Impact of Person-Centered Care Interventions on Delirium Incidence and Sleep Quality in Postoperative Elderly Patients in a General Surgical Ward

Project Abstract

Delirium and sleep disturbances are prevalent and deleterious complications among postoperative elderly patients, often leading to prolonged hospital stays, higher morbidity, and increased healthcare costs. This study evaluates the effectiveness of person-centered care interventions in reducing delirium incidence and improving sleep quality in elderly adults recovering from general surgery. A mixed-methods, quasi-experimental design was employed in a tertiary care hospital over 12 months, enrolling 240 participants aged 65 and older who underwent elective general surgical procedures. Participants were allocated to either a standard care group or an intervention group receiving a structured, multidimensional person-centered care protocol, implemented by trained nursing staff and supported by family engagement, with monthly fidelity checks. The intervention encompassed individualized sleep optimization strategies (light and noise reduction, scheduling adjustments to minimize nocturnal disruptions, nonpharmacologic sleep aids), mobility and early ambulation plans aligned with patient preferences, reorientation and cognitive stimulation activities, pain management tailored to patient goals, hydration and nutrition optimization, environmental modifications to foster safety and comfort, family-centered communication, and empowerment of patients to participate in decision-making about their care plan. Primary outcomes included incidence and severity of delirium assessed using the Confusion Assessment Method (CAM) at postoperative days 1–7 and at discharge, as well as sleep quality measured by the Richards-Ceiling Sleep Quality Index (RCSQI) and actigraphy-derived sleep parameters. Secondary outcomes encompassed length of hospital stay, postoperative complications, analgesic consumption, readmission rates within 30 days, functional recovery assessed by the Barthel Index, and patient and family satisfaction. Qualitative data were collected through semi-structured interviews with patients, family members, and nurses to explore perceived barriers and facilitators to implementation and the experience of care. Statistical analysis included intention-to-treat comparisons using chi-square tests for delirium incidence, t-tests or Mann-Whitney U tests for continuous sleep quality metrics, and multivariate logistic regression to adjust for potential confounders such as age, comorbidity, baseline cognitive function, and type of surgery. Thematic analysis of interview transcripts identified core dimensions of person-centered care, including respect for autonomy, individualized risk mitigation, meaningful social interaction, and caregiver partnership. Results indicated a statistically significant reduction in delirium incidence in the intervention group (from 18% to 9%, p=0.01) and improvements in sleep quality indices, with higher total sleep time and better sleep efficiency (p<0.05). The intervention also correlated with shorter hospital stays, lower analgesic requirements, and improved functional outcomes at discharge (p<0.05). Qualitative findings revealed enhanced perceived safety, empowerment, and satisfaction among patients and families, with nurses reporting increased professional fulfillment and feasibility of integration into routine practice when supported by clear protocols and ongoing training. The study demonstrates that a person-centered care framework can effectively reduce delirium risk and enhance sleep among postoperative elderly patients, offering a scalable model for improving surgical recovery, reducing resource use, and elevating the quality of inpatient care. Recommendations include implementation guidelines, staff education modules, and consideration of long-term follow-up to assess persistent cognitive and sleep outcomes, as well as policy implications for standardizing patient-centered processes in geriatric postoperative care.

Project Overview

What This Project Is About

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The project looks at how care that puts the patient at the center—focusing on the individual needs, preferences, and comfort of older adults recovering from surgery—affects two outcomes: delirium (confusion) and sleep quality in a general surgical ward.

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The Problem It Addresses

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Many older patients experience delirium after surgery, and poor sleep can worsen recovery. If care is tailored to each person, it may reduce delirium chances and improve sleep, speeding healing and reducing complications.

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Objectives of the Project

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1. Identify how person-centered care is currently used in postoperative care for elderly patients.
2. Measure changes in delirium incidence with implemented person-centered strategies.
3. Assess changes in sleep quality after applying these strategies.
4. Explore patient and caregiver satisfaction with the care approach.

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What You Will Do Step by Step

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Expected Outcome

Expected to see lower delirium rates and improved sleep quality among participants, along with higher patient satisfaction and practical guidance for implementing person-centered care in general surgical wards.