The Hospital Elder Life Program (HELP) is designed to prevent delirium in older, hospitalized adults. By systematically identifying and intervening to reduce delirium risks, the program has been shown to improve outcomes for hospitalized, at-risk older adults.
The Issue: Delirium, also known as acute confusional state, is a common but under-recognized problem, particularly among older, hospitalized adults. People who are delirious are disoriented, unable to concentrate, and may experience sensory misperceptions, sleep disturbances, and memory loss.
Each year, delirium complicates the hospital stays of more than 2.3 million elderly patients. These complications result in increased morbidity and mortality, prolonged hospital stays, greater likelihood of needing long-term care, and billions of dollars in excess health care costs. By some estimates, delirium accounts for more than $4 billion of Medicare expenditures.
Organization: Yale University School of Medicine
The Intervention: Developed by researchers at Yale University, the Hospital Elder Life Program (HELP) is an innovative model of hospital care that uses practical interventions to prevent delirium and functional decline in older patients. The goals are to:
- maintain cognitive and physical functioning of high-risk older adults throughout hospitalization;
- maximize patients' independence at discharge;
- assist patients with the transition from hospital to home; and
- prevent unplanned hospital readmissions.
The intervention includes standardized protocols for the management of six risk factors for delirium: cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration.
Interventions are carried out by a skilled interdisciplinary team and trained volunteers. HELP staff—an Elder Life Specialist and Elder Life Nurse Specialist—assess older hospital patients to identify risks and determine which interventions are appropriate, based on each patient's needs. Patients receive personalized interventions that evolve to match their changing needs throughout the course of hospitalization.
Trained HELP volunteers provide assistance to counter the effects of immobility by taking patients for walks three times a day; reduce their need for sleep sedatives by giving them warm milk and back rubs and playing relaxation audiotapes at night; and help keep them mentally active by playing word games and discussing current events. Nurses monitor patients for signs of delirium and work with patients' physicians and other providers to provide evidence-based geriatric care.
HELP is supported by information technology designed to prompt and document recommended interventions, track patient progress, and report clinical and financial performance.
Results: The effectiveness of the program was demonstrated in a controlled clinical trial involving 852 patients ages 70 and older. Incidence of delirium was reduced by 40 percent. In addition, HELP patients had significantly fewer days and episodes of delirium.
The study found that the intervention had no significant effect on the severity of delirium, suggesting that primary prevention of delirium is the most effective treatment strategy.
Analyses of the program's cost-effectiveness found that participants had hospital charges that were $831 lower per hospitalization than non-participants. Savings were statistically significant only for those patients at intermediate risk of developing delirium. The savings offset the costs of the program, and occurred in every cost category (e.g., nursing, diagnostic procedures, ICU, etc.). Thus, the HELP Program improved clinical outcomes for at-risk older hospitalized patients at no additional cost.
Recent analyses demonstrate that HELP patients discharged to nursing homes had lower total nursing home costs ($9,446 savings per long-term nursing home patient in one year) compared with patients who had not received HELP. These nursing home patients also had shorter nursing home length of stay and lower costs per survival day.
Hospital Elder Life Programs have been started in 32 hospitals, including sites in the U.S., Canada, and Australia. Currently, staff members in another 15 hospitals are laying the groundwork to establish programs.
For Further Information: Contact HospitalElderLife@yale.edu or visit www.hospitalelderlifeprogram.org, where visitors can access basic information on how to build the program or view business tools to explore its potential cost-effectiveness at their facilities. Registered HELP sites have access to a private section of the HELP Web site, which is designed to provide information and services to facilitate the administration and evaluation of existing HELP programs. Each spring, HELP sites gather for an annual conference to share clinical updates and innovations.