Ms. Archambault is a social worker in the Department of Geriatrics and Palliative Care; Ms. Doherty and Ms. Kelly served as research assistants within the Geriatric Research Education and Clinical Center at the time the article was written; Ms. Doherty is currently a research assistant, all at the VA Boston Healthcare System in West Roxbury, Massachusetts. Dr. Rudolph is the director of the Center of Innovation in Long-Term Services and Supports at the Providence VA Medical Center in Rhode Island. Ms. Kelly is currently working as a nurse and completing her training as a nurse practitioner candidate.
Social workers in the hospital setting are often responsible for discharge planning, including the reduction of extended LOS and unnecessary readmissions to the hospital. 45 Increased LOS and hospital readmissions are 2 of the primary negative outcomes associated with delirium. Delirium can persist for months beyond hospitalization, making it a relevant issue at the time of discharge and beyond. 46 Distress related to delirium has been documented up to 2 years after onset, due to manifestations of anxiety and depression. 38
Distress impacts patients as well as caregivers who witness the delirium and provide care to the patient afterward. 38 Long-term changes in mood in addition to loss of function as a result of delirium can lead to an increase in stress for both patients and their caregivers. 30 The social work emphasis on counseling and family dynamics as well as the common role of coordinating post-discharge arrangements makes the profession uniquely suited for delirium care.
Barriers
Social workers can play a key role in delirium risk identification and coordination of care but face substantial barriers. Delirium assessments are complex and require training and education in the features of delirium and cognitive assessment. 47 To date, social workers receive limited education about delirium and typically do not make deliberate efforts in prevention, support, and follow-up care.
Conclusion
Social workers will encounter delirium, and their training makes them particularly suited to address this health concern. An understanding of the larger ecologic system is a foundational aspect of social work and an essential component of delirium prevention and care. 41 The multipathway nature of delirium as well as the importance of prevention suggests that multiple disciplines, including social work, should be involved. 1 The American Delirium Society and the European Delirium Association both recognize the need for all HCPs to be engaged in delirium care. 1,48
Social workers in the hospital setting provide communication, advocacy, and education to other HCPs, as well as to patients and families (Figure). Because delirium directly impacts the emotional and logistic needs of patients and their families, it would be advantageous for social workers to take a more active role in delirium risk identification, prevention, and care. Fortunately, the nonpharmacologic approaches that social workers are skilled in providing (eg, education and emotional support) have been shown to benefit patients with delirium and their families.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
