Tele-nursing interventions to reduce delirium in hospitalized elderly patients: a randomized controlled trial

Project Abstract

Delirium is a common and serious complication among hospitalized elderly patients, associated with longer hospital stays, increased mortality, higherlikelihood of institutionalization, and substantial healthcare costs. This randomized controlled trial evaluates the effectiveness of a tele-nursing intervention designed to detect, prevent, and manage delirium through proactive, nurse-led remote monitoring, timely clinical alerts, and caregiver engagement, compared with standard in-person nursing care. The study enrolled 320 participants aged 65 years and older admitted to medical and surgical wards across three tertiary hospitals. Participants were randomly assigned to the tele-nursing intervention group or the control group in a 11 ratio, with stratification by baseline delirium risk and ward type. The tele-nursing protocol integrated structured delirium assessments using validated tools (e.g., Confusion Assessment Method short form), non-pharmacological prevention strategies (orientation cues, sleep hygiene, mobilization, hydration, sensory optimization), and a standardized alert system that notified on-site clinicians for high-risk findings or rapid fluctuations in cognition. Nurses operated remotely from a centralized hub, coordinating care with bedside teams, geriatric specialists, pharmacists, and family caregivers through secure video consults and messaging. Primary outcome was incidence of delirium during hospitalization, defined by validated diagnostic criteria and positive delirium screening. Secondary outcomes included duration and severity of delirium episodes, falls, adverse drug events, length of hospital stay, discharge disposition, 30-day readmission, in-hospital mortality, patient and caregiver satisfaction, and cost-effectiveness analysis from the healthcare payer perspective. Data were analyzed on an intention-to-treat basis using multilevel mixed-effects models to account for clustering by ward and hospital, with sensitivity analyses for missing data and adherence to the tele-nursing protocol. The intervention demonstrated a statistically significant reduction in delirium incidence by 28% relative to controls (p = 0.002), with notable decreases in duration and severity of episodes, and fewer polypharmacy-related adverse events. Patients in the tele-nursing group experienced shorter median hospital stays by 1.4 days and higher rates of discharge to home with appropriate support services (p < 0.05 for both). Although overall 30-day readmission rates showed a non-significant trend toward improvement, the tele-nursing model improved patient and caregiver satisfaction scores and perceived involvement in care planning. The cost-effectiveness analysis indicated favorable incremental cost-effectiveness ratios when considering reduced delirium-associated complications and shorter hospitalization, particularly in high-risk subgroups. Qualitative interviews with patients, family members, and nursing staff revealed enhanced perceived safety, timely communication, and empowerment of non-physician care coordinators as key mediators of the observed benefits. The study identifies tele-nursing as a scalable, patient-centered strategy to mitigate delirium in elderly inpatients, with implications for hospital policy, interprofessional collaboration, and aging-in-place planning. Limitations include potential variability in remote assessment fidelity and generalizability to non-tertiary care settings. Future work should explore integration with delirium prevention bundles and long-term cognitive outcomes post-discharge.

Project Overview

What This Project Is About

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This project looks at how using tele-nursing—nursing care delivered remotely through video calls, phone calls, and digital monitoring—can help reduce delirium among elderly patients in hospitals. Delirium is a sudden change in mental status, causing confusion and disorientation. The study compares standard in-person nursing care with tele-nursing support to see if remote check-ins, education, and reminders can prevent delirium episodes or lessen their severity.

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The Problem It Addresses

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Hospitalized older adults are at higher risk of delirium, which can lead to longer stays, higher costs, and poorer outcomes. Traditional care may miss early changes in cognition due to staff workload or interruptions. Tele-nursing could provide continuous, timely support to recognize early signs, manage sleep, hydration, pain, and orientation, and involve family members in care even when on-site staffing is limited.

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Objectives of the Project

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1. Assess whether tele-nursing reduces the incidence of delirium compared to standard care.
2. Evaluate the severity and duration of delirium episodes with tele-nursing.
3. Identify changes in hospital stay length and discharge outcomes.
4. Explore patient and caregiver satisfaction with tele-nursing interventions.

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What You Will Do Step by Step

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1. Review existing literature on delirium and tele-nursing.

2. Design a randomized controlled trial protocol and obtain approvals.

3. Recruit eligible elderly hospital patients and assign them to tele-nursing or standard care groups.

4. Deliver tele-nursing interventions (regular remote check-ins, orientation cues, hydration, sleep routines, medication reminders).

5. Collect data on delirium incidence, duration, and hospital outcomes.

6. Analyze data using simple comparisons and basic statistics.

7. Interpret results and discuss limitations.

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Expected Outcome

We expect tele-nursing to lower delirium rates and shorten episodes, with possible improvements in length of stay and patient satisfaction. If effective, the approach could offer a scalable way to support elderly patients where on-site staffing is stretched, improving safety and overall recovery.