Preparing Family Caregivers to Recognize Delirium Symptoms in Older Adults After Elective Hip or Knee Arthroplasty

Margaret J. Bull, Marquette University College of Nursing
Lesley Boaz, Marquette University
Mehdi Maadooliat, Marquette University
Mary E. Hagle, Clement J. Zablocki Veterans Affairs Medical Center
Lynn Gettrust, Clement J. Zablocki Veterans Affairs Medical Center
Maureen T. Green, Wheaton Franciscan Healthcare
Sue Baird Holmes, Wheaton Franciscan Healthcare
Jane S. Saczynski, Northeastern University

Journal of the American Geriatrics Society, Vol. 65, No. 1 (January 2017): e13-e17. DOI




To test the feasibility of a telephone-based intervention that prepares family caregivers to recognize delirium symptoms and how to communicate their observations to healthcare providers.


Mixed-method, pre–post quasi-experimental design.


A Midwest Veterans Affairs Medical Center and a nonprofit health system.


Forty-one family caregiver-older adult dyads provided consent; 34 completed the intervention.


Four telephone-based education modules using vignettes were completed during the 3 weeks before the older adult's hospital admission for elective hip or knee replacement. Each module required 20 to 30 minutes.


Interviews were conducted before the intervention and 2 weeks and 2 months after the older adult's hospitalization. A researcher completed the Confusion Assessment Method (CAM) and a family caregiver completed the Family Version of the Confusion Assessment Method (FAM-CAM) 2 days after surgery to assess the older adults for delirium symptoms.


Family caregivers’ knowledge of delirium symptoms improved significantly from before the intervention to 2 weeks after the intervention and was maintained after the older adult's hospitalization. They also were able to recognize the presence and absence of delirium symptoms in the vignettes included in the intervention and in the older adult after surgery. In 94% of the cases, the family caregiver rating on the FAM-CAM approximately 2 days after the older adult's surgery agreed with the researcher rating on the CAM. Family caregivers expressed satisfaction with the intervention and stated that the information was helpful.


Delivery of a telephone-based intervention appears feasible. All family caregivers who began the program completed the four education modules. Future studies evaluating the effectiveness of the educational program should include a control group.