|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:|
|Any mobility or activity of daily living impairment|
|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.
Godfrey et al.
Godfrey et al. BMC Health Services Research 2013 13:341 doi:10.1186/1472-6963-13-341