What is the HELP model for delirium?

Delirium complicates the hospital stays of millions of older adults each year, leading to worse health outcomes and higher costs. The Hospital Elder Life Program (HELP) is an evidence-based, multicomponent strategy specifically designed to address this problem by targeting major risk factors. This model offers a highly effective, non-pharmacological approach to prevent and manage delirium.

Quick Summary

The HELP model for delirium is a non-pharmacological, evidence-based program designed to prevent and manage delirium in hospitalized older adults by addressing key risk factors through an interdisciplinary team.

Key Points

• Proactive Prevention: The HELP model focuses on preventing delirium in older hospitalized patients rather than reacting to it once it occurs.

• Six Key Risk Factors: It targets six modifiable risk factors: cognitive impairment, sleep deprivation, immobility, vision, hearing, and dehydration.

• Non-Pharmacological Interventions: The program uses a range of non-drug interventions, including therapeutic activities, sleep protocols, and early mobilization.

• Interdisciplinary Team: Implementation relies on an interdisciplinary team, including Elder Life Specialists, nurses, and trained volunteers.

• Proven Effectiveness: Numerous studies have shown HELP's effectiveness in reducing delirium incidence, length of stay, and other complications.

• Improved Outcomes: Beyond delirium, the program improves functional independence and cognitive function in older patients.

What is the Hospital Elder Life Program (HELP)?

The Hospital Elder Life Program (HELP) is a proactive, multi-component intervention model developed at Yale University School of Medicine to prevent delirium and functional decline in older, high-risk hospitalized patients. Instead of reacting to delirium after it occurs, the HELP model focuses on systematically identifying and addressing six major, modifiable risk factors. The program is implemented by a dedicated, interdisciplinary team that includes an Elder Life Specialist, nurses, and trained volunteers. The goal is to maintain the cognitive and physical function of older adults throughout their hospital stay, maximize independence at discharge, and prevent readmissions. This approach has been widely studied and proven effective in reducing delirium incidence.

The Six Delirium Risk Factors Targeted by HELP

The HELP model is structured around addressing six core risk factors for delirium that are common in hospitalized older adults. By proactively mitigating these issues, the program significantly lowers the risk of developing delirium.

1. Cognitive Impairment: Delirium often manifests as acute confusion. The HELP model counters this by providing regular orientation and cognitive stimulation to keep patients' minds engaged and aware of their surroundings. This includes daily check-ins, orienting patients to the date and time, and engaging in mentally stimulating activities like puzzles or conversation.
2. Sleep Deprivation: The hospital environment, with its constant interruptions, can severely disrupt sleep patterns. HELP interventions promote natural sleep cycles through non-pharmacological methods, such as offering warm milk or back massages at bedtime. Additionally, the program encourages ward-wide noise reduction to create a quieter, more restful environment.
3. Immobility: Extended bed rest is a significant risk factor for both functional decline and delirium. Early and frequent mobilization is a cornerstone of the HELP model. Volunteers and staff assist patients with ambulation or active range-of-motion exercises several times a day to combat the effects of immobility.
4. Vision Impairment: Poor vision can increase confusion and disorientation. HELP protocols ensure that patients have and use their glasses. The program also provides visual aids like magnifiers and large-print materials to help patients stay oriented and engaged.
5. Hearing Impairment: Similar to vision impairment, hearing loss can cause disorientation and communication frustration. The program ensures patients have their hearing aids and provides portable amplifying devices and special communication techniques as needed to help them interact with their environment and care team.
6. Dehydration: Malnutrition and dehydration can precipitate delirium. HELP addresses this by encouraging oral fluid intake throughout the day and providing feeding assistance during meals to ensure patients receive adequate nutrition.

How the HELP Model is Implemented

The implementation of the HELP model is a structured and organized process that relies on a well-trained, multi-level team.

• Screening and Assessment: Upon admission, patients are screened by an Elder Life Specialist (ELS) to identify their individual risk factors for delirium. The assessment helps determine which specific interventions are most appropriate for the patient's needs.
• Interdisciplinary Collaboration: A collaborative team, including Elder Life Nurse Specialists (ELNS), doctors, physical therapists, and pharmacists, works together to develop a comprehensive care plan. The team meets regularly to review patient progress and adjust interventions.
• Volunteer Engagement: Trained volunteers are a crucial part of the HELP model, providing a significant portion of the non-pharmacological interventions. This allows nurses to focus on other clinical tasks while ensuring patients receive frequent, personalized attention.
• Protocol Delivery: Volunteers and staff follow standardized protocols to deliver interventions related to orientation, therapeutic activities, sleep enhancement, mobilization, and sensory aids. The specific protocols are tailored to the patient's assessed needs.
• Documentation and Tracking: The program uses a tracking system to monitor the delivery of interventions and document patient progress. This helps ensure high adherence rates and provides data on program effectiveness.
• Discharge Planning: HELP staff assist with discharge planning, helping patients transition from the hospital to home or other care settings. This proactive planning reduces the likelihood of unplanned readmissions.

Comparison of HELP vs. Standard Hospital Care

Feature	HELP Model	Standard Hospital Care
Focus	Proactive prevention by targeting risk factors.	Reactive management of delirium once it occurs.
Interventions	Structured, non-pharmacological protocols for sleep, mobility, cognitive stimulation, and sensory enhancement.	Often relies on pharmacological interventions like sedatives or antipsychotics to manage agitation.
Team	Interdisciplinary team with dedicated specialists and trained volunteers.	Nursing and medical staff manage delirium along with other responsibilities, often without specialized training.
Patient Engagement	High patient-centered focus with frequent volunteer interaction, cognitive engagement, and orientation.	Routine medical care with less focus on individualized, non-medical needs that prevent confusion.
Outcomes	Proven to reduce incidence of delirium, falls, and length of hospital stay.	Higher rates of delirium, functional decline, and longer hospital stays.
Cost-Effectiveness	Demonstrated to be cost-effective by reducing complications and readmissions.	Higher costs associated with managing delirium complications and prolonged hospital stays.

The Impact of HELP in Improving Patient Outcomes

Numerous studies have demonstrated the effectiveness of the HELP model. Clinical trials have shown a significant reduction in the incidence of delirium among high-risk elderly patients. Beyond prevention, HELP also positively impacts a variety of other patient outcomes. Patients who receive HELP interventions experience less functional decline and cognitive impairment, fewer falls during their hospital stay, and a reduced need for sedative medications. For older patients, maintaining independence is paramount, and HELP's focus on functional recovery assists in a smoother, more successful transition back to their homes after discharge. Furthermore, the model has proven to be cost-effective for hospitals by decreasing length of stay and preventing costly readmissions. The success of the HELP model has led to its adoption in over 200 hospitals globally, and its principles have been integrated into the Age-Friendly Health Systems framework. For more information on the official program, you can visit the AGS CoCare®: HELP website.

Conclusion: A Shift Towards Proactive and Holistic Care

The HELP model represents a fundamental shift in geriatric hospital care—from reactive treatment to proactive prevention. By addressing the root causes of delirium in older patients, the model not only improves clinical outcomes but also enhances the overall patient experience. The reliance on a structured, non-pharmacological approach and the involvement of trained volunteers creates a more humane and engaging hospital environment. As healthcare systems continue to prioritize patient-centered and cost-effective care, the HELP model stands as a powerful, evidence-based solution for combatting the serious consequences of delirium in our aging population. Its principles can be adapted and applied across various healthcare settings, ensuring better outcomes for vulnerable elders everywhere.

Frequently Asked Questions

How does the HELP model prevent sleep deprivation in hospitals?

The HELP model uses non-pharmacological interventions like offering warm milk or back rubs before bed, providing relaxation music, and minimizing noise in wards to create a more sleep-conducive environment.

What kind of volunteers are used in the HELP model?

Trained volunteers are integral to the HELP model, assisting with daily orientation, cognitive activities, feeding, and mobilization. They are trained specifically for their roles and work under the guidance of program staff.

Is the HELP model only for hospital inpatients?

While originally designed for hospitalized older adults, the principles and components of the HELP model have been adapted for other settings, including long-term care and home care.

What is the role of family members in the HELP model?

Family members are encouraged to be involved in the patient's care. Some adapted versions, like the Family-Involved HELP (FAM-HELP), formalize this involvement to enhance care and aid in delirium prevention.

Does the HELP model reduce the length of hospital stay?

Yes, research has shown that effective implementation of the HELP model can lead to a shorter hospital stay, as preventing delirium helps facilitate a quicker recovery.

How is the HELP model different from standard hospital care for older adults?

The key difference is its proactive and preventative focus on non-pharmacological interventions. Standard care is often reactive, managing delirium symptoms after they appear, sometimes with sedatives.

Is the HELP model cost-effective for hospitals?

Studies have demonstrated that the HELP model is cost-effective by reducing costly complications such as falls, prolonged hospitalizations, and readmissions, which saves healthcare dollars.