Daily orientation program's effect on hospitalized elderly medical patients predicted to be at risk for an acute confusional state

Hospitalization for many elderly patients produces stimuli which may not be easily integrated with previous experiences. A response to these stimuli by the elderly patients has been linked to the development of acute confusional states (ACS). Therefore, the study's purpose was to examine the effect of a daily orientation program on hospitalized elderly medical patients predicted to be at risk for developing ACS. Between October, 1986, and February, 1987, an experimental study using a 2 x 2 x 5 factorial design with repeated measures was conducted in a 132-bed federal hospital located in the southwestern United States. A sample of 40 alert volunteer subjects was selected from a population of hospitalized male United States veterans 65 years of age or older. On admission day, medical patients admitted to the study were randomly assigned either to an experimental or control group and were given both the Confusion Risk Factor Interview (CRFI) and the Mini-Mental State Examination (MMSE). The CRFI determined if the subjects were at high or low risk level for ACS, and the MMSE determined mental status. Subsequently, in the mornings on the next four consecutive hospital days, the high and low risk experimental subjects received the daily orientation program. Each evening on the same four days, all subjects were given the MMSE. The study design concluded when 20 had been assigned to the experimental group and 20 to the control group and the subjects were evenly divided into the two risk levels. A three-factor analysis of variance with repetition over one factor was employed for the study. No main effects were found; however, one simple main effect between the treatment levels and risk levels was found. Therefore, Newman-Keuls technique was applied to the daily mean MMSE scores. No acute confusion occurred among the subjects in any group; however, the experimental low risk group had significantly better mental status scores than the control low risk group. No such effect was found among the high risk groups. In this investigation the elderly patient at low risk for ACS improves in mental status with a daily nursing intervention.