Background on Delirium:
Delirium, an acute decline in attention and cognition, is a common, life-threatening, and potentially preventable clinical syndrome in older persons. The development of delirium often initiates a cascade of events culminating in loss of independence, increased morbidity and mortality, and accelerated health care costs. Delirium in older hospitalized patients has assumed particular importance because patients age > 65 years currently account for more than 49% of all days of hospital care. We estimate that delirium complicates hospital stays for at least 20% of the 12.5 million persons age ≥ 65 years hospitalized each year, and increases hospital costs by $2,500 per patient, an amount that extrapolates to over $6.9 billion (2004 USD) of Medicare hospital expenditures attributable to delirium. Substantial additional costs accrue after hospital discharge because of the need for institutionalization, rehabilitation services, formal home health care, and informal caregiving. These figures underscore the vast clinical and health policy implications of delirium (Inouye SK, NEJM 2006;354:1157-65). Moreover, with the aging of the U.S. population, delirium is a problem that is likely to increase in the future. Finding ways to prevent delirium, such as the Hospital Elder Life Program (HELP) program, will allow us to improve quality of life and healthcare for these vulnerable patients.
The Hospital Elder Life Program:
The Hospital Elder Life Program (HELP) is an innovative model of care, designed to prevent delirium and functional decline in hospitalized older persons (Inouye SKNEJM 1999;340:669-76; JAGS 2000; 48:1697-706; JAGS 2006;54:1492-9). The program trains skilled interdisciplinary staff and volunteers to carry out intervention protocols targeted toward six delirium risk factors: orientation, therapeutic activities, early mobilization, vision and hearing protocols, oral volume repletion, and sleep enhancement. The program is designed to be superimposed on existing hospital units, and does not require a separate, dedicated geriatric unit. HELP has been demonstrated to be effective for prevention of delirium, as well as for prevention of cognitive and functional decline. Cost-effectiveness has been demonstrated previously for both acute hospital costs (Rizzo JAMed Care. 2001;39:740-52; Leslie DL JAGS 2005; 53:405-9) and for long-term nursing home placement costs. In addition, cost savings of over $1.25 million per year (on one hospital unit) were demonstrated at a U.S. hospital where HELP was established (Rubin FH JAGS2006;54:969-74)and in Australia in a capitated system (Caplan GA. Int Med J 2007; 37:95–100). These cost savings were attributed to a shorter length of stay and reduction in variable costs of over 50%. Finally, the HELP model is effective for prevention of falls, pressure sores, and other iatrogenic complications of hospitalization (Bradley EH.Journal of Healthcare Management 2006; 51:323-37). The unique strengths of the HELP model, which contribute to its effectiveness, include the targeted nature of the interventions, early intervention focusing on prevention, well-trained staff dedicated to the program, standardized intervention protocols, tracking of adherence to all protocols, and built-in quality assurance procedures. As of 2010, the program has been disseminated to over 64 hospitals in the U.S., Canada, United Kingdom, Australia, Netherlands, Singapore and Taiwan.
Importantly, the Hospital Elder Life Program has been successful at returning older adults to their homes or previous living situations with maintained or improved ability to function, and results in a high degree of satisfaction with care.