Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA.
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province China.
Am J Geriatr Psychiatry. 2018 Oct;26(10):1015-1033. doi: 10.1016/j.jagp.2018.06.007. Epub 2018 Jun 26.
Delirium, defined as an acute disorder of attention and cognition with high morbidity and mortality, can be prevented by multicomponent nonpharmacological interventions. The Hospital Elder Life Program (HELP) is the original evidence-based approach targeted to delirium risk factors, which has been widely disseminated.
To summarize the current state of the evidence regarding HELP and to highlight its effectiveness and cost savings.
Systematic review of Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from 1999 to 2017, using a combination of controlled vocabulary and keyword terms.
Of the 44 final articles included, 14 were included in the meta-analysis for effectiveness and 30 were included for examining cost savings, adherence and adaptations, role of volunteers, successes and barriers, and issues in sustainability. The results for delirium incidence, falls, length of stay, and institutionalization were pooled for meta-analyses. Overall, 14 studies demonstrated significant reductions in delirium incidence (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.37-0.59). The rate of falls was reduced by 42% among intervention patients in three comparative studies (OR 0.58, 95% CI 0.35-0.95). In nine studies on cost savings, the program saved $1600-$3800 (2018 U.S. dollars) per patient in hospital costs and over $16,000 (2018 U.S. dollars) per person-year in long-term care costs in the year following delirium. The systematic review revealed that programs were generally successful in adhering to or appropriately adapting HELP (n = 13 studies) and in finding the volunteer role to be valuable (n = 6 studies). Successes and barriers to implementation were examined in 6 studies, including ensuring effective clinician leadership, finding senior administrative champions, and shifting organizational culture. Sustainability factors were examined in 10 studies, including adapting to local circumstances, documenting positive impact and outcomes, and securing long-term funding.
The Hospital Elder Life Program is effective in reducing incidence of delirium and rate of falls, with a trend toward decreasing length of stay and preventing institutionalization. With ongoing efforts in continuous program improvement, implementation, adaptations, and sustainability, HELP has emerged as a reference standard model for improving the quality and effectiveness of hospital care for older persons worldwide.
谵妄是一种以高发病率和死亡率为特征的急性注意力和认知障碍，可以通过多组分非药物干预来预防。医院老年人生活计划（HELP）是一种针对谵妄风险因素的原始循证方法，已得到广泛传播。
总结有关 HELP 的现有证据，并强调其有效性和成本节约。
对 1999 年至 2017 年 Ovid MEDLINE、Embase 和 Cochrane 对照试验中心注册库进行系统评价，使用受控词汇和关键词组合。
最终纳入的 44 篇文章中，有 14 篇纳入了有效性的荟萃分析，30 篇纳入了成本节约、依从性和适应性、志愿者的作用、成功和障碍以及可持续性问题的研究。对谵妄发生率、跌倒、住院时间和住院率的结果进行了荟萃分析。总体而言，14 项研究表明谵妄发生率显著降低（优势比 [OR] 0.47，95%置信区间 [CI] 0.37-0.59）。在 3 项比较研究中，干预组患者的跌倒率降低了 42%（OR 0.58，95%CI 0.35-0.95）。在 9 项关于成本节约的研究中，该计划在发生谵妄后的一年中，每位患者节省了 1600-3800 美元（2018 年美元）的住院费用，每人每年节省了 16000 美元（2018 年美元）以上的长期护理费用。系统评价显示，该计划通常能够坚持或适当调整 HELP（n=13 项研究），并发现志愿者的作用很有价值（n=6 项研究）。有 6 项研究检查了实施的成功和障碍，包括确保有效的临床医生领导、寻找高级管理拥护者以及改变组织文化。有 10 项研究检查了可持续性因素，包括适应当地情况、记录积极的影响和结果以及确保长期资金。
医院老年人生活计划可有效降低谵妄发生率和跌倒率，住院时间和住院率呈下降趋势，并可预防住院。通过不断努力改进计划、实施、适应性和可持续性，HELP 已成为改善全球老年人医院护理质量和效果的参考标准模式。
