The Modified and Extended Hospital Elder Life Program: A remote model of care to expand delirium prevention.

BACKGROUND: Delirium is a common complication of hospitalization and is associated with poor outcomes. Multicomponent delirium prevention strategies such as the Hospital Elder Life Program (HELP) have proven effective but rely on face-to-face intervention protocols and volunteer staff, which was not possible due to restrictions during the COVID-19 pandemic. We developed the Modified and Extended Hospital Elder Life Program (HELP-ME), an innovative adaptation of HELP for remote and/or physically distanced applications. METHODS: HELP-ME protocols were adapted from well-established multicomponent delirium prevention strategies and were implemented at four expert HELP sites. Each site contributed to the protocol modifications and compilation of a HELP-ME Operations Manual with standardized protocols and training instructions during three expert panel working groups. Implementation was overseen and monitored during seven learning sessions plus four coaching sessions from January 8, 2021, through September 24, 2021. Feasibility of implementing HELP-ME was measured by protocol adherence rates. Focus groups were conducted to evaluate the acceptability, provide feedback, and identify facilitators and barriers to implementation. RESULTS: A total of 106 patients were enrolled across four sites, and data were collected for 214 patient-days. Overall adherence was 82% (1473 completed protocols/1798 patient-days), achieving our feasibility target of >75% overall adherence. Individual adherence rates ranged from 55% to 96% across sites for the individual protocols. Protocols with high adherence rates included the nursing delirium protocol (96%), nursing medication review (96%), vision (89%), hearing (87%), and orientation (88%), whereas lower adherence occurred with fluid repletion (64%) and range-of-motion exercises (55%). Focus group feedback was generally positive for acceptability, with recommendations that an optimal approach would be hybrid, balancing in-person and remote interventions for potency and long-term sustainability. CONCLUSIONS: HELP-ME was fully implemented at four HELP sites, demonstrating feasibility and acceptability. Testing hybrid approaches and evaluating effectiveness is recommended for future work.

The impact of Hospital Elder Life Program interventions, on 30-day readmission Rates of older hospitalized patients.

OBJECTIVE: This study investigated the impact of the Hospital Elder Life Program (HELP), a geriatric intervention program targeted at reducing delirium, on readmission rates. Secondary goals were to review HELP's impact on average length of stay (ALOS), discharge to the home, and falls. DESIGN: This retrospective 3-year study reviewed inpatients age 70 and older, with one or more of six impairments: functional, renal, cognitive, sleep, visual and hearing. Patients were from a 784 bed teaching hospital in California with admissions between January 1, 2014 and December 31, 2016. This was compared to a matched cohort of patients who did not receive any interventions from HELP volunteers or a HELP geriatric nurse practitioner. Data was also reviewed for impact on goals in age groups 70-85 and 85 + . RESULTS: 2146 HELP patients with an average age of 82.1 showed improvement in 30-day readmission rates, with a readmission rate of 11.3% in the HELP group and 13.5% in the control group (n = 2704, mean 82.5). Detailed age data noted statistical significance only in the 70-85 population for readmission. ALOS was 5.6 and 6.2 days respectively in the HELP and non-HELP population. ALOS was also statistically significant across 70-85 and 85 + . Neither rates of discharge to home nor falls showed any significant improvement. Both control and intervention groups had a disproportionate number of whites and females. CONCLUSION: This study shows hospitals can improve patient outcomes and financial burden from 30-day readmissions and length of stay, particularly in the 70-85 age group, by implementing the Hospital Elder Life Program.