Understanding Postoperative Delirium and Functional Decline
Postoperative delirium (POD) is a significant concern for older adults undergoing surgery. It presents as acute confusion and is associated with serious long-term consequences, including increased risk of dementia, longer hospital stays, and higher healthcare costs. Older adults are particularly vulnerable due to factors like multiple medications, sensory impairments, immobility, and the disruptive hospital environment. Standard hospital care often struggles to effectively address these specific risks.
Introducing the Tailored, Family-Involved Hospital Elder Life Program (t-HELP)
The Tailored, Family-Involved Hospital Elder Life Program (t-HELP) is an adapted version of the original HELP designed to prevent delirium and functional decline in hospitalized older adults. A key feature of t-HELP is its personalization and the active involvement of family members, who receive training to help deliver care and interventions. This approach is especially beneficial in cultures where family plays a central role in healthcare.
Key Interventions of t-HELP
t-HELP uses a non-pharmacological strategy focusing on six modifiable risk factors for delirium:
- Orientation: Regular reorientation by family members using familiar objects like clocks and calendars.
- Therapeutic Activities: Engaging patients in cognitive activities like games and reading.
- Mobilization: Encouraging and assisting with regular physical activity.
- Sensory Enhancements: Ensuring patients use their glasses and hearing aids.
- Sleep Protocol: Promoting natural sleep through relaxation techniques and a quiet environment.
- Hydration & Nutrition: Providing support for adequate fluid and food intake.
The Value of Family Engagement
Family members are crucial partners in t-HELP. By training families, the program leverages their unique position to provide:
- Comfort and Familiarity: Reducing patient anxiety in an unfamiliar hospital setting.
- Emotional Support: Offering vital psychological support during hospitalization.
- Consistent Care: Providing continuous support and monitoring alongside staff.
- Reduced Stress: Helping families feel more empowered and less overwhelmed.
Evidence: The Impact of t-HELP on Outcomes
Research has provided strong evidence regarding what is the effect of the tailored family involved hospital elder life program on postoperative delirium and function in older adults.
Reducing Postoperative Delirium
A significant randomized clinical trial demonstrated that t-HELP substantially reduced the incidence of POD in older surgical patients. The study found a much lower rate of POD in the t-HELP group (2.6%) compared to the usual care group (19.4%), indicating that t-HELP is highly effective in preventing delirium.
Improving Function and Other Outcomes
Beyond delirium prevention, t-HELP also positively impacts patient function:
- Physical Function: Patients in the t-HELP group experienced less decline in daily living activities at discharge.
- Cognitive Function: Cognitive abilities were better maintained or improved in the t-HELP group, with benefits lasting for a month after discharge.
- Hospital Stay: The t-HELP program was associated with a shorter hospital stay, reducing the average length by approximately four days.
Comparing t-HELP and Standard Care
The table below highlights the key differences between t-HELP and standard hospital care:
| Feature | Tailored, Family-Involved HELP | Standard Care |
|---|---|---|
| Delirium Prevention | Proactive, personalized non-pharmacological methods. | Primarily reactive, focusing on managing existing symptoms. |
| Family Role | Actively trained partners in care. | Typically limited to visiting; less active involvement. |
| Functional Outcomes | Aims to maintain physical and cognitive function; less decline observed. | Functional decline is often a more common outcome. |
| Customization | Interventions are tailored to individual patient risks. | More generalized approach to patient care. |
| Environment | Promotes familiarity and routine with family presence. | Can be disorienting due to noise and disrupted routines. |
Implementing t-HELP
Hospitals can implement a t-HELP program by following several steps:
- Identify high-risk older patients.
- Build a multidisciplinary team.
- Develop and deliver family training programs.
- Customize protocols to suit the patient population and cultural context.
- Continuously evaluate patient outcomes.
Conclusion
The tailored family involved hospital elder life program represents a highly effective and evidence-based strategy for enhancing outcomes in older surgical patients. By actively involving trained family members in a personalized, non-pharmacological care plan, t-HELP demonstrably reduces postoperative delirium and preserves physical and cognitive function. This program transforms the hospital experience, promoting a supportive and healing environment. Ultimately, t-HELP underscores the significant positive impact of a collaborative, patient-centered approach in geriatric care.
For more information on the original Hospital Elder Life Program and its transition to the American Geriatrics Society, see American Geriatrics Society - HELP.
