Standardized Delirium and Dementia‐Friendly Mobile Comfort Carts to Increase Senior‐Friendly Non‐Pharmacologic Care
Bibliographic record
Abstract
BACKGROUND: Hospital environments can be harmful to older adults and contribute to hospitalization-associated disability. To improve health outcomes, guidelines recommend more emphasis on non-pharmacological care to better address physical, emotional, cognitive, and rehabilitative needs of older adults. We sought to develop, implement and evaluate the use of standardized mobile 'Comfort Carts' containing non-pharmacological resources to enhance patient comfort, increase cognitive and physical stimulation, and help manage responsive behaviours associated with delirium and dementia. METHODS: A 'Comfort Cart' containing a standardized set of non-pharmacological resources for hospitalized older adults at risk of delirium and responsive behaviours associated with dementia was developed through multidisciplinary stakeholder consultations and a needs assessment survey of clinicians, patients, and hospital volunteers. Hospital volunteers were trained to use the 'Comfort Cart' to facilitate patient interactions and non-pharmacological care to all patients admitted to an orthopedic unit at a tertiary care academic hospital. We conducted daily program audits over a 1-year period and post-implementation surveys to evaluate its effectiveness and acceptability. RESULTS: The 'Comfort Cart' program has facilitated over 669 patient visits to date by hospital volunteers, including 50 with patients with dementia or those at high-risk for delirium and/or responsive behaviours. Over 168 hours of patient-volunteer interactions were logged with a mean visit duration per patient of 16.5 (SD 19.5) minutes. More than half of visits (58.1%) improved patients' mood or behaviour. The longer the duration of a visit, the higher the likelihood that it would improve a patient's mood or behaviour. In post-program implementation surveys, 76% of healthcare staff agreed that the 'Comfort Cart' addressed barriers for implementing non-pharmacological care and 80% of volunteers stated that the 'Comfort Cart' helped them have meaningful visits with patients. All patients and caregivers surveyed felt that the program was important to meet the needs of hospitalized older adults, and 91% reported that it positively contributed to the perceived level of compassionate and overall patient care that they received in hospital. CONCLUSIONS: Standardized mobile 'Comfort Carts' satisfy unmet non-pharmacological needs in the care of older adults and positively impact patient experience in hospital.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".