The Modified and Extended Hospital Elder Life Program: A remote model of care to expand delirium prevention
dc.contributor.author | Fong, Tamara G. | |
dc.contributor.author | Albaum, Jason A. | |
dc.contributor.author | Anderson, Molly L. | |
dc.contributor.author | Cohen, Sara G. | |
dc.contributor.author | Johnson, Shauni | |
dc.contributor.author | Supiano, Mark A. | |
dc.contributor.author | Vlisides, Philip E. | |
dc.contributor.author | Wade, Harley L. | |
dc.contributor.author | Weinberg, Lyn | |
dc.contributor.author | Wierman, Heidi R. | |
dc.contributor.author | Zachary, Wendy | |
dc.contributor.author | Inouye, Sharon K. | |
dc.date.accessioned | 2023-04-04T17:40:22Z | |
dc.date.available | 2024-04-04 13:40:20 | en |
dc.date.available | 2023-04-04T17:40:22Z | |
dc.date.issued | 2023-03 | |
dc.identifier.citation | Fong, Tamara G.; Albaum, Jason A.; Anderson, Molly L.; Cohen, Sara G.; Johnson, Shauni; Supiano, Mark A.; Vlisides, Philip E.; Wade, Harley L.; Weinberg, Lyn; Wierman, Heidi R.; Zachary, Wendy; Inouye, Sharon K. (2023). "The Modified and Extended Hospital Elder Life Program: A remote model of care to expand delirium prevention." Journal of the American Geriatrics Society 71(3): 935-945. | |
dc.identifier.issn | 0002-8614 | |
dc.identifier.issn | 1532-5415 | |
dc.identifier.uri | https://hdl.handle.net/2027.42/176043 | |
dc.description.abstract | BackgroundDelirium 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.MethodsHELP-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.ResultsA 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.ConclusionsHELP-ME was fully implemented at four HELP sites, demonstrating feasibility and acceptability. Testing hybrid approaches and evaluating effectiveness is recommended for future work. | |
dc.publisher | John Wiley & Sons, Inc. | |
dc.subject.other | COVID-19 | |
dc.subject.other | delirium | |
dc.subject.other | delirium prevention | |
dc.subject.other | multicomponent | |
dc.title | The Modified and Extended Hospital Elder Life Program: A remote model of care to expand delirium prevention | |
dc.type | Article | |
dc.rights.robots | IndexNoFollow | |
dc.subject.hlbsecondlevel | Geriatrics | |
dc.subject.hlbtoplevel | Health Sciences | |
dc.description.peerreviewed | Peer Reviewed | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/176043/1/jgs18212_am.pdf | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/176043/2/jgs18212.pdf | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/176043/3/jgs18212-sup-0001-TableS1.pdf | |
dc.identifier.doi | 10.1111/jgs.18212 | |
dc.identifier.source | Journal of the American Geriatrics Society | |
dc.identifier.citedreference | Gan JM, Kho J, Akhunbay-Fudge M, et al. Atypical presentation of COVID-19 in hospitalised older adults. Ir J Med Sci. 2021; 190: 469 - 474. | |
dc.identifier.citedreference | Wilson JE, Mart MF, Cunningham C, et al. Delirium. Nat Rev Dis Primers. 2020; 6: 90. | |
dc.identifier.citedreference | Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008; 168: 27 - 32. | |
dc.identifier.citedreference | Hshieh TT, Inouye SK, Oh ES. Delirium in the elderly. Clin Geriatr Med. 2020; 36: 183 - 199. | |
dc.identifier.citedreference | Hshieh TT, Yue J, Oh E, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Intern Med. 2015; 175: 512 - 520. | |
dc.identifier.citedreference | Khan A, Boukrina O, Oh-Park M, Flanagan NA, Singh M, Oldham M. Preventing delirium takes a village: systematic review and meta-analysis of delirium preventive models of care. J Hosp Med. 2019; 14: E1 - e7. | |
dc.identifier.citedreference | Inouye SK, Bogardus ST Jr, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999; 340: 669 - 676. | |
dc.identifier.citedreference | Hshieh TT, Yang T, Gartaganis SL, Yue J, Inouye SK. Hospital Elder Life Program: systematic review and meta-analysis of effectiveness. Am J Geriatr Psychiatry. 2018; 26: 1015 - 1033. | |
dc.identifier.citedreference | Inouye SK, Bogardus ST Jr, Baker DI, Leo-Summers L, Cooney LM Jr. The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J Am Geriatr Soc. 2000; 48: 1697 - 1706. | |
dc.identifier.citedreference | Rubin FH, Neal K, Fenlon K, Hassan S, Inouye SK. Sustainability and scalability of the Hospital Elder Life Program at a community hospital. J Am Geriatr Soc. 2011; 59: 359 - 365. | |
dc.identifier.citedreference | Rubin FH, Williams JT, Lescisin DA, Mook WJ, Hassan S, Inouye SK. Replicating the Hospital Elder Life Program in a community hospital and demonstrating effectiveness using quality improvement methodology. J Am Geriatr Soc. 2006; 54: 969 - 974. | |
dc.identifier.citedreference | Caplan GA, Harper EL. Recruitment of volunteers to improve vitality in the elderly: the REVIVE study. Intern Med J. 2007; 37: 95 - 100. | |
dc.identifier.citedreference | Rubin FH, Bellon J, Bilderback A, Urda K, Inouye SK. Effect of the Hospital Elder Life Program on risk of 30-day readmission. J Am Geriatr Soc. 2018; 66: 145 - 149. | |
dc.identifier.citedreference | Zachary W, Kirupananthan A, Cotter S, Barbara GH, Cooke RC 3rd, Sipho M. The impact of Hospital Elder Life Program interventions, on 30-day readmission rates of older hospitalized patients. Arch Gerontol Geriatr. 2020; 86: 103963. | |
dc.identifier.citedreference | Wang YY, Yue JR, Xie DM, et al. Effect of the tailored, family-involved Hospital Elder Life Program on postoperative delirium and function in older adults: a randomized clinical trial. JAMA Intern Med. 2020; 180: 17 - 25. | |
dc.identifier.citedreference | Chen CC, Li HC, Liang JT, et al. Effect of a modified Hospital Elder Life Program on delirium and length of hospital stay in patients undergoing abdominal surgery: a cluster randomized clinical trial. JAMA Surg. 2017; 152: 827 - 834. | |
dc.identifier.citedreference | Simpson M, Macias Tejada J, Driscoll A, Singh M, Klein M, Malone M. The bundled Hospital Elder Life Program-HELP and HELP in home care-and its association with clinical outcomes among older adults discharged to home healthcare. J Am Geriatr Soc. 2019; 67: 1730 - 1736. | |
dc.identifier.citedreference | Boockvar KS, Judon KM, Eimicke JP, Teresi JA, Inouye SK. Hospital Elder Life Program in long-term care (HELP-LTC): a cluster randomized controlled trial. J Am Geriatr Soc. 2020; 68: 2329 - 2335. | |
dc.identifier.citedreference | Boockvar KS, Teresi JA, Inouye SK. Preliminary data: an adapted Hospital Elder Life Program to prevent delirium and reduce complications of acute illness in long-term care delivered by certified nursing assistants. J Am Geriatr Soc. 2016; 64: 1108 - 1113. | |
dc.identifier.citedreference | Huson K, Stolee P, Pearce N, Bradfield C, Heckman GA. Examining the Hospital Elder Life Program in a rehabilitation setting: a pilot feasibility study. BMC Geriatr. 2016; 16: 140. | |
dc.identifier.citedreference | Kojaie-Bidgoli A, Sharifi F, Maghsoud F, Alizadeh-Khoei M, Jafari F, Sadeghi F. The modified Hospital Elder Life Program (HELP) in geriatric hospitalized patients in internal wards: a double-blind randomized control trial. BMC Geriatr. 2021; 21: 599. | |
dc.identifier.citedreference | O’Hanlon S, Inouye SK. Delirium: a missing piece in the COVID-19 pandemic puzzle. Age Ageing. 2020; 49: 497 - 498. | |
dc.identifier.citedreference | Ward CF, Figiel GS, McDonald WM. Altered mental status as a novel initial clinical presentation for COVID-19 infection in the elderly. Am J Geriatr Psychiatry. 2020; 28: 808 - 811. | |
dc.identifier.citedreference | Dalkey N, Helmer O. An experimental application of the DELPHI method to the use of experts. Manag Sci. 1963; 9: 458 - 467. | |
dc.identifier.citedreference | Inouye SK. The importance of delirium and delirium prevention in older adults during lockdowns. JAMA. 2021; 325: 1779 - 1780. | |
dc.identifier.citedreference | Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990; 113: 941 - 948. | |
dc.identifier.citedreference | Fick DM, Inouye SK, Guess J, et al. Preliminary development of an ultrabrief two-item bedside test for delirium. J Hosp Med. 2015; 10: 645 - 650. | |
dc.identifier.citedreference | Fick DM, Inouye SK, McDermott C, et al. Pilot study of a two-step delirium detection protocol administered by certified nursing assistants, physicians, and registered nurses. J Gerontol Nurs. 2018; 44: 18 - 24. | |
dc.identifier.citedreference | Husser EK, Fick DM, Boltz M, et al. Implementing a rapid, two-step delirium screening protocol in acute care: barriers and facilitators. J Am Geriatr Soc. 2021; 69: 1349 - 1356. | |
dc.identifier.citedreference | Motyl CM, Ngo L, Zhou W, et al. Comparative accuracy and efficiency of four delirium screening protocols. J Am Geriatr Soc. 2020; 68: 2572 - 2578. | |
dc.working.doi | NO | en |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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