Study Shows Families Can Help Prevent Delirium in Older Surgery Patients
BOSTON – In a study published today in JAMA Internal Medicine, researchers reported that training family members in delirium prevention approaches can significantly reduce the incidence of post-operative delirium by up to 16.8 percent within seven days after surgery. This is important because delirium, a sudden change in mental status, or sudden confusion often occurring after major surgery, acute illness, or hospitalization, can have serious complications such as functional and cognitive decline, prolonged hospital stays, institutionalization, and death.
Delirium prevention through multi-component intervention programs has been well-documented to be effective in up to 50 percent of cases, and greatly assists in the recovery of older adults following major surgery. The Hospital Elder Life Program (HELP), an evidence-based multi-component program that prevents delirium and reduces complications for older adult hospital patients, is currently implemented in more than 200 hospitals worldwide. HELP was created by Sharon Inouye, M.D., M.P.H., Director of the Aging Brain Center at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research and Professor of Medicine at Harvard Medical School.
HELP is often implemented by highly trained volunteers who complete targeted interventions such as walking with patients, assisting with mealtime and hydration, performing cognitively stimulating activities, and completing a non-pharmacological sleep protocol. This study is one of the first randomized controlled trials to demonstrate the success of adapting HELP protocols for non-volunteers or family members, as they are often with vulnerable patients regularly following surgery. Adaptations of the HELP protocol are especially important in countries like China, where volunteers are not utilized in hospital settings.
The randomized controlled trial, which examined data on 281 surgical patients at a hospital in China, compared patients in the tailored, or t-HELP, group to patients receiving usual patient care and treatment. Patients in the t-HELP group received daily intervention protocols from family members as instructed by nursing staff. Patients were evaluated daily until post-operative day seven and completed a one-month phone interview follow-up assessment after discharge. Patients who received the t-HELP protocol were significantly less likely to have post-operative delirium within seven days of surgery than patients who did not receive the protocol (2.6 percent vs. 19.4 percent occurrence). The t-HELP intervention was even more effective in preventing severe delirium. Patients who received the t-HELP protocol showed greater functional and cognitive recovery one month after discharge than those patients who received usual care.
These findings show that HELP can be adapted successfully and tailored to different hospital settings, including utilizing a non-volunteer model and engaging family members in delirium prevention.
Dr. Jirong Yue, M.D., corresponding author, said, “In China, we do not utilize hospital volunteers; however, family members are typically very involved in the care of older hospitalized patients. Adapting HELP for use with family members is a beneficial way to utilize the family as a resource to improve patient outcomes.”
Dr. Inouye, creator of HELP and senior author on this study, said, “HELP has proven to be effective in preventing delirium for hospitalized patients. This important study shows that HELP protocols can successfully be adapted for use with family members instead of volunteers, creating even more potential for HELP to improve care of older adult patients around the world.”
The study was led by researchers at the Department of Geriatrics at Sichuan University and co-authored by researchers at the Harvard Medical School-affiliated Hebrew SeniorLife Marcus Institute. Co-authors included Dr. Inouye (Twitter: @sharon_inouye or @ElderLifeProg) and Sarah Gartaganis, LICSW, M.P.H., Project Director III, Hebrew Rehabilitation Center at Hebrew SeniorLife.
This research was supported by grants from the National Key Research and Development Program of the Ministry of Science and Technology of China (2018YFC1312300), the Milstein Medical Asian American Partnership Foundation (H1403014), National Natural Science Foundation of China (81800092), National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (Z2018B03), Sichuan Science and Technology Program (2018SZ0252), Health Research of Cadres in Sichuan province (2019-109, 2017-111), and in part by grants from the U.S. National Institutes of Health (P01AG031720, K07AG041835, R24AG054259, R01AG044518) and the Milton and Shirley F. Levy Family Chair.
About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making.
About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Based in Boston, the nonprofit, non-sectarian organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visit http://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook, or read our blog.