A Problem Solving Intervention for Post-ICU Cognitive Impairment in Older Adults

NCT03972384 | Completed DMC

• 1 other identifier: 2019H0089
• Study Type: interventional
• Target: 19
• Locations: 1 country
• Sites: 1

Brief Summary

This study will apply an evidence based program to assist ICU survivors to overcome cognitive problems as a result of their critical illness. This study will determine feasibility of recruitment, retention and engagement with the program as well as acceptability of the program to the participants.

Conditions

Critical Illness; Mechanical Ventilation Complication; Delirium; Cognitive Impairment

Keywords

Post-ICU Syndrome; Recovery; Home Discharge; Problem Solving; Adaptation

Outcome Measures

Primary Outcomes (11)

• Change of Cognitive function as measured by Self-Administered Gerocognitive Examination

  Measure of the program's effect on Cognitive Function as measured using the Self-Administered Gerocognitive examination (SAGE) The maximum score is 22. A score of 17 and above is considered normal.

  Week 1 and week 12

• Change in development of Chronic Illness self management practices(as measured by Self-Efficacy Scale)

  Determine the program's effect on Chronic Illness self- management as measured by the Self-Efficacy to Manage Chronic Disease Scale which is made up of 6-items on a visual analog scale, ranging from 1 (not at all confident) to 10 (totally confident).

  Week 2 and Week 12

• Change in medication adherence practices (as measured by Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE))

  Measure change in medication Adherence by using the MedMaIDE scale that contains a maximum total score of 13.

  Week 2 and Week 12

• Change in participant's rate of depression as measured by Patient Health Questionnaire - 2)

  Measure of the program's effect on rate of depression

  Week 1 and Week 12

• Change in anxiety levels as measured by Geriatric Anxiety Scale (GAS)

  Measure change in participant's anxiety levels as measured by Geriatric Anxiety Scale that contains 10 questions on anxiety with a scoring scale of 1-6 = Minimal; 7-9 = Mild, 10 = Moderate; 12-30 = Severe.

  Week 1 and Week 12

• Change in depression levels as measured by Geriatric Depression Scale (GDS)

  Measure change in participant's depression levels as measured by Geriatric Depression Scale that contains 15 questions on depression. A score of 5 or more suggests depression.

  Week 1 and Week 12

• Change in Health related Quality of Life by a Short Form Health Survey - 36

  Measures Health Related Quality of Life

  Week 1 and Week 12

• Assess the effect of the Post-Intensive Care Problem Solving program through intervention completion rates

  Assess the effect of the Post-intensive care program through intervention completion rates.

  15 months

• Access change in participant use of the health system

  Access change in frequency of use of health system by use of the health system by number of times the study participatns use emergency department services, phone calls to physicians.

  Week 12

• Assess change in functional independence when performing activities of daily living as measured by the Katz Activities of Daily Living Scale.

  Measure change in participant's functional independence when performing activities of daily living using the Katz Activities of Daily Living Scale. The Index ranks adequacy of performance in the six functions of bathing, dressing, toileting, transferring, continence, and feeding. Clients are scored yes/no for independence in each of the six functions. A score of 6 indicates full function, 4 indicates moderate impairment, and 2 or less indicates severe functional impairment.

  Week 1 and Week 12

• Assess change in functional independence when performing instrumental activities of daily living using the Lawton Instrumental Activities of Daily Living.

  Assess changes in functional independence when performing instrumental activities of daily living using the Lawton Instrumental Activities of Daily Living. There are eight domains of function measured with the Lawton IADL scale. Women are scored on all 8 areas of function; historically, for men, the areas of food preparation, housekeeping, laundering are excluded. Clients are scored according to their highest level of functioning in that category. A summary score ranges from 0 (low function, dependent) to 8 (high function, independent) for women, and 0 through 5 for men.

  Week 1 and Week 12

Study Arms (2)

Post-ICU Problem Solving

EXPERIMENTAL

The PIC-UPS intervention focuses on self-regulation activities and environmental cues to overcome problems with memory, planning and decision-making. The interventionist uses guided discovery, reviews progress, and emphasizes generalization and transfer to other patient-identified problems. This approach may be more acceptable to participants because they can see the relevance of tasks to everyday life. Activities such as goal-setting, self-evaluation and reflective thinking behaviors enhance self-efficacy and increase the likelihood that the individual will engage in self-management behaviors. The first session of PIC-UPS will be delivered after enrollment to those participants randomized to the intervention group. Weekly intervention sessions will be conducted by a trained interventionist and supplemented by telephone reminders to complete daily homework. Follow-up data collection will be conducted in the home by a blinded data collector three months post-enrollment.

Behavioral: Post-ICU Problem Solving

Control Group

NO INTERVENTION

Participants in the control group will complete several surveys upon enrollment and randomization. Follow-up data collection will be conducted in the home for all participants control group by a blinded data collector three months post-enrollment.

Interventions

Post-ICU Problem Solving BEHAVIORAL

We have adapted the Cognitive Orientation to Daily Occupational Performance (CO-OP) as the Post-ICU Problem Solving intervention to be delivered in the home to patients following an illness that required an ICU stay. CO-OP is a form of meta-cognitive strategy training that teaches individuals to identify and prioritize problematic daily activities, identify barriers impeding performance, generate and evaluate strategies addressing these barriers, and generalize learning through practice. Thus, strategy training teaches skills that can be used to address disability in "real-life" activities, and is integral to personalized rehabilitation services. CO-OP has been adapted in numerous settings and most recently, it is being utilized successfully in patients with acquired cognitive dysfunction following acute stroke. This represents a useful intervention, tested in similar populations with minimal risk to the participants and potential for maximal benefit for this population.

Also known as: PIC-UPS

Post-ICU Problem Solving

Eligibility Criteria

• Age: 55 Years - 89 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• \>55 years old
• discharged home following an ICU stay,
• reside at home and were functionally independent prior to admission to the ICU based on family report,
• speak and read English,
• mechanically ventilated for at least 48 hours,
• have more than one positive clinical measurement of delirium during the ICU stay,
• Montreal Cognitive Assessment score (MoCA) between 25-17.

You may not qualify if:

• Pre-illness diagnosis of dementia or pre-morbid cognitive impairment (IQCODE score \>3.51);
• profound uncorrected visual or hearing impairment that precludes use of the telephone;
• psychiatric condition that precludes full participation in the intervention;
• substance abuse as measured by cut-off score of 2 on CAGE-Substance Abuse Screening Tool;
• discharge to hospice care.

Sponsors & Collaborators

• Ohio State University: lead

Study Sites (1)

The Ohio State University College of Nursing

Columbus, Ohio, 43231, United States

Location

MeSH Terms

Conditions

Critical Illness; Delirium; Cognitive Dysfunction

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Confusion; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Neurocognitive Disorders; Mental Disorders; Cognition Disorders

Study Officials

• Judith A Tate, PhD

  Ohio State University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Data collectors are blind to condition.
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: Two groups randomized to treatment (Post-ICU problem solving program) or usual care (no Post-ICU problem solving program).

Study Record Dates

• First Submitted: April 8, 2019
• First Posted: June 3, 2019
• Study Start: January 21, 2022
• Primary Completion: March 1, 2023
• Study Completion: March 1, 2023
• Last Updated: September 25, 2024

Record last verified: 2024-09

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)