The Modified Hospital Elder Life Program (HELP) in geriatric hospitalized patients in internal wards: A double-blind randomized control trial

Abstract

Background Hospital Elder Life Program (HELP) provides protocols based on factors for reducing delirium. Due to the lack of geriatric wards and aged care teams in Iran, it seems that some of the original HELP interventions need to be modified through a trial study. Hence, this study was conducted to determine whether the Iranian modified HELP could reduce delirium in geriatric hospitalized patients. Methods This double-blind randomized controlled trial was designed and conducted in a hospital at Kashan University of Medical Sciences in Iran. A total of 195 hospitalized patients aged ≥70 years, were 84 in the Intervention Group (IG) and 111 in the Control Group (CG). After assessing delirium risk factors, participants in the IG group received interventions based on the cognitive, vision/hearing, sleep, mobility, feeding, and hydration protocols by nursing students and the CG group received routine care. Delirium incidence was assessed by the Confusion Assessment Method. Delirium incidence, cognitive and functional abilities, frailty, fall, and length of stay were outcomes. Results The mean age of the patients was 78.53(Standard Deviation = 5.87) years. Delirium incidence was higher in the CG comparing to IG (14.71% vs 3.66%).Significant reduction observed in risk incidence of delirium because of interventions [Odds Ratio:0.124, Confidence Interval: 0.03–0.48]. Conclusion The modified HELP effectively reduced delirium rates in geriatric hospitalized patients. Trial registration This study was registered at the Iranian Registry of Clinical Trials IRCT20180910040995N1.

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

“…Modified HELP (mHELP), which implemented a bundle of three HELP interventions by bedside surgical nurses, reduced the odds of delirium by 56% and length of stay by 2 days 15 . Multiple other delirium prevention models have incorporated HELP interventions and demonstrated effectiveness across other settings, including home health care (Bundled HELP and HELP in Home Care), 16 long‐term care (HELP‐LTC), 17,18 acute rehabilitation, 19 and low‐resource settings 20 . In 2019, HELP transitioned to the American Geriatrics Society as AGS CoCare®: HELP.…”

“…15 Multiple other delirium prevention models have incorporated HELP interventions and demonstrated effectiveness across other settings, including home health care (Bundled HELP and HELP in Home Care), 16 long-term care (HELP-LTC), 17,18 acute rehabilitation, 19 and lowresource settings. 20 In 2019, HELP transitioned to the American Geriatrics Society as AGS CoCare ® : HELP.…”

Taming Postoperative Delirium with Dexmedetomidine: A Review of the Therapeutic Agent’s Neuroprotective Effects following Surgery

“…The evidenced-based Hospital Elder Life Program (HELP) is a postoperative, multicomponent delirium prevention program that addresses risk factors such as sleep-wake cycles, immobility, hydration status, and sensory impairment with POD reductions of up to 40% [71,72]. This multidisciplinary program requires specialized institutional infrastructure for proper execution.…”

Unlicensed assistive personnel’s involvement in delivering care to persons with or at risk of delirium: a scoping review protocol

“…2 Thus, initiatives that promote the involvement of unlicensed assistive personnel, such as volunteers, personal care providers, and nursing assistants, have been developed to provide practical, social, and emotional support to persons with or at risk of delirium. 3 Unlicensed assistive personnel can provide companionship; ensure that sensory aids are used; reorient the person; assist with nutrition, hydration, and mobilization; and detect acute changes in a person's mental status and alert nurses of these changes. 4,5 Numerous terms are given to individuals who take on this role, such as "specials," "sitters," "companions," "attendants," or "patient safety aides."…”

“…However, providing this care is challenging because these persons often require supervision that exceeds health care professionals’ capabilities 2. Thus, initiatives that promote the involvement of unlicensed assistive personnel, such as volunteers, personal care providers, and nursing assistants, have been developed to provide practical, social, and emotional support to persons with or at risk of delirium 3. Unlicensed assistive personnel can provide companionship; ensure that sensory aids are used; reorient the person; assist with nutrition, hydration, and mobilization; and detect acute changes in a person’s mental status and alert nurses of these changes 4,5.…”