a. Leveraging Patient Safety Attendants (PSA) for delirium and neuropsychiatric symptoms (NPS) management in hospitalized older adults

a. Leveraging Patient Safety Attendants (PSA) for delirium and neuropsychiatric symptoms (NPS) management in hospitalized older adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report a. Leveraging Patient Safety Attendants (PSA) for delirium and neuropsychiatric symptoms (NPS) management in hospitalized older adults Shaista U Ahmed, MD, MPH, Idris Leppla, MD, Michele Bellantoni, MD, CMD, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7801113/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Delirium and NPS of dementia are associated with multiple negative outcomes in hospitalized older adults. Pharmacological agents offer limited efficacy, with high rates of complications. Multicomponent non-pharmacological approaches for their prevention and management are considered more effective in their management. PSA/ sitters are utilized by hospitals for one-to-one observations of safety and behavior management of these patients, but evidence shows that despite their use the rate of chemical and physical restraint use remains high. Our hypothesis is that training PSAs on delirium and NPS of dementia and providing tools to engage patients can enable them to manage these conditions. Methods: Intervention: We created a 90-minutes workshop curriculum comprised of two components. IN the first part, we teach PSAs the difference between delirium and NPS of dementia, and 4AT delirium tool and in the second part, they learn from occupational therapist, strategies to cognitively re-orient a patient using items in an activity box, environmental clues to avoid behavior escalation, ways to engage in mobility and self-care. After PSA training, the project was piloted in one of the medical wards and survey data collected pre, post -workshop, and in 6 months. RESULTS: Seventeen PSAs were trained, female (94%), Black (80%), with average age ranging from 25- 60 years. Pre-workshop survey indicated PSAs reported “aggression” and “agitation” as most problematic behaviors (confusion, agitation, aggression, socially inappropriate behavior and wandering). In 6-months follow-up, 5 PSA left the hospital. Survey of the 12 PSAs indicates continued improvement in all behaviors but only “socially inappropriate behavior” was statistically significant (p<0.05) and only 55% reported using activity box. Conclusion: This study highlights that our curriculum can significantly improve the knowledge and skills of PSAs in the recognition and management of delirium but increase its adaptability we need close follow up with the PSA pool. Geriatrics & Gerontology Delirium workshop curriculum patient safety attendants/ sitters Management of delirium and dementia in hospitalized older adults Figures Figure 1 Figure 2 Introduction Delirium is common in hospitalized older adults 1 and is associated with multiple negative outcomes including longer length of hospital stay, higher rates of institutionalization, long-term cognitive decline, and increased mortality is associated with multiple negative outcomes 2 . Pharmacological agents for prevention and treating delirium offer limited efficacy and are noted to have high rates of complications including increased risk of fall, cardiovascular complications, and cognitive decline 3,4 . Rather, non-pharmacological approaches for prevention of delirium have shown positive results; using activities that are personalized to the patients’ interests, needs, and abilities are especially beneficial. 5 Hospitals frequently use one-to-one patient safety attendants (PSAs) to help care for patients with delirium. As such, PSAs are well-positioned to help manage delirium but are often under-supported and under-trained to do so effectively. Although multiple non-pharmacological interventions have been shown to be effective in managing delirium and dementia, these have not been the focus of staff educational interventions. Existing educational interventions on caring for delirium and dementia patients are often limited to didactics but lack hands-on training on how to implement non- pharmacological interventions or provide the tools for doing so 6 . Lastly, previous educational interventions often focused on nurses or multiple types of staff, but none specifically focused on PSAs, who may have unique knowledge gaps and needs as we found in our prior work. Building on this earlier work, we created a PSA curriculum 7 to improve PSA knowledge in the management of delirium and provide them with tools for activity-based delirium management. Methods Curriculum Content: The curriculum comprised of a didactic portion (led by psychiatrist IL or geriatrician SA) and a hand-on portion (led by occupational therapists MM and CM). Didactics presented an overview of delirium, including its overlap and distinctions from symptoms of dementia, delirium’s detrimental effects on hospitalized older adults, and the delirium screening tool used in our hospital. The hands-on workshop provided training on environmental awareness and emphasized the importance of establishing rapport and engaging patients in activities. We introduced an “activity box” with various resources for engaging patients, which were selected based on the experience of the geriatric recreational and occupational therapists; these included fidget toys, a weighted gel lap pad to provide comfort, an activity apron with multiple textures and surfaces, sensory balls, crayons, plastic picture cards, matching cards, white boards, lacing boards, photo books, and plastic purses (Figure 1). The workshop demonstrated using these resources as non-pharmacological strategies to manage behavioral symptoms, and shared evidence on the importance of increasing mobility, hydration, oral intake, and achieving independence in activities of daily living (ADL). Curriculum implementation and evaluation: PSAs were recruited to participate in the curriculum via the patient care manager of a medical hospital unit. We placed four activity boxes on the unit. We conducted six 90-minute sessions; each was attended by 2-5 PSAs. Participants completed baseline surveys that assessed demographics and two outcomes: a) self-reported knowledge about managing symptoms of delirium including confusion, aggression, agitation, and socially inappropriate behaviors (1=no knowledge; 2=little knowledge; 3=knowledgeable; 4= very knowledgeable); and b) self-reported practice regarding various patient engagement activities including providing reorientation, ensuring patient safety, helping patient with ADLs, talking to patient about their lives, playing music, playing cross word puzzle and coloring, helping patient to connect with family members, and providing a quiet environment (yes/no). We conducted a follow-up survey 6 months after the curriculum training that assessed the same two outcomes as baseline. We also assessed acceptability of the curriculum and the activity box, measured by extent of agreement with statements: “the training has given me tools to help engage patients” and “I find using the activity box items useful for managing behavioral issues in patients with delirium and dementia” (1=strongly disagree, 5=strongly agree). We also assessed the curriculum’s impact on teamwork, measured by extent of agreement with the statement “the skills learned from the curriculum has helped me become a valuable member of the inpatient team” (1=strongly disagree, 5=strongly agree). Lastly, we asked open-ended questions about general feedback about the curriculum. RESULTS Seventeen PSAs participated in the curriculum from February-April 2024; majority were female (16/17), Black (12/17), <45 years of age (9/15), and had worked as a PSA for at least a year (8/17). 12/17 PSAs completed the 6 months post-curriculum survey; the other 5 had left the institution. Among the 12 participants with follow-up survey results, we found increased self-reported knowledge about symptom management in all domains (Figure 2), where the increases were statistically significant for managing socially inappropriate behavior (p<0.05 using paired t-tests). At baseline, the 17 participants reported high levels of engagement in the various activities we assessed (ranging from 58%-100% across activities) and among the 12 participants with follow-up data, we did not find significant changes in self-reported activity engagement after the curriculum. (p>0.05 for all activities using McNemar’s test). 11/12 participants agreed or strongly agreed that the curriculum helped them engage patients and that the activity box was useful in managing behavioral symptoms. 11/12 participants agreed or strongly agreed that the curriculum helped them become valuable members of the inpatient team. Open-ended responses highlighted that the most useful aspect of the curriculum was the activity boxes. Discussion Our study highlights that a hands-on curriculum can significantly improve the knowledge of PSAs in the management of delirium. It also points out gap and lack of awareness of management of certain behavioral issues of dementia, socially inappropriate behaviors are one of them, none of our participants reported receiving formal training is detecting such behaviors and it effectively management. It is addressed during the OT session, when they talked about the trigger’s detection and environmental awareness. To expand our work, we are in the process of adding more items to the activity box and expanding this project to other hospital units. Strengths and Limitations: The strength of this curriculum includes its high acceptability to PSAs. Feedback from the nursing staff has also been extremely positive. The content of the curriculum addresses learning needs identified from previous feedback, contributing to PSA engagement and perceived relevance. Another strength is that the curriculum is simple and easily reproducible. The activity box items are easy to use, easy to maintain (all items are washable or wipeable), and low-cost. Lessons learned include the importance of early engagement with nursing leadership. The leadership saw the curriculum as valuable for patient care and for reducing nursing and PSA frustration. In turn, their support was instrumental to the successful implementation of the activity boxes. We also learned that frequent check-ins, in person and via email, were important to remind the nurses and PSAs about the activity boxes, and to ensure that the boxes remain appropriately stocked. Lastly, our follow-up results demonstrate the challenge with high turnover. We are planning to create a shorter version of the curriculum that can be administered virtually. Limitations of this project include its small sample size, being limited to a single institution, and lack of patient outcomes. We plan to examine patient outcomes through chart review during the next phase. Conclusion This pilot study demonstrates the feasibility and acceptability of a novel curriculum for training PSAs in the management of delirium in hospitalized older adults and introduces an easily reproducible tool in the form of an “activity box.” Future research can examine expanding such training to other settings and impact on patient outcomes such as the use of antipsychotic meds, physical restraints, and length of hospital stay. Declarations This study was approved by the Johns Hopkins School of Medicine ethics committee, IRB # 00403572. All participants signed a consent, in compliance to the IRB requirements, prior to participating in the study. Acknowledgments: We would like to acknowledge the role of Megan McGowen, OTR and Claire Marsella, OTR, for playing a vital role in the creation of activity boxes and conducting workshops. We also want to thank Rona Carol RN, Shahida Khan, RN, Jonathan Espenancia RN, and Elaine Clayton RN for their role in facilitating patient safety attendant’s participation in workshop and allowing us to pilot this project in their unit. Conflict of Interest: The authors have no conflict of interest. References Rieck KM, Pagali S, Miller DM. Delirium in hospitalized older adults. Hosp Pract . 2020;48(sup1):3-16. doi:10.1080/21548331.2019.1709359 Marcantonio ER. Delirium in Hospitalized Older Adults. New England Journal of Medicine . 2017;377(15):1456-1466. doi:10.1056/nejmcp1605501 Oh ES, Needham DM, Nikooie R, et al. Antipsychotics for Preventing Delirium in Hospitalized Adults. Ann Intern Med . 2019;171(7):474-484. doi:10.7326/M19-1859 Roozebeh Nikooie, Karin Neufeld. Antipsychotics for Treating Delirium in Hospitalized Adults: A Systematic Review. Ann Intern Med . 2019;171(7). Hshieh TT, Yue J, Oh E, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: A meta-analysis. JAMA Intern Med . 2015;175(4):512-520. doi:10.1001/jamainternmed.2014.7779 Abley C, Dickinson C, Andrews Z, Prato L, Lindley L, Robinson L. Training interventions to improve general hospital care for older people with cognitive impairment: Systematic review. British Journal of Psychiatry . Cambridge University Press . 2019;214(4):201-212. doi:10.1192/bjp.2019.29 Ahmed SU, Cayea D, Tackett S, et al. Knowledge and attitudes of patient safety attendants in managing hospitalized older adults with delirium and dementia. J Am Geriatr Soc . John Wiley and Sons Inc . 2024;72(2):616-619. doi:10.1111/jgs.18635 Additional Declarations The authors declare no competing interests. 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1","display":"","copyAsset":false,"role":"figure","size":1213688,"visible":true,"origin":"","legend":"\u003cp\u003eActivity box picture:\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7801113/v1/c69ea57f4ac1504a6bf499d1.png"},{"id":93569952,"identity":"b77a144f-0cae-4120-bf8c-0d0489ed08e7","added_by":"auto","created_at":"2025-10-15 08:55:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":31792,"visible":true,"origin":"","legend":"\u003cp\u003eChange in participants self-reported knowledge rating for managing common delirium and NPS of dementia behaviors before and six- months after curriculum.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;1= No knowledge; 2=little knowledge; 3= knowledge; 4= Very knowledgeable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;p values were calculated using the paired T-test. * Indicates a p-value\u0026nbsp;less than 0.05.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7801113/v1/174e2ecba58bd8ecd7e7e4dd.png"},{"id":93571195,"identity":"4f6df728-4f40-461b-a80c-c3cdb4876509","added_by":"auto","created_at":"2025-10-15 09:03:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2109935,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7801113/v1/9f6d067b-7ea4-4d1f-82e6-0e554ed01ae6.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003ea.\u003c/strong\u003e \u003cstrong\u003eLeveraging Patient Safety Attendants (PSA) for delirium and neuropsychiatric symptoms (NPS) management in hospitalized older adults\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDelirium is common in hospitalized older adults\u003csup\u003e1\u003c/sup\u003e and is associated with multiple negative outcomes including longer length of hospital stay, higher rates of institutionalization, long-term cognitive decline, and increased mortality is associated with multiple negative outcomes\u003csup\u003e2\u003c/sup\u003e. Pharmacological agents for prevention and treating delirium offer limited efficacy and are noted to have high rates of complications including increased risk of fall, cardiovascular complications, and cognitive decline\u0026nbsp;\u003csup\u003e3,4\u003c/sup\u003e.\u0026nbsp;Rather, non-pharmacological approaches for prevention of delirium have shown positive results; using activities that are personalized to the patients\u0026rsquo; interests, needs, and abilities are especially beneficial.\u003csup\u003e5\u003c/sup\u003e Hospitals frequently use one-to-one patient safety attendants (PSAs) to help care for patients with delirium. As such, PSAs are well-positioned to help manage delirium but are often under-supported and under-trained to do so effectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough multiple non-pharmacological interventions have been shown to be effective in managing delirium and dementia, these have not been the focus of staff educational interventions. Existing educational interventions on caring for delirium and dementia patients are often limited to didactics but lack hands-on training on how to implement non- pharmacological interventions or provide the tools for doing so\u003csup\u003e6\u003c/sup\u003e. Lastly, previous educational interventions often focused on nurses or multiple types of staff, but none specifically focused on PSAs, who may have unique knowledge gaps and needs as we found in our prior work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBuilding on this earlier work, we created a PSA curriculum\u003csup\u003e7\u003c/sup\u003e to improve PSA knowledge in the management of delirium and provide them with tools for activity-based delirium management. \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eCurriculum Content:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe curriculum comprised of a didactic portion (led by psychiatrist IL or geriatrician SA) and a hand-on portion (led by occupational therapists MM and CM). Didactics presented an overview of delirium, including its overlap and distinctions from symptoms of dementia, delirium\u0026rsquo;s detrimental effects on hospitalized older adults, and the delirium screening tool used in our hospital.\u003c/p\u003e\n\u003cp\u003eThe hands-on workshop provided training on environmental awareness and emphasized the importance of establishing rapport and engaging patients in activities. We introduced an \u0026ldquo;activity box\u0026rdquo; with various resources for engaging patients, which were selected based on the experience of the geriatric recreational and occupational therapists; these included fidget toys, a weighted gel lap pad to provide comfort, an activity apron with multiple textures and surfaces, sensory balls, crayons, plastic picture cards, matching cards, white boards, lacing boards, photo books, and plastic purses (Figure 1). The workshop demonstrated using these resources as non-pharmacological strategies to manage behavioral symptoms, and shared evidence on the importance of increasing mobility, hydration, oral intake, and achieving independence in activities of daily living (ADL).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCurriculum implementation and evaluation:\u003c/strong\u003e PSAs were recruited to participate in the curriculum via the patient care manager of a medical hospital unit. We placed four activity boxes on the unit. We conducted six 90-minute sessions; each was attended by 2-5 PSAs. Participants completed baseline surveys that assessed demographics and two outcomes: a) self-reported knowledge about managing symptoms of delirium including confusion, aggression, agitation, and socially inappropriate behaviors (1=no knowledge; 2=little knowledge; 3=knowledgeable; 4= very knowledgeable); and b) self-reported practice regarding various patient engagement activities including providing reorientation, ensuring patient safety, helping patient with ADLs, talking to patient about their lives, playing music, playing cross word puzzle and coloring, helping patient to connect with family members, and providing a quiet environment (yes/no).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe conducted a follow-up survey 6 months after the curriculum training that assessed the same two outcomes as baseline. We also assessed acceptability of the curriculum and the activity box, measured by extent of agreement with statements: \u0026ldquo;the training has given me tools to help engage patients\u0026rdquo; and \u0026ldquo;I find using the activity box items useful for managing behavioral issues in patients with delirium and dementia\u0026rdquo; (1=strongly disagree, 5=strongly agree). We also assessed the curriculum\u0026rsquo;s impact on teamwork, measured by extent of agreement with the statement \u0026ldquo;the skills learned from the curriculum has helped me become a valuable member of the inpatient team\u0026rdquo; (1=strongly disagree, 5=strongly agree). Lastly, we asked open-ended questions about general feedback about the curriculum. \u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eSeventeen PSAs participated in the curriculum from February-April 2024; majority were female (16/17), Black (12/17), \u0026lt;45 years of age (9/15), and had worked as a PSA for at least a year (8/17). 12/17 PSAs completed the 6 months post-curriculum survey; the other 5 had left the institution.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong the 12 participants with follow-up survey results, we found increased self-reported knowledge about symptom management in all domains (Figure 2), where the increases were statistically significant for managing socially inappropriate behavior (p\u0026lt;0.05 using paired t-tests).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt baseline, the 17 participants reported high levels of engagement in the various activities we assessed (ranging from 58%-100% across activities) and among the 12 participants with follow-up data, we did not find significant changes in self-reported activity engagement after the curriculum. (p\u0026gt;0.05 for all activities using McNemar\u0026rsquo;s test).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e11/12 participants agreed or strongly agreed that the curriculum helped them engage patients and that the activity box was useful in managing behavioral symptoms. 11/12 participants agreed or strongly agreed that the curriculum helped them become valuable members of the inpatient team. Open-ended responses highlighted that the most useful aspect of the curriculum was the activity boxes. \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study highlights that a hands-on curriculum can significantly improve the knowledge of PSAs in the management of delirium. It also points out gap and lack of awareness of management of certain behavioral issues of dementia, socially inappropriate behaviors are one of them, none of our participants reported receiving formal training is detecting such behaviors and it effectively management. It is addressed during the OT session, when they talked about the trigger\u0026rsquo;s detection and environmental awareness. To expand our work, we are in the process of adding more items to the activity box and expanding this project to other hospital units.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe strength of this curriculum includes its high acceptability to PSAs. Feedback from the nursing staff has also been extremely positive. The content of the curriculum addresses learning needs identified from previous feedback, contributing to PSA engagement and perceived relevance. Another strength is that the curriculum is simple and easily reproducible. The activity box items are easy to use, easy to maintain (all items are washable or wipeable), and low-cost.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLessons learned include the importance of early engagement with nursing leadership. The leadership saw the curriculum as valuable for patient care and for reducing nursing and PSA frustration. In turn, their support was instrumental to the successful implementation of the activity boxes. We also learned that frequent check-ins, in person and via email, were important to remind the nurses and PSAs about the activity boxes, and to ensure that the boxes remain appropriately stocked. Lastly, our follow-up results demonstrate the challenge with high turnover. We are planning to create a shorter version of the curriculum that can be administered virtually.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLimitations of this project include its small sample size, being limited to a single institution, and lack of patient outcomes. We plan to examine patient outcomes through chart review during the next phase. \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis pilot study demonstrates the feasibility and acceptability of a novel curriculum for training PSAs in the management of delirium in hospitalized older adults and introduces an easily reproducible tool in the form of an \u0026ldquo;activity box.\u0026rdquo; Future research can examine expanding such training to other settings and impact on patient outcomes such as the use of antipsychotic meds, physical restraints, and length of hospital stay.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cspan\u003eThis study was approved by the Johns Hopkins School of Medicine ethics committee, IRB # 00403572. All participants signed a consent, in compliance to the IRB requirements, prior to participating in the study.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e We would like to acknowledge the role of Megan McGowen, OTR and Claire Marsella, OTR, for playing a vital role in the creation of activity boxes and conducting workshops. We also want to thank Rona Carol RN, Shahida Khan, RN, Jonathan Espenancia RN, and Elaine Clayton RN for their role in facilitating patient safety attendant\u0026rsquo;s participation in workshop and allowing us to pilot this project in their unit.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e The authors have no conflict of interest. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRieck KM, Pagali S, Miller DM. Delirium in hospitalized older adults. \u003cem\u003eHosp Pract\u003c/em\u003e. 2020;48(sup1):3-16. doi:10.1080/21548331.2019.1709359\u003c/li\u003e\n\u003cli\u003eMarcantonio ER. Delirium in Hospitalized Older Adults. \u003cem\u003eNew England Journal of Medicine\u003c/em\u003e. 2017;377(15):1456-1466. doi:10.1056/nejmcp1605501\u003c/li\u003e\n\u003cli\u003eOh ES, Needham DM, Nikooie R, et al. Antipsychotics for Preventing Delirium in Hospitalized Adults. \u003cem\u003eAnn Intern Med\u003c/em\u003e. 2019;171(7):474-484. doi:10.7326/M19-1859\u003c/li\u003e\n\u003cli\u003eRoozebeh Nikooie, Karin Neufeld. Antipsychotics for Treating Delirium in Hospitalized Adults: A Systematic Review. \u003cem\u003eAnn Intern Med\u003c/em\u003e. 2019;171(7).\u003c/li\u003e\n\u003cli\u003eHshieh TT, Yue J, Oh E, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: A meta-analysis. \u003cem\u003eJAMA Intern Med\u003c/em\u003e. 2015;175(4):512-520. doi:10.1001/jamainternmed.2014.7779\u003c/li\u003e\n\u003cli\u003eAbley C, Dickinson C, Andrews Z, Prato L, Lindley L, Robinson L. Training interventions to improve general hospital care for older people with cognitive impairment: Systematic review. \u003cem\u003eBritish Journal of Psychiatry\u003c/em\u003e.\u003cem\u003eCambridge University Press\u003c/em\u003e. 2019;214(4):201-212. doi:10.1192/bjp.2019.29\u003c/li\u003e\n\u003cli\u003eAhmed SU, Cayea D, Tackett S, et al. Knowledge and attitudes of patient safety attendants in managing hospitalized older adults with delirium and dementia. \u003cem\u003eJ Am Geriatr Soc\u003c/em\u003e.\u003cem\u003eJohn Wiley and Sons Inc\u003c/em\u003e. 2024;72(2):616-619. doi:10.1111/jgs.18635\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Johns Hopkins School of Medicine","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Delirium, workshop curriculum, patient safety attendants/ sitters, Management of delirium and dementia in hospitalized older adults","lastPublishedDoi":"10.21203/rs.3.rs-7801113/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7801113/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDelirium and NPS of dementia are associated with multiple negative outcomes in hospitalized older adults. Pharmacological agents offer limited efficacy, with high rates of complications. Multicomponent non-pharmacological approaches for their prevention and management are considered more effective in their management. PSA/ sitters are utilized by hospitals for one-to-one observations of safety and behavior management of these patients, but evidence shows that despite their use the rate of chemical and physical restraint use remains high. Our hypothesis is that training PSAs on delirium and NPS of dementia and providing tools to engage patients can enable them to manage these conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe created a 90-minutes workshop curriculum comprised of two components. IN the first part, we teach PSAs the difference between delirium and NPS of dementia, and 4AT delirium tool and in the second part, they learn from occupational therapist, strategies to cognitively re-orient a patient using items in an activity box, environmental clues to avoid behavior escalation, ways to engage in mobility and self-care. After PSA training, the project was piloted in one of the medical wards and survey data collected pre, post -workshop, and in 6 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeventeen PSAs were trained, female (94%), Black (80%), with average age ranging from 25- 60 years. Pre-workshop survey indicated PSAs reported “aggression” and “agitation” as most problematic behaviors (confusion, agitation, aggression, socially inappropriate behavior and wandering). In 6-months follow-up, 5 PSA left the hospital. Survey of the 12 PSAs indicates continued improvement in all behaviors but only “socially inappropriate behavior” was statistically significant (p\u0026lt;0.05) and only 55% reported using activity box.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study highlights that our curriculum can significantly improve the knowledge and skills of PSAs in the recognition and management of delirium but increase its adaptability we need close follow up with the PSA pool.\u003c/p\u003e","manuscriptTitle":"a. Leveraging Patient Safety Attendants (PSA) for delirium and neuropsychiatric symptoms (NPS) management in hospitalized older adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 08:54:33","doi":"10.21203/rs.3.rs-7801113/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"731941b3-b570-45f1-8c2a-14b898d78cd9","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55916238,"name":"Geriatrics \u0026 Gerontology"}],"tags":[],"updatedAt":"2025-10-15T08:54:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-15 08:54:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7801113","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7801113","identity":"rs-7801113","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}