Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2023 Mar;71(3):935-945. doi: 10.1111/jgs.18212. Epub 2023 Jan 13.
Delirium is a common complication of hospitalization and is associated with poor outcomes. Multicomponent delirium prevention strategies such as the Hospital Elder Life Program (HELP) have proven effective but rely on face-to-face intervention protocols and volunteer staff, which was not possible due to restrictions during the COVID-19 pandemic. We developed the Modified and Extended Hospital Elder Life Program (HELP-ME), an innovative adaptation of HELP for remote and/or physically distanced applications.
HELP-ME protocols were adapted from well-established multicomponent delirium prevention strategies and were implemented at four expert HELP sites. Each site contributed to the protocol modifications and compilation of a HELP-ME Operations Manual with standardized protocols and training instructions during three expert panel working groups. Implementation was overseen and monitored during seven learning sessions plus four coaching sessions from January 8, 2021, through September 24, 2021. Feasibility of implementing HELP-ME was measured by protocol adherence rates. Focus groups were conducted to evaluate the acceptability, provide feedback, and identify facilitators and barriers to implementation.
A total of 106 patients were enrolled across four sites, and data were collected for 214 patient-days. Overall adherence was 82% (1473 completed protocols/1798 patient-days), achieving our feasibility target of >75% overall adherence. Individual adherence rates ranged from 55% to 96% across sites for the individual protocols. Protocols with high adherence rates included the nursing delirium protocol (96%), nursing medication review (96%), vision (89%), hearing (87%), and orientation (88%), whereas lower adherence occurred with fluid repletion (64%) and range-of-motion exercises (55%). Focus group feedback was generally positive for acceptability, with recommendations that an optimal approach would be hybrid, balancing in-person and remote interventions for potency and long-term sustainability.
HELP-ME was fully implemented at four HELP sites, demonstrating feasibility and acceptability. Testing hybrid approaches and evaluating effectiveness is recommended for future work.
谵妄是住院的常见并发症，与不良结局相关。多组分谵妄预防策略，如医院老年生活计划（HELP）已被证明有效，但依赖于面对面的干预方案和志愿者工作人员，由于 COVID-19 大流行期间的限制，这是不可能的。我们开发了改良和扩展的医院老年生活计划（HELP-ME），这是 HELP 的一种创新改编，适用于远程和/或物理距离应用。
HELP-ME 方案改编自成熟的多组分谵妄预防策略，并在四个专家 HELP 地点实施。每个地点都为方案修改做出了贡献，并在三个专家小组工作组中编写了 HELP-ME 操作手册，其中包含标准化方案和培训说明。从 2021 年 1 月 8 日至 2021 年 9 月 24 日，通过七次学习会议和四次辅导会议对实施情况进行了监督和监测。通过遵守方案的比率来衡量实施 HELP-ME 的可行性。进行焦点小组讨论，以评估可接受性，提供反馈，并确定实施的促进因素和障碍。
四个地点共纳入 106 名患者，共收集了 214 名患者的 1798 个患者日的数据。总体依从率为 82%（1473 项完成方案/1798 个患者日），达到了我们总体依从率>75%的可行性目标。个别方案的依从率从 55%到 96%不等。依从率较高的方案包括护理谵妄方案（96%）、护理药物审查（96%）、视力（89%）、听力（87%）和定向（88%），而补液（64%）和活动范围运动（55%）的依从率较低。焦点小组的反馈总体上是可接受的，建议最佳方法是混合方法，平衡面对面和远程干预的效力和长期可持续性。
HELP-ME 在四个 HELP 地点全面实施，证明了可行性和可接受性。建议未来的工作中测试混合方法并评估有效性。
