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UPMC Shadyside Begins Program To Prevent Delirium In Elderly

PITTSBURGH, February 27, 2002 — With the establishment of the Hospital Elder Life Program (HELP), geriatricians at UPMC Shadyside have taken an innovative approach to preventing older patients from declining physically and mentally while hospitalized.

The goals of HELP are to maintain physical and cognitive functioning of high-risk older adults throughout their hospitalization, maximize their independence at discharge, assist with the transition from hospital to home and prevent unplanned hospital re-admissions.

People aged 65 and older account for more than 48 percent of all of hospital care nationwide and nearly 75 percent at UPMC Shadyside. Functional and cognitive decline occur in 33-50 percent of hospitalized older people, often due to delirium, which is an acute confusional state that can develop in vulnerable people due to the stresses of acute illness.

"The elderly population is a vulnerable group with multiple chronic health conditions and special needs, they are more likely to develop delirium during their hospitalization," said Fred Rubin, M.D., chairman of the department of internal medicine at UPMC Shadyside and a board-certified geriatrician.

"While we provide excellent care for our elderly patients, loss of independence and institutionalization are frequent outcomes of a hospital stay. With the increase in the nation's elderly population this problem is likely to grow."

HELP consists of a skilled interdisciplinary team with geriatric expertise, assisted by trained volunteers, who carry out needed interventions to address the special needs of each older patient.

Under the program, patients 70 and older are screened on admission to UPMC Shadyside for six delirium risk factors: cognitive impairment, sleep deprivation, immobility, dehydration, and vision or hearing impairment. During the hospital stay, interventions to address the appropriate risk factors are implemented by a geriatrician, a geriatric nurse practitioner, an elder life specialist and trained volunteers. All work closely with the primary nurses on patient units throughout the hospital. Patient participation in the program is voluntary.

Interventions may include a daily visitor to provide orientation, communications and social support, feeding assistance, therapeutic activities to provide mental stimulation and socialization, mobilization in the form of daily exercise and help with walking, non-pharmacologic sleep enhancement, and adaptations and equipment for vision and hearing problems.

"Any interventions we can make to help prevent delirium will lower the number of elderly patients discharged from the hospital to nursing homes and subsequent unplanned re-admissions to the hospital," said Dr. Rubin. "We also expect that our efforts will help to reduce the cost of care for these at-risk patients."

HELP is modeled after a pilot program developed at Yale-New Haven Hospital and is being funded through a grant from the Shadyside Hospital Foundation.

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