All ETDs from UAB

Advisory Committee Chair

Kevin Fontaine

Advisory Committee Members

Cynthia Brown

Olivio Clay

Nataliya Ivankova

Richard Kennedy

Ann Elizabeth Montgomery

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


Delirium, or the sudden onset of confusion, is common, highly distressing, debilitating, and deadly among hospitalized older adults and is associated with adverse outcomes for their family caregivers. As people are living longer with more complex conditions, more people will face the task of caregiving for older adults with delirium. Family caregivers can make meaningful contributions to delirium care, but high distress, insufficient knowledge, and lack of skills often seen in caregivers can lead to maladaptation and negative health outcomes. A few studies have focused on distress in caregivers from witnessing delirium episodes; however more research is needed to understand the strain of caregiving on physical, emotional, social, and financial well-being as well as perceived support needs. This assessment will inform the identification of strategies that may improve coping in caregivers and inform family-centered care. Therefore, the aim of this dissertation research is 1) to determine the levels of strain and to gain an in-depth understanding of experiences and support needs of caregivers of older adults with delirium (paper one), 2) to review the literature on hospital-based delirium education interventions for patients and families (paper two), and 3) to assess the outcomes of a clinical model of care that aims to reduce hospital-associated disability thus reducing caregiver strain (paper three). Overall, the findings of this dissertation reveal high levels of strain in delirium caregivers and point to the potential utility of hospital-based delirium education activities and care approaches to address to strain and support needs of delirium caregivers. Future studies should assess the utility of comprehensive interventions to support delirium caregivers via unit-level redesign and delirium educational approaches with a randomized controlled trial design.

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