New York University Rory Meyers College of Nursing, New York, NY, USA.
Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Am Med Dir Assoc. 2023 Aug;24(8):1133-1142. doi: 10.1016/j.jamda.2023.05.032. Epub 2023 Jun 12.
The Hospital Elder Life Program (HELP) is a multicomponent delirium prevention program targeting delirium risk factors of cognitive impairment, vision and hearing impairment, malnutrition and dehydration, immobility, sleep deprivation, and medications. We created a modified and extended version of the program, HELP-ME, deployable under COVID-19 conditions, for example, patient isolation and restricted staff and volunteer roles. We explored perceptions of interdisciplinary clinicians who implemented HELP-ME to inform its development and testing. This was a qualitative descriptive study of HELP-ME among older adults on medical and surgical services during the COVID-19 pandemic. Participants included HELP-ME staff at 4 pilot sites across the United States who implemented HELP-ME.We held five 1-hour video focus groups (5-16 participants/group) to review specific intervention protocols and the overall program. We asked participants open-endedly about positive and challenging aspects of protocol implementation. Groups were recorded and transcribed. We used directed content analysis to analyze data. Participants identified general, technology-related, and protocol-specific positive and challenging aspects of the program. Overarching themes included the need for enhanced customization and standardization of protocols, need for increased volunteer staffing, digital access to family members, patient technological literacy and comfort, variation in the feasibility of remote delivery among intervention protocols, and preference for a hybrid program model. Participants offered related recommendations. Participants felt that HELP-ME was successfully implemented, with some modifications needed to address limitations of remote implementation. A hybrid model combining remote and in-person aspects was recommended as the preferred option.
医院老年人生活计划（HELP）是一个多成分的谵妄预防计划，针对认知障碍、视力和听力障碍、营养不良和脱水、不动、睡眠剥夺和药物等谵妄风险因素。我们创建了该计划的修改和扩展版本，即 HELP-ME，可在 COVID-19 条件下部署，例如患者隔离和限制工作人员和志愿者角色。我们探讨了实施 HELP-ME 的跨学科临床医生的看法，以为其开发和测试提供信息。这是一项针对 COVID-19 大流行期间医疗和外科服务中老年人的 HELP-ME 的定性描述性研究。参与者包括美国 4 个试点地点的 HELP-ME 工作人员，他们实施了 HELP-ME。我们举行了 5 次 1 小时的视频焦点小组（每组 5-16 名参与者），以审查特定的干预方案和整个计划。我们向参与者提出了有关方案实施的积极和挑战方面的开放式问题。对小组进行了录音和转录。我们使用有针对性的内容分析来分析数据。参与者确定了该计划的一般、技术相关和特定协议的积极和挑战方面。总体主题包括需要增强协议的定制和标准化、需要增加志愿者人员配置、与家人进行数字访问、患者的技术素养和舒适度、干预方案中远程提供的可行性的差异，以及对混合方案模式的偏好。参与者提出了相关建议。参与者认为 HELP-ME 已成功实施，但需要进行一些修改以解决远程实施的限制。建议采用混合模式，结合远程和现场方面，作为首选方案。
