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November 2, 2012
Preventing delirium and functional decline in older patients are goals of the newly implemented Hospital Elder Life Program (HELP) in the Acute Care of the Elderly Unit (ACE) at Victoria Hospital, London Health Sciences Centre (LHSC).
Ten to 15 percent of seniors are admitted to hospital with delirium, while an additional 15-25 percent develop the disorder following admission.
HELP, a unique program, which integrates principles of geriatrics into acute care practices with standardized programs and individualized interventions, is available to ACE unit patients who are at risk of developing delirium symptoms such as sudden confusion, fluctuations in mental status, disorganized thinking or inattention.
Risk factors for delirium include visual and hearing deficits, mobility and cognitive impairments, dehydration and poor nutrition. There are four themes in HELP, all directed at alleviating these delirium risks. The themes with examples of interventions are: Daily Visiting (orientation activities); Therapeutic Activities (such as reading a newspaper, playing cards or one-on-one discussion); Exercise or Early Mobilization (where the volunteer acts as a "cheerleader"); and, Meal Assistance and/or Fluid Repletion (helping with tray set up or encouraging fluid intake).
“This program has been shown, amongst other outcomes, to reduce the incidence of delirium, improve consistency and quality of care and patient safety,” says Donna Wiancko, Nurse Practitioner, ACE Unit. “This contributes to enhancing our approach to a senior friendly environment on the ACE unit.”
Essential to HELP is the involvement of specially trained volunteers who interact directly with the nurse practitioner and assessed patients and carry out activities under the four intervention themes. All volunteer and patient activities are documented and reviewed daily by the nurse practitioner, who also obtains input from an interprofessional care team. Volunteers are required to undertake extensive training and education prior to working with patients in 20-40 minutes sessions, twice daily.
Cathy Dai, a medical sciences student at Western University, chose to volunteer for the program due to its uniqueness and the opportunity to help patients with a variety of activities. “I am able to see an improvement in the patient and am happy to play a role in helping to enrich their quality of life.”
“I enjoy having a volunteer spend time with me and especially enjoy having the newspaper read to me and participating in activities to help my mobility,” says Veronica Duguay, a 76 year-old visually impaired patient, who has been on the ACE Unit for almost three weeks. “It keeps my mind and body active and makes me feel better.”
The HELP program at LHSC is based on research and evidence that comes from work done at Yale University School of Medicine and demonstrates how best practices can be implemented in an acute care clinical setting.