Effect of the Tailored, Family-Involved Hospital Elder Life Program on Postoperative Delirium and Function in Older Adults

Abstract

IMPORTANCE Postoperative delirium (POD) is a common condition for older adults, contributing to their functional decline.OBJECTIVE To investigate the effectiveness of the Tailored, Family-Involved Hospital Elder Life Program (t-HELP) for preventing POD and functional decline in older patients after a noncardiac surgical procedure. DESIGN, SETTING, AND PARTICIPANTSA 2-arm, parallel-group, single-blind, cluster randomized clinical trial was conducted from August 24, 2015, to February 28, 2016, on 6 surgical floors (gastric, colorectal, pancreatic, biliary, thoracic, and thyroid) of West China Hospital in Chengdu, China. Eligible participants (n = 281) admitted to each of the 6 surgical floors were randomized into a nursing unit providing t-HELP (intervention group) or a nursing unit providing usual care (control group). All randomized patients were included in the intention-to-treat analyses for the primary outcome of POD incidence. Statistical analysis was performed from April 3, 2016, to December 30, 2017. INTERVENTIONS In addition to receiving usual care, all participants in the intervention group received the t-HELP protocols, which addressed each patient's risk factor profile. Besides nursing professionals, family members and paid caregivers were involved in the delivery of many of the program interventions. MAIN OUTCOMES AND MEASURES The primary outcome was the incidence of POD, evaluated with the Confusion Assessment Method. Secondary outcomes included the pattern of functional and cognitive changes (activities of daily living [ADLs], instrumental activities of daily living [IADLs], Short Portable Mental Status Questionnaire [SPMSQ]) from hospital admission to 30 days after discharge, and the length of hospital stay (LOS). RESULTS Of the 475 patients screened for eligibility, 281 (171 [60.9%] male, mean [SD] age 74.7 [5.2] years) were enrolled and randomized to receive t-HELP (n = 152) or usual care (n = 129). Postoperative delirium occurred in 4 participants (2.6%) in the intervention group and in 25 (19.4%) in the control group, with a relative risk of 0.14 (95% CI, 0.05-0.38). The number needed to treat to prevent 1 case of POD was 5.9 (95% CI, 4.2-11.1). Participants in the intervention group compared with the control group showed less decline in physical function (median [interquartile range] for ADLs: −5 [−10 to 0] vs −20 [−30 to −10]; P < .001; for IADLs: −2 [−2 to 0] vs −4 [−4 to −2]; P < .001) and cognitive function (for the SPMSQ level: 1 [0.8%] vs 8 [7.0%]; P = .009) at discharge, as well as shorter mean (SD) LOS (12.15 [3.78] days vs 16.41 [4.69] days; P < .001). CONCLUSIONS AND RELEVANCEThe findings suggest that t-HELP, with family involvement at its core, is effective in reducing POD for older patients, maintaining or improving their physical and cognitive functions, and shortening the LOS. The results of this t-HELP trial may improve generalizability and increase the implementation of this program.

Increasing burden of nursing care on the treatment of COVID-19 patients in the ageing society: analyses during the first to the third wave of pandemic in Kyoto City, Japan

“…Second, early approaches for delirium prevention and management must be adapted. The Hospital Elder Life Program provides creative approaches that comprise several intervention methods, such as providing tablet computers for remote coaching and communication by professionals, volunteers, or family members and providing sleep enhancement methods [12,13]. Early interventions for adequate programmes for COVID-19 patients, especially elderly patients, are necessary.…”

Predictors of Delirium in Octogenarian Patients Hospitalized for a Hip Fracture

“…The data from our study relate visual deficit to delirium and drug administration. Other investigations do this as well, such as the one carried out by Inouye et al [ 21 ]. In their study, they showed that acting on variables that are expected to increase the risk of developing delirium could reduce the number and duration of episodes of this syndrome in hospitalized patients.…”

Postoperative Delirium

“…When these interventions are delivered by family members, the number needed to treat to prevent 1 case of postoperative delirium was 5.9 (95% CI: 4.2-11.1). 34 Fluid fasting for more than 6 h is an independent risk factor for postoperative delirium (OR = 10.6; 95% CI: 1.4-78.6). 35 Thus, when the surgery is elective, patients at higher risk for delirium should be prioritized for surgery earlier in the day to reduce unanticipated prolonged preoperative fasting, sleep alteration, and interruption of medication schedules.…”