Table 4.
The Hospital Elder Life Program (HELP)
| Inclusion criteria for the Hospital Elder Life Program | |
|---|---|
| Age 70 years and older | |
| At least one risk factor for cognitive or functional decline. Risk factors include: | |
| Cognitive impairment | |
| Any mobility or activity of daily living impairment | |
| Vision impairment | |
| Hearing impairment | |
| Dehydration | |
| Able to communicate verbally or in writing. Nonverbal patients who can communicate in writing are included. | |
|
Interventions to prevent delirium | |
|
Risk factor |
Preventative intervention* |
| Cognitive impairment |
• Orientation board with names of care team members and daily schedule |
| • Orienting communication | |
| • Cognitive stimulation activities three times daily (e.g. discussion of current events, reminiscence, word games) | |
| Sleep deprivation |
• Non-pharmacologic sleep protocol at bedtime: |
| ○ Warm drink (milk or herbal tea) | |
| ○ Relaxation tapes or music | |
| ○ Back massage | |
| • Unit-wide noise reduction strategies (e.g. quiet hallways) | |
| • Schedule readjustments to allow uninterrupted sleep (e.g. rescheduling of medications and procedures) | |
| Immobility |
• Ambulation or active range-of-motion exercises three times daily |
| • Minimizing immobilizing equipment (e.g., bladder catheters, physical restraints) | |
| Vision impairment |
• Visual aids (e.g. glasses or magnifying lenses) |
| • Adaptive equipment (e.g. large illuminated telephone keypads, large print books, fluorescent tape on call bell) | |
| • Daily reinforcement of their use | |
| Hearing impairment |
• Portable amplifying devises and special communication techniques |
| • Daily reinforcement of these adaptations | |
| • Earwax dis-impaction as needed | |
| Dehydration | • Early recognition of dehydration and oral volume repletion (i.e. encouragement of oral intake of fluids) |
| • Feeding assistance and encouragement during meals | |
The “core” interventions to prevent delirium are supplemented by a number of clinical and educational “program interventions”.
* Undertaken by Elder Life staff and volunteers.
Adapted with permission from Sharon K. Inouye, M.D., MPH and the Hospital Elder Life Program, LLC.