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Am J Geriatr Psychiatry. 2018 Oct;26(10):1015-1033. doi: 10.1016/j.jagp.2018.06.007. Epub 2018 Jun 26.

Hospital Elder Life Program: Systematic Review and Meta-analysis of Effectiveness.

Author information

1
Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA. Electronic address: thshieh@bwh.harvard.edu.
2
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province China.
3
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA.
4
Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
5
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.

Abstract

BACKGROUND:

Delirium, defined as an acute disorder of attention and cognition with high morbidity and mortality, can be prevented by multicomponent nonpharmacological interventions. The Hospital Elder Life Program (HELP) is the original evidence-based approach targeted to delirium risk factors, which has been widely disseminated.

OBJECTIVE:

To summarize the current state of the evidence regarding HELP and to highlight its effectiveness and cost savings.

METHODS:

Systematic review of Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from 1999 to 2017, using a combination of controlled vocabulary and keyword terms.

RESULTS:

Of the 44 final articles included, 14 were included in the meta-analysis for effectiveness and 30 were included for examining cost savings, adherence and adaptations, role of volunteers, successes and barriers, and issues in sustainability. The results for delirium incidence, falls, length of stay, and institutionalization were pooled for meta-analyses. Overall, 14 studies demonstrated significant reductions in delirium incidence (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.37-0.59). The rate of falls was reduced by 42% among intervention patients in three comparative studies (OR 0.58, 95% CI 0.35-0.95). In nine studies on cost savings, the program saved $1600-$3800 (2018 U.S. dollars) per patient in hospital costs and over $16,000 (2018 U.S. dollars) per person-year in long-term care costs in the year following delirium. The systematic review revealed that programs were generally successful in adhering to or appropriately adapting HELP (n = 13 studies) and in finding the volunteer role to be valuable (n = 6 studies). Successes and barriers to implementation were examined in 6 studies, including ensuring effective clinician leadership, finding senior administrative champions, and shifting organizational culture. Sustainability factors were examined in 10 studies, including adapting to local circumstances, documenting positive impact and outcomes, and securing long-term funding.

CONCLUSION:

The Hospital Elder Life Program is effective in reducing incidence of delirium and rate of falls, with a trend toward decreasing length of stay and preventing institutionalization. With ongoing efforts in continuous program improvement, implementation, adaptations, and sustainability, HELP has emerged as a reference standard model for improving the quality and effectiveness of hospital care for older persons worldwide.

KEYWORDS:

Delirium prevention; Hospital Elder Life Program; multicomponent nonpharmacological intervention

PMID:
30076080
PMCID:
PMC6362826
[Available on 2019-10-01]
DOI:
10.1016/j.jagp.2018.06.007

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