Feature Article The effect of range of motion exercises on delirium prevention among patients aged 65 and over in intensive care units Canan Karadas, MSc * , Leyla Ozdemir, RN, PhD Hacettepe University Faculty of Nursing, Ankara, Turkey article info Article history: Received 27 June 2015 Received in revised form 7 December 2015 Accepted 14 December 2015 Available online 4 January 2016 Keywords: Intensive care Mobility Range of motion Delirium Geriatrics abstract The purpose of this study was to determine the effect of range of motion exercises on preventing delirium and shortening the duration of delirium among patients in the intensive care unit who are aged 65 and over. The study was conducted in the intensive care unit on patients with non-invasive me- chanical ventilation. The sample size included 47 patients from the intervention group and 47 from the control group. The incidence of delirium was 8.5% in the intervention group and 21.3% in the control group. The duration of delirium was 15 h for patients in the intervention group and 38 h for those in the control group. Although delirium incidence and duration decreased by 2.5-fold in the intervention group compared to the control group; there was no significant relationship between the intervention and control groups. In conclusion, as the decreases in delirium occurrence and duration were not statistically significant, the effect of range of motion exercises was limited. Ó 2015 Elsevier Inc. All rights reserved. Introduction Delirium, as an acute state of confusion, is a severe geriatric syndrome common among older patients in the intensive care unit (ICU) that is caused by a decrease in functional, metabolic and cognitive activities. 1,2 Delirium is a complicated clinical syndrome affected by patients’ physiological parameters and their health conditions. These parameters are utilized to develop a model to predict delirium. Inouye et al.’s model to predict delirium includes four risk factors for delirium: the presence of cognitive and vision impairment, an Acute Physiology and Chronic Health Assessment II (APACHE II) score of 16 or above, and a bloodeurea nitrogen (BUN)/ serum creatinine ratio of 18 or above. 3 Delirium occurs at a high incidence in patients with ventilation support. In invasive me- chanic ventilation (IMV), the patient is supported via an endotra- cheal tube that provides positive pressure from a ventilator. 4 In non-invasive mechanic ventilation (NIMV), the patient is supported by a face mask that provides positive pressure from a ventilator. NIMV has certain advantages, such as a decreased need for seda- tion, a reduced use of physical restraints, a decreased number of tubes, low anxiety levels due to the patient’s speaking ability, improved nutrition levels by oral feeding, and a decreased risk of respiratory infections. 5,6 Delirium incidence differs as to the type of ventilation support. Although its incidence in patients with NIMV is 20%e50%, in patients with IMV this ratio is 60%e80%. 7 Among elderly populations, the incidence is also high. More than 20% of people aged 65 and over suffer from delirium at the time of admission to the emergency room. 8 This number varies from 20% to 79% in the ICU. 9e11 Although delirium screening is important, 10,12,13 it does not ensure an improvement in health outcomes. Therefore, the clinical guidelines of the National Institute for Health and Care Excellence (NICE) and the ABCDE bundle recommend early mobility to prevent delirium. 12,13 The ABCDE bundle is a set of evidence-based practices designated by an acronym that represents ABC: awakening and breathing coordination, D: delirium monitoring and management, and E: early mobility. 12 The ABC component contains sedation awakening and spontaneous breathing trials. The D component includes delirium screening by a validated tool such as the Intensive Care Delirium Screening Checklist or the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The E component contains early mobility encouragement and safety screening for vital and hemodynamic signs. 7,14 Early mobility refers to the mobilization of patients in the first 48 h after ICU admission, and it includes movements varying from passive range of motion (ROM) exercises to ambulation in the unit. 15 The ABCD components are implemented in many ICUs as part of routine care, but the E component has certain implementation deficits. 7 Although exercise Conflict of interest: The authors have no financial disclosures to declare and no conflicts of interest to report. * Corresponding author. Adnan Saygun Cad., D-Bloklar-1, Kat 06100 Samanpazarı , Ankara, Turkey. Tel.: þ90 534 348 40 34. E-mail address: karadas.canan@gmail.com (C. Karadas). Contents lists available at ScienceDirect Geriatric Nursing journal homepage: www.gnjournal.com 0197-4572/$ e see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.gerinurse.2015.12.003 Geriatric Nursing 37 (2016) 180e185