IU and Regenstrief studying decreasing dementia after delirium for older ICU survivors
INDIANAPOLIS – Researchers from the Indiana University Center for Aging Research and the Regenstrief Institute are developing and testing the nation's first program to deliver via telemedicine specially designed cognitive training and physical exercise programs to the homes of hospital intensive care survivors who have experienced delirium while in the ICU. Delirium is an acute brain failure resulting in confusion and long-term memory problems that affects 70 percent of older ICU patients.
Every year at least two million older Americans experience delirium in the ICU predisposing them to dementia and long-term disability. Currently, there are no effective, scalable models of recovery care to remediate or treat ICU-acquired cognitive impairment and its deleterious effects on quality of life and independence, according to Babar Khan, MD, of the IU Center for Aging Research and Regenstrief Institute who leads the innovative study.
Supported by a new $3.48 million grant from the National Institute on Aging, the clinician-researchers are conducting a randomized controlled trial of 300 older adult ICU survivors combining 12 weeks of a facilitator-led, one-on-one or small group format cognitive training and physical exercise delivered over the internet at home. The individually tailored training and exercise regimens can increase in intensity as the older adult moves through the program.
Study participants–survivors of medical or surgical ICUs at Eskenazi Health, IU Health University Hospital or IU Health Methodist Hospital, age 65 and older–will be randomly divided into one of four groups:
- One hour three times a week of physical exercise with an online coach plus one hour three times a week of cognitive training with an online coach
- One hour three times a week of physical exercise with an online coach plus online counseling about brain health
- One hour three times a week of cognitive training with an online coach plus online materials about physical exercise
- Online counseling about brain health plus materials about physical exercise
All study participants will be provided with computers with wireless internet access and trained to use the study's pre-set multiparty videoconferencing programs and to locate individualized counseling information. Family caregiver participation will be encouraged.
The researchers will evaluate the ICU survivors at the end of 12 weeks of the telemedicine program for cognitive or physical improvements and again 12 weeks later to determine whether improvements persisted three months after telemedicine outreach ended.
This work builds upon Dr. Khan's experience in developing the nation's first collaborative care prototype clinic–the Eskenazi Health Critical Care Recovery Center–focusing on the extensive cognitive, psychological and physical recovery needs of intensive care unit survivors who are seen after hospital or rehabilitation facility discharge. Dr. Khan is a critical care medicine physician and an implementation scientist with the Indiana Clinical and Translational Science Institute's IU Center for Health Innovation and Implementation Science. He directs the Eskenazi Health Critical Care Recovery Center.
"We have learned from our work with ICU survivors in the CCRC that unfortunately not everyone can come to the clinic or get to their physical therapy appointment or have a cognitive or physical therapist come to their home, said Dr. Khan. "Utilizing computers and the internet to provide cognitive and physical training to a large group of people in one-on-one or small group sessions in their homes, we hope to see a decrease in dementia, anxiety and depressive symptoms, and enhanced physical functioning and quality of life."
Co-investigators of NIA grant R01AG055391 are Regenstrief Institute investigator Malaz Boustani, MD, MPH, founder of the Indiana Clinical and Translational Science Institute's IU Center for Health Innovation and Implementation Science; associate director of the IU Center for Aging Research and a Regenstrief Institute investigator; Frederick Unverzagt, PhD; and Sujuan Gao, PhD, of the IU School of Medicine and IU Center for Aging Research; Daniel O. Clark, PhD, of the IU Center for Aging Research, Regenstrief Institute and IU School of Medicine.
In previous work the researchers have studied cognitive and physical training for older adults with dementia and depression. They have successfully utilized telemedicine with older adults.
Cindy Fox Aisen