Background: Delirium is associated with high morbidity and mortality in hospitalized older adults. Sleep is a modifiable risk factor for delirium. Eye masks (EMs) and earplugs (EPs) have been shown to improve sleep and effective reduce delirium in the ICU. This study examines the clinical usability of this intervention component in general medicine patients. We aim to assess the feasibility and acceptability of an EM and EP intervention to prevent delirium in hospitalized older adults and assess methodology for a larger randomized trial.
Methods: Using a single group prospective research design, we piloted the feasibility and acceptability of wearing EMs and EPs overnight, and of collecting daily screenings of delirium using the 3D-Confusion Assessment Measure (CAM), and daily self-reported information about wear time and sleep quality. A sample of older adults aged ≥ 60 years, delirium-free at baseline, were recruited within 48 hours of admission to Duke Hospital general medicine service. Patients received a set of EPs and EMs and were instructed to wear them nightly. Patients’ delirium status, wear time, and sleep quality were collected daily during in-person assessments for ≤ first 5 nights of hospitalization.
Results: Nineteen eligible patients were approached, and 10 (53%) enrolled in the study; 70% completed all daily assessments (18 total follow-ups), with a mean follow-up of 2 days. Overall, 80% of patients wore EMs for ≥1 night (mean 4.4hrs/night, SD 2.6), 70% of patients wore EPs for ≥1 night (mean 4.1hrs/night, SD 2.6). Mean hours of reported sleep was 5.7 hrs/night (SD 2.8), 60% reported that EMs or EPs improved their sleep. No patients screened positive for delirium, with 100% of daily 3D-CAM assessments completed during follow-ups.
Conclusions: This pilot study demonstrated the feasibility and acceptability of using a non-pharmacologic intervention to improve sleep and reduce the risk of delirium that can be implemented through health system delirium care redesign efforts. These data will also inform study design and protocol development for a larger-scale randomized study.