NIDUS is a collaborative research network dedicated to promoting innovation and fostering advances in delirium research through development of innovative research and measurement resources, training opportunities, pilot funding and dissemination of information.
NIDUS’ unparalleled efforts to advance delirium research include: developing a database of ongoing delirium studies -- to encourage multi-site collaboration, secondary analyses of existing delirium data, and facilitation of pilot studies; developing resources to help researchers choose and compare tools for assessing delirium and integrate information collected across multiple delirium studies; maintaining a large database (over 3,000 citations) of curated delirium studies for easy access for busy clinicians and researchers; providing annual pilot grants to encourage innovative research in new areas of study; hosting an intensive training boot camp for researchers new to the field of delirium; and holding an annual scientific symposium for delirium researchers.
NIDUS is funded through an award from the National Institutes of Health/National Institute on Aging (grant no. R24AG054259). The NIDUS Network and BootCamp will be renewed soon for another 5 years. Please stay tuned. You can learn more about NIDUS at our website, deliriumnetwork.org and on Twitter @nidus_delirium and @sharon_inouye.
The RISE study (Role of Inflammation after Surgery in Elders) funded by the Alzheimer Drug Discovery Foundation (ADDF) seeks to understand the role of inflammation in delirium and long-term cognitive decline. Increasing evidence links neuro-inflammation to Alzheimer’s Disease, post-operative cognitive decline and delirium. For example it is possible that delirium, which often occurs following major physiologic disruptions including medical illness and surgery, may accelerate cognitive decline via by inflammatory mechanisms. RISE has identified important risk markers for delirium and cognitive decline as well as biomarkers of inflammation. This study holds great promise to accelerate anti-inflammatory treatment interventions with the goal of reducing delirium and long-term cognitive decline following surgery.
Surgery and hospitalization in older adults can often lead to delirium, and in turn these patients may develop difficulties in thinking, functioning, and memory. Previous studies have shown these changes occur in 30-40% of older adults. The original SAGES I (Successful Aging after Elective Surgery) study was designed to examine the risk factors, causes, and duration of these changes in thinking and functioning. The SAGES I study is one of the largest of its kind, examining 566 older adults after surgery, and is the first ever Program Project (P01) Grant on delirium funded by the National Institutes of Health. The SAGES II study, also examines changes in thinking and functioning of older adults, and will extend SAGES I through exploration of the role of inflammation, Alzheimer’s disease biomarkers, brain plasticity, and complicated delirium (i.e., delirium associated with long-term cognitive decline) in a cohort of older adults. SAGES II includes the original 566 older adult cohort included in the original SAGES I study along with 350 additional participants. Ultimately, the results of these studies may contribute to finding ways of helping older adults successfully recover after surgery, avoid hospital- and surgery-related complications, and maintain their cognitive abilities. SAGES is funded by NIA grant P01 AG031720 (Inouye).
The original BASIL I (Better Assessment of Illness) study aimed to create a new instrument to measure the severity of delirium, developed and validated in a cohort of 352 medical patients. Delirium is preventable and treatable, but good measures of delirium severity are needed to understand the clinical course and recovery, and to test the effectiveness of treatment on relevant clinical outcomes. Severity is a complex topic and may mean different things to patients and those providing care. The results of the BASIL study may ultimately help to reduce healthcare utilization, and to minimize distress to patients and caregiving burden to family members and nurses. The BASIL II renewal study will extend our prior work by defining delirium severity in patients with Alzheimer’s disease and related disorders, and developing new ways to measure delirium severity in participants both with and without dementia. BASIL II will enroll a new cohort of 450 patients across 3 sites, including medical, surgical and nursing home populations. BASIL is funded by NIA grant R01 AG044518 (Jones/Inouye).
The AGS CoCare: Hospital Elder Life Program (HELP) is an innovative model of hospital care designed to prevent delirium and functional decline in hospitalized older adults. HELP uses interdisciplinary staff and targeted intervention protocols to improve patients' outcomes and provide cost-effective care.
The primary goals of the program are:
These goals have been accomplished using a multicomponent intervention strategy. In addition to targeted interdisciplinary geriatric assessment, HELP uses an innovative volunteer model to provide personal, supportive attention to vulnerable older patients. HELP materials include a structured curriculum for instructing volunteers to deliver daily orientation, early mobilization, feeding assistance, therapeutic activities, a non-pharmacological sleep protocol, and hearing/vision adaptations.
In 2020, a formal partnership between HELP and the American Geriatrics Society led to the establishment of the AGS CoCare: Hospital Elder Life Program. The AGS CoCare portfolio provides a whole host of resources for health professionals implementing the program at their institution. This includes a new website, e-learning modules, program manuals, and hours of video instruction. For decades, HELP has been successful at returning older adults to their homes or previous living situations with maintained or improved ability to function. With extensive demonstrated clinical- and cost-effectiveness in over 25 published studies, HELP provides training and support for skilled interdisciplinary staff to implement the program, which has been adopted by over 200 hospitals worldwide. Visit the AGS CoCare: HELP website for more information on how to establish HELP at your hospital (http://help.agscocare.org/). Follow us on twitter at: @ElderLifeProg and @sharon_inouye. AGS CoCare HELP holds an annual conference, 2 national interest group sessions per year, and ongoing Coaching calls throughout the year.
In 2018, the Aging Brain Center team, under direction of Dr. Sharon Inouye, began a partnership with the West Health Foundation to develop the ED-DEL, a program assisted by the “ED-DEL Change Package and Toolkit” for implementing a delirium program in the emergency department. This step-by-step guide for implementation includes frameworks for conceptualizing change in the organization, a bibliography of literature on delirium and its presentation in the emergency department, and many resources and tools to aid in launching a delirium program.
The team is currently piloting the ED-DEL by working with four interdisciplinary emergency department teams from geographically diverse regions in the US to help implement delirium programs. Next stages in the ED-DEL project include analyzing data from the piloting process and developing a plan for larger scale dissemination.
Since the onset of COVID-19, Dr. Sharon Inouye and the Aging Brain Center team have been hard at work conducting research on how the virus has impacted older adults and updating the AGS CoCare: Hospital Elder Life Program (HELP) materials to be relevant to current healthcare restraints (https://help.agscocare.org/productAbstract/H00107). Dr. Inouye has written on how delirium can be a presenting symptom of COVID-19 in older adults, as opposed to fever or chest pain (https://academic.oup.com/ageing/article/49/4/497/5831131). She has been interviewed on the subject for the New York Times (https://www.nytimes.com/2020/05/10/opinion/coronavirus-hospital-delirium.html). Dr. Inouye has also contributed her efforts to the COVID-19 Conversations webinar series from the American Public Health Association and the National Academy of Medicine (http://covid19conversations.org).
In addition, the ABC team will be exploring the effects of social isolation resulting from the COVID pandemic on the physical, mental and cognitive health of older adults through a supplement to the SAGES study (see above, P01 AG031720). This sub-study, the COVID-Related Isolation AND Elders with Resilience (CORIANDER) study, is being led by Assistant Scientist Dr. Tamara Fong.
COVID-19 has exposed ageism in our healthcare system, and Dr. Inouye has spearheaded a systematic review of clinical trials globally (registered in clinicaltrials.gov) to found that treatment and vaccine trials for COVID-19 often exclude older adults either through explicit age criteria or exclusion criteria that unnecessarily target age-related yet manageable conditions, such as well-managed hypertension or Type II diabetes. You can read this important research brief in JAMA Internal Medicine (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2020.5084).
Delirium is a frequent and often-missed presentation of a COVID-19 infection. In recent work involving a cohort of >800 patients presenting to the ED, Dr. Inouye, working with EDs across the country, demonstrated that delirium is the 6th most common presenting sign/symptom in older adults with COVID-19, and can be the only presenting symptom. You can read this important research in JAMA Network Open (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.29540).