Confusion with elderly patients has been a clinical, nursing problem for many years. Older adults who become confused when hospitalized, or whose pre-existing, cognitive difficulties worsen over the course of hospitalization, present a nursing challenge in terms of patient safety, client and family emotional well-being, and the individual's potential for self-care during and after the hospital stay. Our nursing texts and clinical articles relate a variety of nursing interventions, which have as a common base, the development of a supportive physical, sensory and interpersonal environment to reduce or prevent confusion in older patients. Yet, the problem of confusion with elderly patients remains a serious problem whose incidence is increasing. The purpose of this study was to pilot test the environmental optimization intervention protocol, which includes the environmental optimization interventions (EOI) and innovation strategies.