Support program for older adults after ICU discharge

Anticipating Decline and Providing Therapy (ADAPT): Post-ICU Cognitive Screening Pilot and Feasibility Randomized Controlled Trial

This study tests a new support program for older adults who had delirium in the ICU to see if it helps them get better care after they leave the hospital.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 120 (estimated)
• Ages: 60 Years and up
• Sex: All
• Sponsor: Wake Forest University Health Sciences (other)
• Locations: 1 site (Winston-Salem, North Carolina)
• Trial ID: NCT06182995 on ClinicalTrials.gov

What this trial studies

This pilot feasibility study compares usual care following Intensive Care Unit (ICU) discharge with the Anticipating Decline and Providing Therapy (ADAPT) intervention, which includes routine cognitive impairment screening for older adults. The program targets individuals aged 60 and older who have experienced delirium during their ICU stay, providing them with a specialized care plan if cognitive impairment is detected. The study aims to enroll 120 participants and incorporates feedback from both ICU survivors and primary care physicians to enhance the intervention's effectiveness.

Who should consider this trial

Good fit: Ideal candidates are older adults aged 60 and above who have been discharged from the ICU after a minimum 72-hour stay and experienced delirium.

Not a fit: Patients with a prior history of dementia or those with a life expectancy of less than six months due to pre-existing conditions may not benefit from this study.

Why it matters

Potential benefit: If successful, this program could significantly improve cognitive health outcomes for older adults recovering from ICU stays.

How similar studies have performed: While this approach is innovative, similar studies focusing on post-ICU cognitive health have shown promising results in improving patient outcomes.

Eligibility criteria

Inclusion Criteria:

* Age 60 and older at time of discharge from intensive care unit
* Minimum 72 hour Intensive Care Unit stay in an ICU at Atrium Health Wake Forest Baptist
* Delirium during ICU stay as determined by positive Confusion Assessment Method (CAM)-ICU score, review of clinical - documentation, or discussion with clinical team
* Primary care provider in the Atrium Health Wake Forest system or intention to follow with Primary Care Physician in Atrium Health system
* English speaking

Exclusion Criteria:

* Death during initial hospitalization and/or discharge to Hospice
* Life-expectancy \< 6 months from pre-existing illness (defined as diagnosis of metastatic cancer, cirrhosis, advanced heart failure, prior palliative care referral)
* Acute Traumatic Brain Injury
* Continued residence in skilled nursing facility or rehab that prevents ability to complete study telephone call at time of first cognitive screen attempt
* Prior history of dementia in electronic health record
* Language or communication barrier that prohibits intervention participation
* Participant cannot identify family or caregiver contact or family/caregiver unwilling to participate
* Subject or legally authorized representative (LAR) decline consent
* Unstable telephone service for contact after hospital discharge
* Primary residence outside of North Carolina

Where this trial is running

Winston-Salem, North Carolina

• Atrium Health Wake Forest Baptist — Winston-Salem, North Carolina, United States (RECRUITING)

Study contacts

• Principal investigator: Jessica Palakshappa, MD — Wake Forest University Health Sciences
• Study coordinator: Darja Ward

Conditions: Cognitive Impairment, Dementia, Post ICU Syndrome, Critical Illness, Cognitive Impairment, Mild, Post ICU, Post-ICU Screening, older adults