Delirium Risk and Healthcare Utilization Among Homebound Veterans
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Background and significance: Delirium is a serious clinical syndrome encountered in geriatric patients, which leads to higher costs, increased healthcare utilization and mortality. Evaluating older adults for delirium risk factors, screening, early diagnosis and prevention strategies can help maintain health. Purpose and objectives: The Buffalo NY Veterans Administration Home Based Primary Care (HBPC) team is positioned to work toward minimizing patient delirium risk and improving outcomes, however the team does not currently screen for delirium risk. The purpose of this project was to develop a tool to evaluate for delirium risk in the HBPC population and to validate the tool via a prospective chart review of healthcare use. Theoretical framework: Neuman’s Systems Model guided this study. Methods and design: A comprehensive literature review established evidence-based delirium risk factors and guided tool development. Chart review established delirium risk followed by a prospective chart review to evaluate healthcare utilization. Results: Average delirium risk score, based on scale of 0-10 was 6.98, SD 1.51, range 3-10, suggesting high delirium risk in the sample (n=66). 36.4% of the sample developed delirium during the chart review period. Conclusion: HBPC has a high-risk population for delirium development. The sample is significantly skewed; tool validation though healthcare utilization was unsuccessful. Future recommendations: HBPC would be better suited to focus efforts on delirium screening and risk mitigation. Use of the delirium risk assessment tool in traditional primary care may be helpful in both evaluate delirium risk and evaluating tool validity via healthcare utilization.