Evaluation of a Multidimensional Occupational Therapy Environmental Checklist for People Experiencing Delirium During Hospital Admission: A Quasi-Experimental Study.

Abstract

Objective: Delirium, an acute medical emergency, significantly impacts older adults, increasing morbidity, mortality and healthcare costs (estimated at $8.8 billion annually in Australia). Environmental modifications in hospital wards are underexplored despite their potential to mitigate delirium's effects. This study evaluated a multidimensional occupational therapy environmental checklist's impact on functional and service outcomes for hospitalised delirium patients compared to standard care.

Methods: A quasi-experimental design was employed, collecting pre- and post-intervention data from 100 electronic medical records (50 comparison, 50 intervention) on a Geriatric Evaluation and Management ward in Melbourne, Australia. The checklist, implemented by occupational therapists and allied health assistants, targeted orientation, object accessibility, daily routines and safety. Outcomes included length of stay, adverse events (e.g., falls, pressure injuries) and Functional Independence Measure (FIM) scores. Descriptive statistics, t-tests and χ² tests were conducted using SPSS Statistics 28 (p < 0.05).

Results: The intervention group showed a 27% reduction in total adverse events (comparison: n = 37; intervention: n = 27) and significantly higher FIM scores at discharge (motor: t = -2.38, p = 0.02; cognitive: t = -2.62, p = 0.01; total: t = -3.24, p < 0.001). However, length of stay (comparison: M = 28.2 days; intervention: M = 29.36 days; t = -0.20, p = 0.84) and adverse event rates (χ² = 1.48, p = 0.22) did not differ significantly. The intervention group had a higher fall admission rate (36% vs. 2%; χ² = 20.38, p < 0.001).

Conclusions: The checklist enhances functional recovery in older adults with delirium, reducing adverse events. Larger, multi-site studies are needed to confirm efficacy and generalisability, supporting occupational therapy's role in delirium management.