Delirium Care Expanded Through Remote Protocols

Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research

A new study published in the Journal of American Geriatrics Society (JAGS) found that modifying a well-established and highly successful delirium prevention program for use when in-person or face-to-face interactions are limited or restricted is both feasible and acceptable to hospital staff and patients.

Developed because of COVID-19, the modified and extended Hospital Elder Life Program (HELP-ME) multicomponent delirium prevention protocols provide support for remote or physically distanced applications. Implemented at four HELP sites across the country, the adaptations necessary for HELP-ME were feasible to implement and provided a way to continue support during the pandemic, allowing for new connections to be made and strengthening existing relationships with nursing, physical and occupational therapy, HELP staff and volunteers in delirium prevention.

Delirium is a common complication of hospitalization for older adults, characterized by an acute change in attention and cognition, and associated with serious complications, including increased rates of morbidity, institutionalization, and mortality. More than 2.6 million adults, age 65 years and older develop delirium each year, with associated healthcare costs attributable to delirium estimated at more than $164 billion per year in the United States. However, numerous studies have shown at least 40% of cases may be preventable using multicomponent delirium prevention strategies, such as HELP, which has been implemented in more than 200 hospitals worldwide since 1999.

Tamara G. Fong, M.D., Ph.D. (first author), Associate Scientist, Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, and Sharon K. Inouye, M.D., M.P.H. (senior author), Director, Aging Brain Center, and Milton and Shirley F. Levy Family Chair and Professor of Medicine, Harvard Medical School, led the study, “The Modified and Extended Hospital Elder Life Program (HELP-ME): A Remote Model of Care to Expand Delirium Prevention,” which developed modifications to HELP that would allow clinicians to continue to implement delirium prevention during the COVID-19 pandemic, and in other settings where the patient must be isolated from staff caring for them or where sufficient staff may not be available (such as rural settings or during natural disasters).

The study achieved full implementation and high adherence across all four sites. Qualitative feedback from sites during the focus group was largely positive, and supported the overall acceptability of the HELP-ME strategy. For example, all sites reported that participating in HELP-ME revitalized their overall HELP program, because it helped them recognize that it was still possible to implement intervention protocols even during COVID-19.

“This is an important contribution to the care of older hospitalized adults because while multicomponent delirium prevention strategies like HELP have proven to be effective, many rely on an interdisciplinary team of hospital staff and trained volunteers to administer face-to-face intervention protocols.” said Dr. Inouye, who developed HELP. “During the COVID-19 pandemic when access to patients was limited, HELP-ME was both feasible and acceptable to patients and staff.”

“HELP-ME also contributed to the education of hospital nursing staff regarding the importance of delirium prevention especially during COVID-19 more broadly, and helped to support nursing staff throughout a difficult time. Importantly, HELP-ME allowed for additional interaction that would not have otherwise been possible during the pandemic,” said Dr. Fong.

“HELP-ME has the potential to broaden the reach of already established multicomponent delirium prevention models to aid in improving the care of older adults,” said Mr. Jason Albaum, second author on the study.

The participating HELP sites included: Maine Medical Center, Allegheny Health Network, California Pacific Medical Center, University of Utah Health. Coauthors also joined from Vassar College and Michigan Medicine.

Funding came from an Interventional Studies in Aging Center pilot grant from the Marcus Institute for Aging Research and from the National Institute on Aging (Grant no. R33AG071744 to Dr. Inouye).

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, was founded in 1903 and today is a national leader dedicated to empowering seniors to live their best lives. Hebrew SeniorLife cares for more than 3,000 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline; and Jack Satter House, Revere. Hebrew SeniorLife also trains more than 1,000 future health care professionals each year, and conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research

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