July 30, 2018

Storytelling may help reduce delirium in hospitalized elderly patients

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delirium streamArtist-in-residence Elizabeth Vander Kamp laughs with a patient during an Arts in Medicine visit.Many hospitalized patients, especially older adults, are at risk of developing delirium, a risk that is increased by the presence of cognitive, functional, visual or hearing impairment or depression.

Performing arts programs that include storytelling and poetry may be beneficial in lowering that risk, suggests a study from the University of Alabama at Birmingham.

Storytelling and poetry/monologue recitation are forms of arts-based experiences designed to enhance healing. These activities provide cognitive stimulation and may be beneficial, says Katrina Booth, M.D., a physician and medical director in the UAB Acute Care for Elders unit and a study co-author. 

“There are no proven medication options to prevent delirium, so the only prevention is to optimize the patient’s physical and mental health with non-medications,” Booth said. “For each prevented case of delirium, the health care system saves $2,500. Services like UAB’s Arts in Medicine program should be available in all health care systems and are truly a complement to traditional medical care.”

The study, published in Innovation in Aging, is the first to evaluate this association between a bedside storytelling intervention delivered by artists-in-residence and changes in measures of cognitive dysfunction in hospitalized older adults, to the best of Booth and her co-authors’ knowledge. Research is an important goal for the AIM program, and more research on arts interventions is anticipated.

The pilot study of 50 patients age 65 or older was conducted in the UAB ACE unit at UAB Highlands Hospital in 2016. Two artists-in-residence, part of UAB’s Institute for Arts in Medicine, visited the patients once for 15 minutes of bedside storytelling or poetry during their hospital stay. Patients were asked if they would like to hear a story or poem, and could choose the type, whether it be religious, humorous, a folk or fairy tale, or a legend or myth. The session was designed to be interactive, with the patient’s having the opportunity to reflect on the story or poem and share stories from his or her own life.

The effect of the experience on delirium screening scores and patient satisfaction was evaluated and found that an artist-in-residence-delivered storytelling/poetry experience was associated with a lower delirium score at discharge. The result remained significant after adjusting for age, baseline cognitive impairment and general well-being. Patients with severe agitation or delirium, those who needed medication for delirium, and those who refused or did not want to participate were excluded.

Arts in medicine programs have emerged as a patient-centered approach that aims to improve health-related quality of life for patients in hospitals. Despite advances in the management of delirium, pain, distress and anxiety in the elderly population in hospitals across the country, there are challenges that still remain, says lead study author Maria Danila, M.D., associate professor of medicine in the Division of Clinical Immunology and Rheumatology.

“Arts in medicine programs have opened doors to different ways to promote a healing environment,” Danila said. “The results of our study suggest that the arts in medicine program was well-received and may assist patients with their recovery. Such arts in medicine programs may be beneficial to patients across the health system, and are an exciting addition to the UAB’s healing opportunities.”

The UAB Arts in Medicine program, initiated in 2013, is a partnership between UAB Medicine and UAB’s Alys Stephens Performing Arts Center and aims to transform the health care environment and enhance healing and wellness for patients, visitors and staff through creative arts experiences.

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