Cases of Persistent Delirium at Nursing Homes Dropped in Recent Years: Study

Researchers note that the 2014 IMPACT Act has helped reduce overprescribing of antipsychotics.

According to the findings of a new study, the number of older patients in nursing homes across the U.S. who are experiencing delirium has decreased over the past decade.

Delirium is a serious condition marked by confusion, inattention and fluctuating awareness. It is common among older adults in nursing homes and is often an indicator of nursing home neglect. Ongoing delirium in residents is linked to poor quality of care and can lead to serious consequences, including hospital readmission, long-term institutionalization and death.

However, new findings published in the journal JAMA Network Open on March 17, indicate that not only have the number of cases of delirium dropped, but many of those cases have been resolved, resulting in positive health benefits.

Researchers from the Institute for Aging Research, Hebrew SeniorLife in Boston, Massachusetts, studied persistent delirium care in skilled nursing facilities following the implementation of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, which focused on improving the quality of post-acute care in nursing home facilities, as well as improving outcomes and reducing deaths.

The IMPACT Act focuses on reducing antipsychotic medication use, standardizing patient assessments to identify patient needs, establishing consistent management practices, and improving care coordination and quality reporting.

The research team, which was led by Dr. Chan Mi Park, examined data from more than 307,000 Medicare beneficiaries, including admissions from skilled nursing facilities from a Medicare random sample. Researchers conducted delirium assessments between January 1 and December 31 in 2014 and 2019.

According to the findings, among 162,000 patients in 2014, a total of 6,900 had delirium, or about 4.2%. Comparatively, 3,600 patients out of 145,000 had delirium in 2019, or about 2.5%.

The data also indicates persistent delirium in skilled nursing facilities decreased from 62% in 2014 to 55% in 2019, dropping from 3,300 patients to 1,300 patients by 2019. Cases of delirium that were resolved increased from 29% in 2014 to 37% of cases by 2019, the researchers noted.

Researchers indicate that more than two million Medicare beneficiaries are discharged from hospitals to skilled nursing facilities each year for follow up care. The data from the new study indicates the IMPACT act is helping to reduce the number of delirium cases and increase the number of resolved delirium cases, improving care at many skilled nursing facilities.

However, researchers warn that the high number of remaining persistent delirium cases highlights a need for further research and regulatory efforts to improve delirium care management.

Delirium and “Chemical Restraint”

Older patients have long been known to be prone to delirium. Those who suffer from delirium in the ICU often experience longer comas and longer hospital stays as well.

However, patients transferred to skilled nursing facilities to recuperate may also be given antipsychotics and sedatives to help keep them calm, a controversial practice known as “chemical restraint.”

Research indicates these sedatives and antipsychotics are often overprescribed to older patients and that these drugs can increase an older person’s risk of falling and suffering serious fractures.