Hospital elder life program linked to improved function, lower risk of delirium in post-operative elderly patients

1. In this randomized clinical trial in China of a tailored, family-involved hospital elder life program (t-HELP) was linked to a substantially lower risk of post-operative delirium for patients over the age of 70 years undergoing an elective surgical procedure.

2. Compared to the usual care control population, participants in the t-HELP intervention had less decline in cognition and functional status at time of discharge.

Evidence Rating Level: 2 (Good)

Study Rundown: Post-operative delirium is a common complication following surgical procedures among elderly patients, and is associated with increased mortality, morbidity, and healthcare costs. Efforts to prevent delirium for patients in hospital often require multi-disciplinary interventions and quite often need to be individualized to the needs of a particular patient. In order to better suit the cultural landscape of elder care in the Chinese hospital system, the current study evaluated the effectiveness of 11 integrated protocols for personalized delirium risk factor reduction involving family members as care providers (Tailored, family-involved hospital elder life program, t-HELP). The study found that amongst older patients admitted for elective surgical interventions, implementation of t-HELP was associated with significantly lower risk of delirium in the post-operative period and had improved cognition and functional status at time of discharge.

The strengths of the study included the randomized design and unique inclusion of the patient family members into individualized care programs. The main limitations of the study included the single-blinded design, and lack of long-term follow up data on cognition and function following discharge from hospital.

Click to read the study in JAMA Internal Medicine

Relevant Reading: A Family Involvement and Patient‐Tailored Health Management Program in Elderly Korean Stroke Patients’ Day Care Centers

In-Depth [randomized controlled trial]: This study was a cluster-randomized, single-blinded control trial that included patients treated at one of six surgical floors of West China Hospital in Chengdu, China. Patients were included if they were 70 years of age or older and were admitted for an elective surgical procedure with an estimated length of stay of 2 days or greater. Patients were excluded if they had delirium or significant cognitive deficit at baseline, psychiatric illness, alcohol withdrawal, or life expectancy less than 3 months. The t-HELP intervention adapted 3 universal and 8 personalized protocols for previously established for delirium reduction, and integrated family-members into patient care for the protocol tasks. The control group patients entered into a standard nursing unit and received standard post-operative care. Primary outcome was incidence of post-operative delirium evaluated by Confusion Assessment Method score. Secondary outcomes included functional and cognitive status at discharge. A total of 281 patients were included in the study with 152 being involved in the t-HELP intervention. The t-HELP study arm had significantly lower incidence of post-op delirium (2.6% vs. 19.4%, relative risk of 0.14, 95%CI, 0.05-0.38). The t-HELP patients also demonstrated less functional decline and improved cognitive scores at discharge.

Image: PD

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