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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
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
AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH 3
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
AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH 5
DETAILED RESULTS:
KNOWLEDGE OF AND EXPERIENCE WITH DELIRIUM
AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH
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
AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH
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
AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH 8
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%
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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
AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH
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
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DETAILED RESULTS:
PREVENTION AND TREATMENT STRATEGIES
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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
AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH
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
AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH
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)
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IMPLICATIONS
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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
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METHODOLOGY
AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH
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
AARP.ORG/RESEARCH | © 2019 AARP ALL RIGHTS RESERVED AARP RESEARCH 19
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.
AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH 20
APPENDIX:
SAMPLE DEMOGRAPHICS
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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
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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%
Current medical specialty
Internal medicine 8%
Nephrology 1%
Neurology 3%
OB-GYN 4%
Occupational therapy 1%
Oncology (all types) 8%
Orthopedics 2%
Physical therapy 10%
Current medical specialty
Podiatry 1%
Psychiatry 4%
Pulmonology 2%
Radiology (all types) 2%
Surgery (all types except oral surgery)
16%
Urology 1%
AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH 23
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
AARP.ORG/RESEARCH | © 2020 AARP ALL RIGHTS RESERVED AARP RESEARCH
Cheryl Lampkin, AARP Research
Laura Mehegan, AARP Research
G. Rainville, AARP Research
For media inquiries, please contact
This research was designed and executed by AARP Research
24