Anticipating Decline and Providing Therapy

This pilot feasibility study will be a randomized control trial of usual care following Intensive Care Unit (ICU) discharge compared to the Anticipating Decline and Providing Therapy (ADAPT) screening and support intervention. The trial aims to enroll 120 older adults (age 60 or older).

Inclusion Criteria: * Age 60 and older at time of discharge from intensive care unit * Minimum 72 hour Intensive Care Unit stay in an ICU at Atrium Health Wake Forest Baptist * Delirium during ICU stay as determined by positive Confusion Assessment Method (CAM)-ICU score, review of clinical - documentation, or discussion with clinical team * Primary care provider in the Atrium Health Wake Forest system or intention to follow with Primary Care Physician in Atrium Health system * English speaking Exclusion Criteria: * Death during initial hospitalization and/or discharge to Hospice * Life-expectancy \< 6 months from pre-existing illness (defined as diagnosis of metastatic cancer, cirrhosis, advanced heart failure, prior palliative care referral) * Acute Traumatic Brain Injury * Continued residence in skilled nursing facility or rehab that prevents ability to complete study telephone call at time of first cognitive screen attempt * Prior history of dementia in electronic health record * Language or communication barrier that prohibits intervention participation * Participant cannot identify family or caregiver contact or family/caregiver unwilling to participate * Subject or legally authorized representative (LAR) decline consent * Unstable telephone service for contact after hospital discharge * Primary residence outside of North Carolina