Department of Nursing, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J Am Coll Surg. 2011 Aug;213(2):245-52. doi: 10.1016/j.jamcollsurg.2011.05.004. Epub 2011 Jun 8.
Postsurgical functional decline is common in older patients and can lead to frailty and increased mortality. Comprehensive interventions such as the Hospital Elder Life Program (HELP) have been shown to be effective, but modifying the HELP to include only 3 key interventions might prove cost-effective for surgical patients.
Consecutive patients from August 2007 through April 2009 (n = 179) were enrolled if they had undergone common elective abdominal surgical procedures, such as gastrectomy, cholecystectomy, and Whipple surgery. A modified HELP intervention consisting of early mobilization, nutritional assistance, and therapeutic (cognitive) activities implemented by a trained nurse was introduced on a surgical ward in May 2008. Patients enrolled before May 2008 received usual care and served as controls (n = 77). Those enrolled after the modified HELP intervention constituted the experimental group (n = 102). Changes in performance of activities of daily living, nutritional status, and cognitive function between admission and discharge were the primary end points.
Independent of baseline functions, education, periampullary diagnosis, comorbidity, surgical procedure, and duration of surgery, patients in the HELP group declined significantly less on activities of daily living performance and nutritional status (p < 0.001) than controls. The delirium rate was also significantly lower in the HELP group (0%) than in the control group (16.7%) (p < 0.001).
The modified HELP intervention effectively reduced older surgical patients' functional decline and delirium rates by hospital discharge. This program, conducted by a trained nurse, was not costly but did require commitment and ongoing cooperation between physician and nursing leadership to achieve compliance with the protocols.
术后功能衰退在老年患者中很常见，可导致虚弱和死亡率增加。综合干预措施，如医院老年生活计划（HELP）已被证明是有效的，但修改 HELP 仅包括 3 个关键干预措施可能对手术患者具有成本效益。
如果患者接受了常见的择期腹部手术，如胃切除术、胆囊切除术和胰十二指肠切除术，他们将从 2007 年 8 月至 2009 年 4 月连续入组（n = 179）。2008 年 5 月，在一个外科病房引入了一种由经过培训的护士实施的改良 HELP 干预措施，包括早期活动、营养辅助和治疗（认知）活动。2008 年 5 月之前入组的患者接受常规护理作为对照组（n = 77）。接受改良 HELP 干预的患者构成实验组（n = 102）。入院和出院时日常生活活动能力、营养状况和认知功能的变化是主要终点。
与基线功能、教育程度、壶腹周围诊断、合并症、手术程序和手术持续时间无关，HELP 组的日常生活活动能力和营养状况下降明显少于对照组（p < 0.001）。HELP 组的谵妄发生率也明显低于对照组（0%比 16.7%）（p < 0.001）。
改良 HELP 干预通过出院有效减少了老年手术患者的功能下降和谵妄发生率。该方案由经过培训的护士实施，成本不高，但需要医生和护理领导层的承诺和持续合作，以遵守方案。
