Hospital delirium in the rapidly aging incarcerated population
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PROJECT SUMMARY/ABSTRACT The older incarcerated population in the United States (US) has increased by more than 4,000% since 1981. By 2030, there will be more than 400,000 adults ≥50 years in US prisons. These individuals experience frequent hospitalizations, putting them at risk for delirium, a condition frequently seen in older adults and associated with high morbidity and mortality. Incarcerated individuals face higher rates of both known delirium risk factors and incarceration-specific risk factors. Similarly, incarcerated patients may not receive standard evidence-based delirium prevention measures during hospitalizations due to incarceration-specific barriers (e.g. routine shackling). Despite the increased risk of delirium in hospitalized older incarcerated adults, there are virtually no data on delirium prevalence or incidence in this population or on the frequency with which they receive evidence-based delirium screening and prevention. The goal of the proposed research is to establish foundational data on delirium epidemiology (including prevalence, incidence, and risk factors), on the frequency of delivery of evidence-based delirium prevention measures (e.g. cognitive stimulation, ambulation), and on potential barriers and facilitators to delivery of those measures in this high-risk population. These goals will be achieved through qualitative interviews with all relevant stakeholders, including correctional officers, a group that has not previously been included in discussions around this issue, through a prospective observational trial, and through a pilot study that establishes a novel multidisciplinary team to address delirium prevention among older incarcerated patients. My long-term career goal is to improve the hospital care of the rapidly aging population of older incarcerated adults, with a specific focus on delirium screening and prevention. Through this award, I aim to strengthen my geriatric and delirium-specific knowledge, solidify my research design skills, particularly in acute care environments and with marginalized populations, and begin training in behavioral intervention science. I will access a wealth of resources through the University of Wisconsin School of Medicine and Public Health, including the opportunity to receive mentorship from world leaders in geriatrics and health disparities and from researchers with established track records working with incarcerated populations and correctional systems. Building on the training, mentorship, and data that I will obtain through this career development award, I will submit an R01 to undertake a multi-site study that will further increase knowledge surrounding delirium, delirium screening, and delirium prevention in older incarcerated patients. My definitive goal is to design, test, and implement an incarceration-specific approach to evidence-based delirium measures that will reduce the risk of delirium in the marginalized and high-risk population of older incarcerated adults.
