Aims - Dementia and Delirium Outreach Team (DDOT) service was developed as an innovative, integrated approach to help manage older adults with cognitive impairment and behavioural symptoms, in tertiary hospital non-geriatric wards. It adopts a team-based, inter-disciplinary strategy, incorporating person-centred care interventions. The primary objectives are timely diagnosis and decreasing physical restraints.
Methods - The DDOT consists of geriatrician, geriatric psychiatrist, geriatric Advance Practice Nurse, and psychologist. Older adults with possible delirium and dementia, with behavioural disturbance, are referred from general medical wards. Holistic assessment and management are performed in close collaboration with primary team doctors and nurses. The main outcome measures are new diagnosis of delirium and dementia, and changes in physical restraints, AEC (Anticholinergic Effect on Cognition), CAM-S (Confusion Assessment Method Severity), and PAS (Pittsburgh Agitation Scale).
Results - 75 patients were reviewed over 9 months. 82% of patients had a new diagnosis of delirium, while 27% had a new diagnosis of dementia. 81% were on physical restraints ; 52% of these were discontinued. 84% of patients had PAS score >= 2, denoting significant agitation ; this reduced to 17%. Mean CAM-S was reduced from 13.8 to 6.4. 100% had AEC scored ; mean AEC was reduced from 2.5 to 1.3.
Conclusions - The novel DDOT is effective in assessing and managing vulnerable patients with delirium, dementia and behavioural disturbance in general wards, with measurable improvement in outcomes. This integrated, inter-disciplinary service improves care for these complex patients, and can be replicated across other hospitals and health systems.