„TRAnsport und DElir bei älteren Menschen“ (TRADE) - Entwicklung einer komplexen Intervention für ältere Menschen zur Delirreduktion bei einem Orts-/Raumwechsel

Background: Delirium, which is characterized by impaired attention and consciousness, can have serious consequences for older people, such as: B. an increased need for care. Despite the frequency of such cases, there has been little research on delirium prevention in the context of hospital transfers and discharges. To close this gap, the TRADE project (TRAnsport and DElir for older people) was initiated. The project was funded by the Federal Joint Committee – Innovation Committee (funding number: 01VSF18052).

Objective: The aim of this project was to develop and test the feasibility of an intervention for the prevention of delirium during the transfer and discharge processes of older, hospitalized people, in accordance with the United Kingdom (UK) Medical Research Council (MRC) framework for complex interventions ( Leinert et al., 2021).

Methods: Several studies were conducted within TRADE, focusing on the first two phases of the UK MRC framework for complex interventions: development and feasibility.

Phase 1: Development of the complex intervention

Using a multi-method study1 (focus groups1, expert workshop1 (including the preliminary results of a systematic review1 and an observational study), Delphi survey1), a complex intervention including a program theory1 was developed (Denninger et al., 2024).

Phase 2: Feasibility

In phase 2, the feasibility of the developed intervention was tested as part of a cluster-randomized controlled study in a stepped wedge design, accompanied by a mixed-methods process evaluation1 (individual interviews1, focus groups1, document1 and actual analyzes1, standardized questionnaires1, website Calls1) and a health economic evaluation.

Results: The developed intervention includes a structured transfer and discharge pathway that includes an 8-point delirium prevention program as a guide for caregivers of older people. Implementation strategies include information materials, training for healthcare professionals, the involvement of gatekeepers and champions, current analysis and the dissemination of relevant information to stakeholders.

The findings from the cluster-randomized controlled study with accompanying process evaluation on 18 wards in four hospitals contribute to the further development of the intervention.

Legend: 1 = Components of the dissertation 

Literature references:

Denninger, N.‑E., Brefka, S., Skudlik, S., Leinert, C., Mross, T., Meyer, G., Sulmann, D., Dallmeier, D., Denkinger, M. & Müller, M. (2024). Development of a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers: A multi-method study. International Journal of Nursing Studies, 150, 104645. https://doi.org/10.1016/j.ijnurstu.2023.104645

Leinert, C., Brefka, S., Braisch, U., Denninger, N., Müller, M., Benzinger, P., Bauer, J., Bahrmann, A., Frey, N., Katus, H. A., Geisler , T., Eschweiler, G., Klaus, J., Seuffer-lein, T., Schuetze, K., Gebhard, F., Dreyhaupt, J., Muche, R., Pahmeier, K., . . . Denkinger, M. (2021). A complex intervention to promote prevention of delirium in older adults by targeting caregiver’s participation during and after hospital discharge – study protocol of the TRAnsport and DElirium in older people (TRADE) project. BMC Geriatrics, 21, 646. https://doi.org/10.1186/s12877-021-02585-0