Hospital Elder Life Program in the Real World: The Many Uses of the Hospital Elder Life Program Website

The Hospital Elder Life Program (HELP) can prevent delirium, a common condition in older hospitalized adults associated with substantial morbidity, mortality, and healthcare costs. In 2011, HELP transitioned to a web‐based dissemination model to provide accessible resources, including implementation materials; information for healthcare professionals, patients, and families; and a searchable reference database. It was hypothesized that, although intended to assist sites to establish HELP, the resources that the HELP website offer might have broader applications. An e‐mail was sent to all HELP website registrants from September 10, 2012, to March 15, 2013, requesting participation in an online survey to examine uses of the resources on the website and to evaluate knowledge diffusion related to these resources. Of 102 responding sites, 73 (72%) completed the survey. Thirty‐nine (53%) had implemented and maintained an active HELP model. Twenty‐six (35%) sites had used the HELP website resources to plan for implementation of the HELP model and 35 (50%) sites to implement and support the program during and after launch. Sites also used the resources for the development of non‐HELP delirium prevention programs and guidelines. Forty‐five sites (61%) used the website resources for educational purposes, targeting healthcare professionals, patients, families, or volunteers. The results demonstrated that HELP resources were used for implementation of HELP and other delirium prevention programs and were also disseminated broadly in innovative educational efforts across the professional and lay communities.     

The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program

OBJECTIVES: To describe the Hospital Elder Life Program, a new model of care designed to prevent functional and cognitive decline of older persons during hospitalization. PROGRAM STRUCTURE AND PROCESS: All patients aged > or =70 years on specified units are screened on admission for six risk factors (cognitive impairment, sleep deprivation, immobility, dehydration, vision or hearing impairment). Targeted interventions for these risk factors are implemented by an interdisciplinary team-including a geriatric nurse specialist, Elder Life Specialists, trained volunteers, and geriatricians--who work closely with primary nurses. Other experts provide consultation at twice-weekly interdisciplinary rounds. INTERVENTION: Adherence is carefully tracked. Quality assurance procedures and performance reviews are an integral part of the program. PROGRAM OUTCOMES: To date, 1,507 patients have been enrolled during 1,716 hospital admissions. The overall intervention adherence rate was 89% for at least partial adherence with all interventions during 37,131 patient-days. Our results indicate that only 8% of admissions involved patients who declined by 2 or more points on MMSE and only 14% involved patients who declined by 2 or more points on ADL score. Comparative results for the control group from the clinical trial were 26% and 33%, and from previous studies 14 to 56% and 34 to 50% for cognitive and functional decline, respectively. Effectiveness of the program for delirium prevention and of the program's nonpharmacologic sleep protocol have been demonstrated previously. CONCLUSIONS: These results suggest that the Hospital Elder Life Program successfully prevents cognitive and functional decline in at-risk older patients. The program is unique in its hospital-wide focus; in providing skilled staff and volunteers to implement interventions; and in targeting practical interventions toward evidence-based risk factors. Future studies are needed to evaluate cost-effectiveness and longterm outcomes of the program as well as its effectiveness in non-hospital settings.     

Replicating the Hospital Elder Life Program in a community hospital and demonstrating effectiveness using quality improvement methodology

OBJECTIVES: To evaluate a replication of the Hospital Elder Life Program (HELP), a quality-improvement model, in a community hospital without a research infrastructure, using administrative data. DESIGN: A pretest/posttest quality-improvement study. SETTING: A 500-bed community teaching hospital in western Pennsylvania. PARTICIPANTS: Four thousand seven hundred sixty-three hospitalized patients aged 70 and older admitted to one nursing unit over 3.5 years. INTERVENTION: Application of the HELP multicomponent intervention targeting patients at risk for delirium. MEASUREMENTS: A proxy measure for delirium was developed using administrative data to calculate delirium rate and differences in variable costs of care and length of stay for patients before and after the intervention. Similar calculations were used in delirious patients for variable costs and length of stay before and after the intervention. Satisfaction surveys were administered to nursing staff and patient families before and after the intervention. RESULTS: The intervention reduced the absolute rate of delirium according to proxy report 14.4% from baseline, which represented a relative reduction in risk of 35.3% (P=.002). Total costs on this 40-bed nursing unit were reduced $626,261 over 6 months. Satisfaction of nursing staff and families was high in the intervention group. In addition, the intervention showed sustained benefits over time and remains funded by the hospital. CONCLUSION: HELP can be successfully replicated in a community hospital, yielding clinical and financial benefits.     

择期行减重手术患者的心理控制源状况

目的了解择期行减重手术患者的心理控制源倾向及其与生活质量的相关性。 方法选择2016年9月至2018年6月暨南大学附属第一医院胃肠外科接受减重手术的90例肥胖症患者作为研究对象。采用多维度健康心理控制源量表(MHLC)、广泛性焦虑量表（GAD-7）、患者健康问卷抑郁症状群量表（PHQ-9）、健康调查简表(SF-36)对90例择期行减重手术治疗的住院患者进行问卷调查。 结果择期行减重手术患者心理控制源的健康内部控制分值低于常模(P<0.05),健康权威人士控制和健康机遇控制分值高于常模(P<0.05)。有情绪障碍与无情绪障碍患者之间的健康机遇控制分值差异有统计学意义（P<0.05）。心理控制源健康机遇控制分值与生活质量评分呈负相关(P<0.05)。 结论情绪障碍影响患者心理控制源,心理控制源健康机遇控制与生活质量呈负相关,择期行减重手术患者健康权威人士和机遇心理控制源倾向明显。     

Physiological Redundancy in Older Adults in Relation to the Change with Age in the Slope of a Frailty Index

OBJECTIVES: To test the proposition, using routinely available clinical data, that deficit accumulation results in loss of redundancy. In keeping with the reliability theory of aging, this would be quantitated by attenuation in the slope of a Frailty Index (FI) with age. The more deficits, the less steep the slope and the less redundancy. DESIGN: Cross‐sectional analysis of a prospective cohort study, with 5‐year mortality data. SETTING: The clinical sample of the second wave of the Canadian Study of Health and Aging. PARTICIPANTS: Two thousand three hundred five people aged 70 and older at baseline. MEASUREMENTS: A FI based on data used for a Comprehensive Geriatric Assessment (CGA), the slope of the relationship between age and the FI‐CGA, the limit value of the FI‐CGA, mortality. RESULTS: An age‐invariant limit to deficit accumulation was demonstrated; the observed 99% limit was 0.66. At the 25th percentile of deficit accumulation (FI‐CGA ～0.18), the slope of the FI‐CGA in relation to age was 0.044 (range 0.038–0.049). When deficits had increased to 75% of the maximum value (FI‐CGA ～0.52), the slope fell to 0.021 (range 0.016–0.027). By the 85th percentile (FI‐CGA ～0.6), the slope had become statistically indistinguishable from 0. CONCLUSION: As predicted by the reliability theory of aging, the rate of deficit accumulation slows with increasing frailty. A FI derived from data routinely collected as part of a CGA can in this way quantify loss of redundancy in older adults. Quantifying loss of redundancy can aid clinical decision‐making; its application to individual prognostication in clinical samples warrants further evaluation.     

老年HIV/AIDS患者衰弱综合征的研究进展

[摘要]?衰弱综合征（衰弱）是一种由机体退行性改变和多种慢性疾病引起的机体易损性增加的综合征,与临床不良结局密切相关,严重影响HIV/AIDS患者的身体功能和生存质量。抗反转录病毒治疗（anti-retroviral therapy, ART）有效抑制了HIV复制,延长了感染者寿命,加速了HIV/AIDS患者的老龄化趋势。本文围绕老年HIV/AIDS患者衰弱的流行病学特征、可能机制以及应对措施进行综述,为老年HIV/AIDS患者衰弱的早期识别和及时干预提供参考。     

唑吡坦片对冠状动脉介入手术患者住院费用的影响

目的观察唑吡坦片对冠状动脉介入手术患者住院费用的影响。方法采用前瞻性随机双盲对照的方法,将246例拟诊为冠状动脉粥样硬化性心脏病而择期行首次冠状动脉介入手术的患者,分为安慰剂组（122例）或唑吡坦片治疗组（124例）。所有患者均于入组当晚开始每晚睡前服用唑吡坦片5mg或外形、性状类似于治疗药的安慰剂,三天后行冠状动脉介入治疗。所有患者均于术前24小时内行中国版90项症状清单（SCL-90）评价。结果两组间年龄、体重、烟酒嗜好等比较差异无统计学意义（P〉0．05）;两组间合并高血压和糖尿病的人数差异无统计学意义（均P〉0．05）。与对照组比较,唑吡坦片组冠状动脉介入术前患者躯体化、焦虑、恐怖、精神病性和总均分等项目评分均有明显下降,差异均有统计学意义（P〈0．05,〈0．01）。与对照组比较,唑吡坦片组的住院时间和住院费用显著减少,差异有统计学意义（P〈0．05）。结论术前服用唑吡坦片可改善冠状动脉介入手术患者的心理状况,减少患者住院时间,降低住院费用。