oral surgery)

16%

Urology 1%


QS4: Approximate what percentage of your patients are age 50 or older?

Sample Demographics: Percentage of Patients Age 50-plus

0% 0%

20%

44%

36%

None Less than 25% 25% to less than 50% 50% to less than 75% 75% or more

Percent of patients age 50-plus


Cheryl Lampkin, AARP Research

[email protected]

Laura Mehegan, AARP Research

[email protected]

G. Rainville, AARP Research

[email protected]

For media inquiries, please contact

[email protected]

This research was designed and executed by AARP Research

24

mailto:[email protected]




2020 aarp delirium and brain health survey: healthcare ... · laura mehegan, aarp research...

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