The Portal of Geriatrics Online Education

Emergency Medicine

Hospital Elder Life Program (HELP)

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Abstract: 

DELIRIUM PREVENTION:  THE HOSPITAL ELDER LIFE PROGRAM (HELP)

These materials provide background, organizational, and training materials that will allow you to set up a Hospital Elder Life Program at your institution. This is an innovative model of care designed to prevent delirium and functional decline, and is available for your use free of charge. Setting up a HELP program is not a small undertaking, and will require considerable commitment on your part.  We hope these materials will help you on your journey. 

Sharon K. Inouye, MD, MPH

Educational objectives: 

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. 

Additional information/Special implementation requirements or guidelines: 

Program Materials

You will find on this website the manuals and DVD which are designed to help you implement the HELP model of care.  There are other tools/materials presented that are available on the HELP website (hospitalelderlifeprogram.org). To access these materials on the HELP website you will have to create a user account. Once you do so you can go to the link on the left side of the page labeled "Program Materials". To assure program effectiveness, we hope that you will implement this model carefully and with close fidelity to the original model.  

Business Tools (HELP Website)

The first step for successful implementation of the Hospital Elder Life Program is to convince key decision-makers at your organization of its value. This involves putting yourself in the position of these decision-makers and providing convincing arguments for the program. HELP is demonstrably effective in preventing delirium but "selling" your administration on the program involves translating this improvement in the quality of care into measures that are meaningful to decision-makers—measure such as reductions in length of stay or in re-hospitalizations. 

The HELP Business Tools provide you with what you need to build support for HELP in your organization. Included in this resource are:

  • A Power Point presentation that you can use in your hospital
  • A questionnaire designed to help you collect relevant data about patient demographics and hospital utilization that will help you design a program with maximum impact
  • A set of excel worksheet tools

Manuals

There are 4 Hospital Elder Life Program Manuals included here. We have provided capsule descriptions of each below.

The Organizational and Procedural Manual (Overview and Structure) provides a comprehensive administrative overview of the program. The manual covers: program goals; establishing facility support; setting up the program; administrative structure; quality assurance procedures; strategies to improve adherence; and the volunteer component. 

The Organizational and Procedural Manual (The Clinical Process) contains a detailed overview of the clinical components of HELP as they relate to older people. Sections are arranged chronologically (in order of how procedures would be applied in the hospitalization of an individual patient). The sections include: the screening and enrollment process, the interventions, and discharge and post-discharge procedures. Interventions are organized by the personnel involved (volunteer, geriatric nursing and interdisciplinary). Also included are educational interventions to improve geriatric expertise and references.

The Database Manual provides all of the assessments and data collection forms required for the program. Sample forms and worksheets are provided for all members of the HELP team.  This paper-based system will allow any program to operate even without computer support initially. 

The Volunteer Training Manual covers all program interventions for the volunteers who will perform them. Separate sections in the manual cover the daily visitor program, the therapeutic activities program, the early mobilization program and the feeding assistance program. The manual includes information on the overall volunteer responsibilities, and provides step-by-step training instructions for the volunteers. This manual is designed to be used in conjunction with the volunteer training DVD. 

DVD

This DVD provides an overview of the HELP program for staff, as well as an introduction for volunteers.  It also illustrates each of the HELP volunteer interventions visually for training purposes.  The DVD sections are:

  • Overview for Staff
  • Volunteer Introduction
  • Daily Visitor
  • Therapeutic Recreation
  • Early Mobilization
  • Feeding Assistance

For Assistance

Please note that Dr. Inouye is not available to answer your questions directly.  The HELP website provides a wealth of resources to support you as you implement the Hospital Elder Life Program delirium prevention model.  More resources—including a complete listing of HELP Centers of Excellence and a discussion forum--will appear on the website in the near future.  Welcome on board!

<www.hospitalelderlifeprogram.org>

For brief questions only, you can email us at:  ElderLife@hrca.harvard.edu. A HELP consultant will answer targeted email questions within about 5 working days.

Date posted: 
Fri, 01/01/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 07/29/2010
Product Viewing Instructions: 
You will need to register for an account and fill out a brief questionnaire before gaining access to the materials.
Contact Person/Corresponding Author:



Suggested Citation:
Hospital Elder Life Program (HELP). POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/200

Elder Care: A Resource for Interprofessional Providers: Pneumonia in Nursing Home Patients

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Sponsors: 
Product Information
Estimated time to complete: 
1
Abstract: 

 Nursing Home-Acquired Pneumnonia is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they have become favorites in all training settings.

Educational objectives: 
Objectives:
1. List the diagnostic criteria for nursing home-acquired pneumonia (NHAP)
2. List likely differences in the microbiology of mild vs severe NHAP
3. Explain the differences in approach to treating NHAP in the nursing home vs in a hospital
Additional information/Special implementation requirements or guidelines: 
Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as
(1) content is not changed, 
(2) no one is charged a fee to use or read the publication, 
(3) authors and their affiliated institutions are noted without change, and 
(4) the reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatric Education Center."
Publications from, presentations from, and/or citations to this product: 

Some Elder Care Provider sheets are featured in the Arizona Geriatrics Society Journal, which is published twice yearly.

Date posted: 
Thu, 03/21/2019
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 03/11/2019
Contact Person/Corresponding Author:



Suggested Citation:
Elder Care: A Resource for Interprofessional Providers: Pneumonia in Nursing Home Patients. POGOe - Portal of Geriatrics Online Education; 2019 Available from: https://pogoe.org/taxonomy/term/200

UM Geriatrics Clinical Decision Making Instrument

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

The University of Michigan Geriatrics Center, with support from the Donald W. Reynolds Foundation, developed this 24-item multiple choice instrument for assessing knowledge of clinical geriatrics among health professionals. The instrument emphasizes inpatient care and common geriatric syndromes. It was designed primarily for use among house officers (resident and fellows) in surgical specialties and medical subspecialties, but may also be used among residents in primary care disciplines and medical students. The UM Geriatrics Clinical Decision Making Assessment should prove useful to training programs in surgical specialties and medical subspecialties to gather baseline data, implement curricula, and measure the effects of curricular change on the knowledge of trainees in caring for the complex and interacting needs of older adults. The instrument is also available at http://www.med.umich.edu/geriatrics/edu/gme1.htm

This product consists of the following documents:

  • UM Geriatrics Clinical Decision-Making Assessment
  • Answer Key with Explanations
Educational objectives: 

This instrument was developed to provide program directors a general indicator of geriatrics clinical knowledge among groups of house officers, rather than a comprehensive assessment of individual physicians’ knowledge related to the care of older patients. The instrument was designed to be brief to enhance administration to large groups of house officers with busy schedules.

Specifically, the instrument was designed to include:

  • (a) a focus on clinical management rather than nonclinical issues (e.g., social support, long-term care, health systems organization, and finance; to maintain coherence, relevance, and brevity);
  • (b) a case-based multiple choice format (to enhance clinical relevance and reliability of scoring); and
  • (c) a length of 20 to 25 items (to allow a completion time of 30 minutes or less).
Additional information/Special implementation requirements or guidelines: 

For reliability and validity information, read the article cited below, “Brief Instrument to Assess Geriatrics Knowledge of Surgical and Medical Subspecialty House Officers” (published in the Journal of General Internal Medicine).

Publications from, presentations from, and/or citations to this product: 

Williams, B. C., & Fitzgerald, J. T. (2006). Brief report: Brief instrument to assess geriatrics knowledge of surgical and medical subspecialty house officers. Journal of General Internal Medicine, 21(5), 490-493. http://dx.doi.org/10.1111/j.1525-1497.2006.00433.x

Date posted: 
Thu, 04/29/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 03/29/2018
Contact Person/Corresponding Author:



Suggested Citation:
and . UM Geriatrics Clinical Decision Making Instrument. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/200

Quick Reference for Geriatric Syndromes

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

A quick reference card set of geriatric syndromes designed for bedside use, which fits in a white coat pocket.

Educational objectives: 

Identification of, assessment of, and intervention with important geriatric syndromes frequently encountered in inpatient and outpatient clinical settings.

Additional information/Special implementation requirements or guidelines: 

Content available as PDF file. Cards may be printed and bound for hard-copy reference.

Publications from, presentations from, and/or citations to this product: 

2008 Southern Group on Educational Affairs (SGEA) Conference (demonstration)

Date posted: 
Wed, 03/31/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 07/18/2012
Contact Person/Corresponding Author:



Suggested Citation:
Quick Reference for Geriatric Syndromes. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/200

Texas Tech Medcast Reynolds Geriatric Step 2 CK Test Prep Series 09-10: No. 42--Harry the Hyperkalemic

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

The Step2CK Test Prep Series was created by fourth-year students at the Texas Tech School of Medicine in Lubbock as a project of the fourth-year geriatrics rotation. It was developed as part of the Reynolds Geriatrics Podcast series, which is supported in part by an Aging and Quality of Life grant from the D.W. Reynolds Foundation. 

Educational objectives: 

This espisode is based on Question 42 of the 2009 Step2CK Sample Exam.

Learning Objectives: the third-year medical student studying for the Step2CK exam should be able to:

  • List the common diuretic medication that can cause hyperkalemia 
  • Identify the importance of adverse drug effects on the geriatric population 
  • Describe the risk of polypharmacy in elderly adults
Additional information/Special implementation requirements or guidelines: 

The episodes in this series are based on questions that have geriatrics content and patient vignettes from the 2009 Step2CK Sample Exam, available from http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri.... For more information on the series, go to http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri....

Date posted: 
Fri, 08/12/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/22/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , and . Texas Tech Medcast Reynolds Geriatric Step 2 CK Test Prep Series 09-10: No. 42--Harry the Hyperkalemic. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/200

Elder Care: A Resource for Interprofessional Providers: Macular Degeneration

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Sponsors: 
Product Information
Estimated time to complete: 
1
Abstract: 

Macular Degeneration is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings.

Educational objectives: 
  1. Identify the main risk factors for age-related macular degeneration (AMD)
  2. Identify common symptoms and signs of early AMD
  3. State whether or not vitamin supplements have benefit for treating AMD
Additional information/Special implementation requirements or guidelines: 
Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as
(1) content is not changed, 
(2) no one is charged a fee to use or read the publication, 
(3) authors and their affiliated institutions are noted without change, and 
(4) the reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatric Education Center."
Publications from, presentations from, and/or citations to this product: 
The Elder Care provider sheets are occasionally published in the Arizona Geriatrics Society Journal, which is published twice yearly.

Nelson, D. and Medina-Walpole, A. (2010, December), Elder care provider fact sheets. Journal of the American Geriatrics Society, 58(12), 2414-2415. Also available online.

Date posted: 
Fri, 06/30/2017
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 06/30/2017
Contact Person/Corresponding Author:



Suggested Citation:
Elder Care: A Resource for Interprofessional Providers: Macular Degeneration. POGOe - Portal of Geriatrics Online Education; 2017 Available from: https://pogoe.org/taxonomy/term/200

Elder Care: A Resource for Interprofessional Providers: COPD Management in Older Adults with Heart Disease or Diabetes

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Sponsors: 
Product Information
Estimated time to complete: 
1
Abstract: 

COPD Management in Older Adults with Heart Disease or Diabetes is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings.

Educational objectives: 

Objectives:

1. State whether or not beta blocker therapy for cardiac indications can be safely prescribed to patients who also have COPD

2. State what is known about the safety of prescribing long-acting beta-agonists for COPD to patients who also have heart disease

3. Identify risks of prescribing inhaled steroids to patients who have COPD and diabetes

Additional information/Special implementation requirements or guidelines: 
Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as
(1) content is not changed, 
(2) no one is charged a fee to use or read the publication, 
(3) authors and their affiliated institutions are noted without change, and 
(4) the reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatric Education Center."
Publications from, presentations from, and/or citations to this product: 

The Elder Care provider sheets are occasionally published in the Arizona Geriatrics Society Journal, which is published twice yearly

Nelson, D. and Medina-Walpole, A. (2010, December), Elder care provider fact sheets. Journal of the American Geriatrics Society, 58(12), 2414-2415. Also available online.

Date posted: 
Thu, 06/30/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 06/30/2016
Contact Person/Corresponding Author:



Suggested Citation:
and . Elder Care: A Resource for Interprofessional Providers: COPD Management in Older Adults with Heart Disease or Diabetes. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/200

Aging for Specialists Medical Student Conference

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
2
Abstract: 

The Medical Students’ Aging for Specialists Conference brings together medical students (MS1,2) and faculty leaders (Deans, Dept Heads, Program Directors) together in a lunch-time symposium that confirms the importance of aging principles of care no matter what career path students may follow – especially surgical and related medical specialties. Following a brief lecture by a national Visiting Professor, faculty lead informational and motivational discussions at breakout tables. This product includes: a "How To" facilitators' instruction guide; 23 individual Fact (or "Aging Pearls") sheets which contain specialty-specific intriguing geriatric facts along with questions to stimulate discussion at the breakout tables (answer guides are also provided for all but FCM and IM); an evaluation tool; and a video of our keynote speaker, Dr. John Burton's lecture launching our 2007 conference.We suggest that the conference be co-sponsored by your Student Section of the AGS.

Educational objectives: 
  1. Explain the relevance of aging principles of care for all career paths that a student may choose .
  2. Describe three specialty-specific geriatric facts related to your specialty career choice.
Date posted: 
Wed, 10/14/2009
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 07/31/2012
Contact Person/Corresponding Author:



Suggested Citation:
Aging for Specialists Medical Student Conference. POGOe - Portal of Geriatrics Online Education; 2009 Available from: https://pogoe.org/taxonomy/term/200

Post-Operative Delirium

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Abstract: 

Introduction and basic training on the evaluation and management of post-operative delirium in the elderly. Two levels are available: Level 1 (M3-M4); and Level 2 (PGY1). Copy the links below and paste into your browser window: For Level 1 (M3-M4): http://app1.unmc.edu/geriatricsed/delirium For Level 2 (PGYI): http://app1.unmc.edu/geriatricsed/delirium/residents

Educational objectives: 

Evaluation, prevention, and management of post-operative delirium. Learners should be able to: 1. Define delirium and describe the criteria for diagnosis. 2. Describe the incidence, morbidity, mortality and general costs of delirium. 3. List the pathophysiology of delirium. 4. List the risk factors for delirium. 5. Describe the clinical features of a patient with delirium. 6. Contrast the clinical features of dementia versus delirium. 7. Describe the prevention of delirium. 8. Describe the evaluation of delirium. 9. Describe the management of a delirious elder.

Additional information/Special implementation requirements or guidelines: 

Copy the links below and paste into your browser window: For Level 1 (M3-M4): http://app1.unmc.edu/geriatricsed/delirium For Level 2 (PGYI): http://app1.unmc.edu/geriatricsed/delirium/residents

Date posted: 
Sun, 02/04/2007
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 11/13/2009
Contact Person/Corresponding Author:



Suggested Citation:
Post-Operative Delirium. POGOe - Portal of Geriatrics Online Education; 2007 Available from: https://pogoe.org/taxonomy/term/200

Pattern Recognition Questions

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Abstract: 

The University of Nebraska Medical Center has developed three sets of questions for the Internal Medicine Clerkship, the Pattern Recognition series. 

Educational objectives: 

Differential diagnosis of dementing disorders; differential diagnosis for UI. After completion learners should be able to:

  1. identify the key diagnostic features that differentiate the cause of geriatric syndromes such as incontinence and dementia; and
  2. identify important aspects of history, physical and special diagnostics in evaluation of geriatric syndromes.
Date posted: 
Thu, 08/06/2009
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/18/2011
Contact Person/Corresponding Author:



Suggested Citation:
Pattern Recognition Questions. POGOe - Portal of Geriatrics Online Education; 2009 Available from: https://pogoe.org/taxonomy/term/200

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