At 1-year post-ICU discharge, two-thirds of ICU survivors experience cognitive dysfunction at a severity comparable to that of patients with mild Alzheimer's disease or moderate traumatic brain injury, regardless of age or pre-morbid chronic illness burden. Despite the prevalence, significance and persistence of cognitive impairment following critical illness, few interventions have been tested that help ICU survivors overcome these cognitive changes. The purpose of this pilot study is to evaluate the feasibility, acceptability and efficacy of a problem solving intervention, Post Intensive Care Unit Problem Solving (PIC-UPS) in the home setting for older adult ICU survivors suffering from post-ICU cognitive impairment. This study will employ a small-scale two-group randomized controlled trial (RCT) comparing the effect of a ten session intervention with a Control Group (CG) for older adult ICU survivors who have cognitive impairment at hospital discharge on cognitive function, chronic illness self-management, affective well-being (anxiety, depression), health care utilization and health related quality of life (HR-QoL). The components of PIC-UPS include (1) in-person, in-home strategy training designed to overcome cognitive problems by employing comprehensive structured problem- solving strategies delivered by trained interventionists and (2) concomitant use of smartphone technology specifically designed to remind and reinforce in-person training. The study will be conducted in the adult medical ICUs at a large Midwestern academic medical center with older adult participants (n=80) recruited prior to home discharge and randomized to either intervention or control group. Baseline data collection will occur at enrollment. The first session of PIC-UPS will be delivered after enrollment to those participants randomized to the intervention group n the hospital setting. Weekly intervention sessions (9) 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 for all participants (intervention and control group) by a blinded data collector three months post-enrollment. This study will provide data on processes critical to further hypothesis development and to the successful development of a large RCT to test the effectiveness of PIC-UPS on cognitive function, chronic illness self- management, affective well-being (anxiety, depression), health care utilization and HR-QoL in older adult ICU survivors who suffer cognitive impairment at hospital discharge. In addition, our pilot will provide infrastructure for a larger trial (e.g., manual of operations, web-based data collection form), a manuscript describing the pilot study findings, and an R01 application to NIA.
This study will test a problem-solving intervention (PIC-UPS) to assist older adults to overcome cognitive impairment, chronic illness self-management, affective well-being, health care utilization and quality of life during the post-ICU period. This pilot study will provide data on processes critical to further hypothesis development and to the successful development of a large RCT to advance the science of dementia related disease in older adult ICU survivors.
