LDS Hospital has become only the third hospital in the nation to adopt a program to intervene before frail elderly patients suffer from acute episodes of confusion that are not uncommon with hospitalization.
The Hospital Elder Life Program (HELP), based on a program designed at Yale University School of Medicine, pairs volunteers and staff members with patients who are at risk for the condition, which can increase health-care costs, lengthen inpatient stays and even lead to a downward health spiral that may not be reversed.
"Delirium complicates hospital stays for well over 2 million older patients each year," said Dr. Sarah Goodlin, one of the hospital's geriatricians and the new program's director. "We believe we will reduce the number of people who develop confusion during their hospital stay with this innovative approach."
The delirium seems to take a cognitive, emotional and physical toll on patients.
LDS Hospital found one-third of its control group had problems with memory that got worse over the course of the hospital stay, Lawrence said. And 80 percent of those needed more help at home or had to go into a nursing home briefly after hospitalization. The program's goal is to prevent those complications through interventions.
Confusion risk factors include any level of cognitive impairment, sleep deprivation, dehydration, vision or hearing problems and mobility issues. When people who are already frail and have one or more of the risk factors are "taken out of the routine and surroundings they're used to and put it a hospital, it throws them for a loop," said Beth Walter, HELP program manager.
Currently, HELP serves the general medical floor, with plans to expand into the rest of the hospital. Enrollment is voluntary.
Nurse practitioner Paula Lawrence works with nursing staffers to increase their skills in caring for older patients. A pharmacist, dietitian, physical and occupational therapist and others are part of the team to enhance the patient's wellbeing. The program brings with it both extra screening and follow-up, Lawrence said.
But the heart of the program is a volunteer staff, trained specifically to meet the needs of this hospitalized population, Walter said.
Patients need to stay oriented, so information like what day it is and the doctors' and nurses' names are written on a board in the room. For people with vision impairments, several strategies are used, from simply cleaning or repairing eye glasses to providing phones with large keys and illuminated pads, magnifying glasses or fluorescent tape to make it easier to find the phone.
Amplifiers are available for folks with hearing impairments. Staff will clean out hearing aids or even remove ear wax. "The things that get overlooked sometimes can make a huge difference," Walter said.
Perhaps most important is companionship, provided by volunteers who are also willing to take patients for a walk if they can safely do so. Volunteers conduct range of motion exercises. And they'll do some recreational activities, from just visiting to working puzzles. They've learned to help with relaxation techniques.
"A lot of what we do in this program is not necessarily something new or never done, but when a patient is in the hospital and the staff is busy, volunteers go in and really enhance the care, one on one," Walter said. "Anything we can do to make them more comfortable and more aware of their surroundings helps."
In Yale's study, the incidence of delirium was reduced by 40 percent.
Walter hopes to find more volunteers in the coming weeks.
E-mail: lois@desnews.com