Modified Hospital Elder Life Program in the emergency department of a public university hospital: a multicomponent intervention program for preventing delirium

Abstract

Objective To evaluate the feasibility of implementing an adaptation of the Hospital Elder Life Program (HELP) with the participation of family caregivers in a public university hospital. Method Descriptive exploratory pilot study developed with 30 hospitalized patients and their caregivers. Registration Forms were applied to identify risk factors for delirium, to select intervention protocols, and track implementation. Participants' level of satisfaction and barriers to implementing the program were assessed through qualitative interviews. Secondary results were collected from medical records. Descriptive statistical analysis was performed to characterize the sample and content analysis was used to analyze qualitative data. Results Most patients were female (60%), with a mean age of 74.3 years, incomplete elementary school (60%), widowed/divorced (56.7%) and living with family members (83.3%) at home (93.3%). 56.7% had been hospitalized in the last year and 93.3% had at least one risk factor for delirium. Food assistance and fluid replacement was the protocol with the highest adherence (96.2%) and guidance (76.5%) with the lowest. Participants were satisfied and believe that HELP contributed to improving patient outcomes. The reasons for not performing the proposed intervention were related to the hospital structure or organization, the patient and the companion. Conclusion Our results suggest that having family members act as “volunteers” is a viable strategy to implement HELP. This strategy can promote its implementation in public hospitals in low and middle-income countries.

Understanding family carer experiences and perceptions of engagement in delirium prevention and care for adults in hospital: Qualitative systematic review

“…Family carers in one study in the ICU setting also suggested a communication resource box could be shared by family carers and staff (Bannon et al., 2018). Lack of access to glasses and hearing aids was identified as a barrier to communication and family carer ability to support delirium management (Assis et al., 2022).…”

Partnering with carers in the management of delirium in general acute care settings: An integrative review

“…Based on a consensus approach, the studies included in this review were found to be of moderate (score of 3) to high quality (score of 5; Table 1). 23 Four studies were conducted in the United States of America [27][28][29][30] ; and one each in Brazil, 31 Chile 32 and South Korea. 33 Study designs included one randomised controlled trial, 32 two quasi-experimental pre-post-test designs, 29,30 two descriptive exploratory studies, 28,31 one qualitative study 33 and one mixed-method design.…”

“…23 Four studies were conducted in the United States of America [27][28][29][30] ; and one each in Brazil, 31 Chile 32 and South Korea. 33 Study designs included one randomised controlled trial, 32 two quasi-experimental pre-post-test designs, 29,30 two descriptive exploratory studies, 28,31 one qualitative study 33 and one mixed-method design. 27 One study did not report carer characteristics.…”

“…In addition to increasing knowledge for both carers 27,[29][30][31]33 and nurses, 29,30,33 therapeutic nurse-carer relationships were also identified as important for effective partnerships in the management of delirium. [28][29][30]33 Therapeutic nurse-carer relationships were achieved through concurrent carer-nurse education 29 and reciprocal, clear and honest communication, in which carers and nurses shared concerns and challenges about the management of delirium.…”

“…33 Kang et al 33 reported that it was important that nurses documented work with carers and communicate carers' needs with other health-care professionals to provide clarity and responsibility of roles. Barriers to effective partnerships in the management of delirium included miscommunication and forgetfulness of carers to share information with other family members, 31,33 a lack of nurses' time and nurse shortages. 28,33…”