Margarete L. Zalon

A volunteer-based Hospital Elder Life Program to reduce delirium.

A community hospital with nearly 50% of its admitted patients 70 years or older adapted the well-established Hospital Elder Life Program (HELP). The primary adaptation entailed an enhanced participation of trained volunteers in HELP interventions designed to prevent and reduce delirium. Integral program elements include detailed volunteer training, required demonstration of competencies, and regular evaluation and feedback of volunteers provided by program staff. Nurse satisfaction with HELP increased from 64% to 91% in the second year of implementation, and a survey of patients and families indicated that 95% were satisfied with HELP. This innovative volunteer-assisted model of elder care support was positively embraced by patients, their families, and the nursing staff and supported by nursing administration. The use of volunteers is a cost-effective method of enhancing the nursing care of vulnerable elders during hospitalization.

Using PDAs to detect cognitive change in the hospitalized elderly patient

The Hospital Elder Life Program (HELP) program is designed to prevent delirium and cognitive decline in the hospitalized elderly patient. Personal digital assistants (PDAs) were trialed in collecting assessment data for the HELP program. Data for a mental status assessment (Mini-Mental Status Examination), delirium assessment (Confusion Assessment Method), and a depression screen for 352 patients enrolled over a 4-month period were collected. Participants had a slight but significant increase in cognitive function. PDAs are a useful adjunct to care enabling the staff to monitor the cognitive status of hospitalized elderly patients and track program outcomes.

Hospitalized Older Adults With Established Delirium: Recognition, Documentation, and Reporting

Delirium, a life-threatening complication for hospitalized older adults associated with adverse outcomes, is often underrecognized and underreported. The purpose of the current study was to analyze delirium documentation for hospitalized older adults. Charts of 34 patients, aged 71 and older with documented delirium and referral to a Hospital Elder Life Program, were reviewed. With the exception of International Classification of Diseases-9 coding, delirium was only mentioned in 12 (35.3%) charts, although descriptors potentially indicative of delirium were usually recorded. Of these, the most frequently recorded were confusion (94.1%), mental status change (70.6%), and disorientation (61.8%). When nurses charted delirium descriptors, only 5.9% of their notes included physician referral. Physician responses were to order diagnostic tests and medications, usually antipsychotic or benzodiazepine agents. Of 28 patients requiring transfer to another facility after discharge, delirium was mentioned in only one transfer note. Commonly used delirium descriptors can be used for the development of natural language processing tools for clinical decision support. [Journal of Gerontological Nursing, 43(3), 32-40.].