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Featured Article: Using Simulated Family Presence to Reduce Agitation

Family visitation in the hospital can be a huge source of comfort to patients during their stay, particularly elderly patients. Loved ones can bring a sense of familiarity and relief from the stress and fear of being in the hospital. In fact, family visitation may provide more impact than just the comfort it brings patients. Research in this subject is emerging, but preliminary evidence suggests that family involvement in care can improve delirium outcomes. However, not all families have unlimited time for visits, and some live geographically far from loved ones. How can patients experience the clinical benefits of family visitation when it is otherwise unavailable?

Simulated family presence, or SFP, can be a supplement or alternative to in-person visitation. SFP is an audio or video recording of families played to patients when in-person visits are not feasible. Agitated patients with dementia have responded positively to SFP in nursing home settings, with it increasing their level of calmness and reducing their resistance to care. Delirium and dementia can share similar symptoms, such as agitation, and clinical providers often mistake signs of delirium as the natural progression of dementia. Other non-pharmacological approaches have been found beneficial for preventing or managing delirium, such as the Hospital Elder Life Program. However, there was little to no research  on SFP in delirious patients, when Christine Waszynski, APRN, and a group of researchers in Hartford, CT conducted a study on the impacts of SFP in a group of 126 patients with hyperactive or mixed delirium.

man holding video camera Waszynski and colleagues showed patients with hyperactive or mixed delirium either a brief, videotaped message from their family (primarily adult children), a video with images and sounds of rain falling on tropical flowers, or no video when they became agitated while in the hospital. The SFP videos ranged from 45-90 seconds long, and the majority included a personalized, positive greeting to the patient. Observers filmed and rated the patients’ behavior on the Agitated Behavior Scale (ABS) before the video, during its airing, immediately after, and 30 minutes later.  94.1% of the SFP group experienced a reduction in agitation during the intervention, while 70% of the nature group and 29.7% of the usual care (no video) group experienced agitation reduction during the intervention.

While this significant improvement in ABS score in the SFP group is notable, 60% of both the SFP and nature groups and 65% of the usual care group had baseline dementia. Given that SFP is known to be effective for agitation in populations with dementia, it is possible that patients with delirium but not dementia will not benefit as much from this intervention. An important next step in future research could be studying the effects of SFP on patients with and without dementia, comparing their results. In addition, further research is needed on the distinction in clinical benefits between SFP and other distracting or pleasant imagery, such as the nature video, which led to a smaller, but still significant, reduction in agitation. An increased focus on the impacts of family visitation, be it in-person or SFP, could be an important next step in the field of delirium management and improved patient care.

Written by Maggie Webb, Hospital Elder Life Program Research Assistant

Featured Article:

Waszynski, C.M., Milner, K.A., Staff, I., Molony, S.L. (2017). Usiated family presence to decrease agitation in older hospitalized delirious patients: A randomized controlled trial. International Journal of Nursing Studies, 77:154-61. doi:10.1016/j.ijnurstu.2017.09.0p>

Additional References

Delirium or Dementia – Do you know the difference? (2018). Retrieved February 1, 2018, from

Halloway, S. (2013). A family approach to delirium: a review of the literature. Aging and Mental Health, 18(2):129-39. doi:10.1080/13607863.2013.814102

Inouye, S.K., Bogardus, S.T. Jr., Baker, D.I., Leo-Summers, L., Cooney, L.M. Jr. (2000). The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Journal of the American Geriatrics Society, 48(12):1697-706. doi:10.1111/j.1532-5415.2000.tb03885.x

Lund, D.A., Hill, R.D., Caserta, M.S., Wright, S.D. (1995). Video Respite: an innovative resource for family, professional caregivers, and persons with dementia. Gerontologist, 35(5):683-7. PMID:8543227

O’Connor, C.M., Smith, R., Nott, M.T., Lorang, C., Mathews, R.M. (2011). Using Video Simulated Presence to reduce resistance to care and increase participation of adults with dementia. American Journal of Alzheimer’s Disease and Other Dementias, 26(4):317-25. doi:10.1177/1533317511410558


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