Delirium: Prevalence and outcome in the very old in 27 medical departments during a one-year prospective study

Objective The prevalence and effects of delirium in very old individuals aged ≥80 years have not yet been systematically evaluated. Therefore, this large single-center study of the one-year prevalence of delirium in 3,076 patients in 27 medical departments of the University Hospital of Zurich was conducted. Methods Patient scores on the Delirium Observation Screening scale, Intensive Care Delirium Screening Checklist, Diagnostic and Statistical Manual, 5th edition, and electronic Patient Assessment–Acute Care (nursing tool) resulted in the inclusion of 3,076 individuals in 27 departments. The prevalence rates were determined by simple logistic regressions, odds ratios (ORs), and confidence intervals. Results Of the 3,076 patients, 1,285 (41.8%) developed delirium. The prevalence rates in the 27 departments ranged from 15% in rheumatology (OR = 0.30) to 73% in intensive care (OR = 5.25). Delirious patients were more likely to have been admitted from long-term care facilities (OR = 2.26) or because of emergencies (OR = 2.24). The length of their hospital stay was twice as long as that for other patients. Some died before discharge (OR = 24.88), and others were discharged to nursing homes (OR = 2.96) or assisted living facilities (OR = 2.2). Conclusion This is the largest study to date regarding the prevalence of delirium in patients aged ≥80 years and the medical characteristics of these patients. Almost two out of five patients developed delirium, with a high risk of loss of independence and mortality.

A Longitudinal Study of Older Adults’ Acceptance of Robot Companions and Their Effects on Well-Being

Robotic animal-like companions for older adults are promising technologies that have shown to have health benefits, especially for individuals with dementia, and good adoption rates in some previous studies. Our project, Affordable Robotic Intelligence for Elderly Support, aims to design new capabilities for companionship and smart care, but at high affordability. In a 6-month longitudinal study of baseline acceptance and well-being, we assessed the impact of an Ageless Innovation Joy for All™ robotic pet on user acceptance and emotional well-being (depression, loneliness, positive emotions). Nineteen participants from independent and assisted living facilities completed three standardized in-person surveys, each 3 months apart, including the CES-D, measures of Loneliness, Emotions, Attitude towards Technology (ATI), and various measures of evaluation of and engagement with robotic technology. The measures showed modest to very good reliability and meaningful construct validity. Participants in this sample showed little depression or loneliness, and these levels did not further decrease over the six months. People welcomed the pet and expressed positive evaluations of it, and these sentiments were stable over time. Attitudes toward technology varied but were unrelated to well-being measures and to robot evaluations. Our current conclusion, on the basis of a small sample, is that the selected robotic pet companion is appreciated and seen as beneficial, and for adults who are already low in depression and loneliness, the robot companion helps maintain the adult’s emotional well-being but does not further increase it.

Challenges of Implementing the PRISM 2.0 Trial for Supporting Social Connectivity Through Technology

Following the success of the Personal Reminder Information and Social Management (PRISM) trial, which found that a specially designed computer system for older adults can enhance social connectivity and reduce loneliness among older adults at risk for social isolation, the PRISM 2.0 trial sought to replicate and extend these results to a new technology platform (tablet rather than desktop) with expanded social features and diverse populations of older adults, including older adults living in rural areas, assisted living communities, and senior housing. This symposium discusses the aims of the trial conducted by the Center for Research and Education on Aging and Technology Enhancement (CREATE), challenges encountered (including challenges related to the COVID-19 pandemic), and solutions to those challenges. S. Czaja will begin with an overview of the PRISM 2.0 system and the trial. J. Sharit will discuss challenges encountered working within the context of assisted living facilities and with impaired participants. This will be followed by a discussion of technical challenges encountered during the course of the trial presented by N. Charness. W. Rogers will present training issues involved (both with respect to participants and assessors). Finally, W. Boot will describe challenges encountered with measuring and quantifying technology use during the trial. Lessons learned are applicable to many types of technology interventions administered in diverse contexts. D. Plude, Deputy Director in the Division of Behavioral and Social Research of NIA, will serve as discussant.

Challenges of Implementing the PRISM 2.0 Clinical Trial With Assisted Living and Impaired Participants

The PRISM 2.0 clinical trial examined the benefits of a software system, implemented on a computer tablet, which was designed to support access to information, engagement, and social connectivity among older people. Participants across three sites were recruited from rural locations, senior living housing facilities, and assisted living facilities (ALFs) and correspondingly randomized into either the Prism or control (tablet computer without the PRISM system) conditions. In this talk, we focus on the challenges associated with including ALF participants at key stages of the trial. These stages included telephone prescreening, baseline assessment, training on the system, and 6-, 9-, and 12-month follow-up assessments. Inability to meet inclusion criteria related to cognitive and sensory-motor considerations was a common problem, as was the ability to sustain attention during the training sessions. Recommendations for recruitment and retaining older adults in ALFs for these types of studies will be offered.

How Does Aging in Place Help Us Understand Loneliness During the COVID-19 Pandemic?

Co-sponsored by the Disasters and Older Adults, Loneliness and Social Isolation, and Rural Aging Interest Groups, five presenters will highlight multiple circumstances regarding the intersection of social isolation or loneliness and the impact of COVID-19. Haverhals and colleagues interviewed veterans and their caregivers to identify the impact of changes in care delivery and social isolation as a result of the pandemic. Findings indicated differences in feelings of isolation among individuals living in their own home or assisted living facilities. Hua et al. examined whether individuals in long-term care communities were lonelier than individuals in the community during the pandemic using data from the NHATS COVID-19 module with higher levels of loneliness reported from individuals living in more restricted communities. Henning-Smith and colleagues explored differences in social activities among rural and urban participants in the COVID-19 Coping Study. Their study provides awareness into the ways rural and urban older adults stayed connected during the pandemic. Peterson et al. examined the effect of COVID-19 on care in Florida nursing homes and assisted living communities and on residents’ anxiety with higher levels of anxiety reported by residents in nursing homes. Using the Coping with Loneliness, Isolation and COVID19 Global Survey, O’Sullivan and colleagues utilized the lens of ‘place’ to examine factors associated with those experiencing loneliness and/or social isolation during the pandemic with insights from a public health perspective. Collectively, these presenters will provide evidence of the challenges associated with older adults’ social isolation and loneliness throughout the COVID-19 pandemic.

Impact of Social Isolation Due to COVID-19 on VA Home-Based Primary Care Veterans and Caregivers

In December 2020 we began conducting phone interviews with Veterans, and their caregivers, receiving care through the United Sates (US) Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) program. Our goal was to describe experiences of Veterans and caregivers managing changes in care delivery related to the COVID-19 pandemic and navigating increased social isolation due to social distancing. We interviewed 38 Veterans (average age 78) and caregivers (average age 62) across seven VA HBPC programs. Findings showed those living in their own homes found increased isolation more manageable than those living in assisted living facilities, which restricted visitors. Caregivers had a harder time managing isolation than Veterans, as Veterans were used to being primarily homebound. Veterans and caregivers relied on increased phone communication with their HBPC teams, with some began participating in virtual visits. Implications include insights into better supporting older, homebound adults and their caregivers during disasters.

Information and Communication Technology Changes in Long-Term Care Due to COVID-19

Residents of long-term care (LTC) facilities (e.g., nursing homes, assisted living facilities) have historically been vulnerable to feelings of loneliness and social isolation. Due to the COVID-19 pandemic, LTC facilities were required to restrict public access in March 2020. LTC communities were not prepared for the residents’ increased socioemotional needs which arose because of the mandated facility lockdown. This study investigated ICT use in LTC facilities and how ICTs are being used by residents since the onset of the COVID19 pandemic. Seventy LTC administrators in South Carolina (12 nursing homes and 58 assisted living facilities) completed an online survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of COVID-19. Administrators from fifty-three percent of LTC facilities reported purchasing ICTs for their residents to use for communicating with family members and telehealth since the onset of COVID-19. LTC administrators reported that using the ICTs helped residents to socialize more frequently and feel more socially connected to their family members, friends and/or other residents. Barriers to ICT use included staff not having time to assist residents with technology, broken technology, and residents not wanting to share technology. LTC facilities were not adequately prepared to support the socioemotional needs of their residents in the event of a federally mandated facility lockdown. Future research should investigate the ICTs available for residents’ use in a national sample of LTC facilities and how LTC administrators adapted the ICTs available as a result of their experiences with COVID-19.