Hospital Elder Life Program in Long‐Term Care (HELP‐LTC): A Cluster Randomized Controlled Trial
BACKGROUND/OBJECTIVES The Hospital Elder Life Program (HELP) has been shown to prevent delirium in hospitalized older adults. The objective of this study was to test the efficacy of HELP adapted to long‐term care (HELP‐LTC). DESIGN Cluster randomized controlled trial. SETTING A 514‐bed academic urba...
Saved in:
Published in | Journal of the American Geriatrics Society (JAGS) Vol. 68; no. 10; pp. 2329 - 2335 |
---|---|
Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Hoboken, USA
John Wiley & Sons, Inc
01.10.2020
Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | BACKGROUND/OBJECTIVES
The Hospital Elder Life Program (HELP) has been shown to prevent delirium in hospitalized older adults. The objective of this study was to test the efficacy of HELP adapted to long‐term care (HELP‐LTC).
DESIGN
Cluster randomized controlled trial.
SETTING
A 514‐bed academic urban nursing home.
PARTICIPANTS
A total of 219 long‐term nursing home residents who developed an acute illness or change in condition were randomly assigned to HELP‐LTC (n = 105) or usual care (n = 114) by unit.
INTERVENTION
HELP‐LTC is a multicomponent intervention targeting delirium risk factors of cognitive impairment, immobility, dehydration, and malnutrition. Two certified nursing assistants (CNAs) delivered HELP‐LTC components twice daily 7 days per week. In addition, recommendations were given to primary providers to reduce medications associated with delirium.
MEASUREMENTS
Delirium (primary outcome) and delirium severity were ascertained each weekday by a research assistant blinded to group assignment, using the Confusion Assessment Method (CAM) and CAM severity score (CAM‐S), respectively. Cognitive function was determined using the Cognitive Performance Scale (CPS). Hospitalization was ascertained by chart review.
RESULTS
Participants were 81.7 years of age on average and 65.3% female. At baseline, usual care group participants had better cognitive function than intervention group participants (CPS = 1.33 vs 2.25; P = .004). Delirium symptoms declined over the course of the episode (mean CAM‐S = 3.63 at start vs 3.27 at end). Overall, 33.8% of the total sample experienced incident delirium. After adjusting for baseline cognitive function, no significant differences were found in delirium or delirium severity between intervention and usual care groups. Hospitalization was not significantly different between groups.
CONCLUSION
An intervention targeting delirium risk in long‐term nursing home residents did not prevent delirium or reduce delirium symptoms. Baseline differences in cognitive function between groups, greater than expected improvements in both groups, quality‐enhancing practices such as consistent assignments delivered to both groups, and adaptations of the intervention may have biased results toward null. J Am Geriatr Soc 68:2329–2335, 2020. |
---|---|
Bibliography: | Presented in part at the 2019 American Geriatrics Society Annual Scientific Meeting. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 Author contributions: Study concept and design (Boockvar, Teresi, Inouye), acquisition of subjects and/or data (Boockvar, Judon), analysis and interpretation of data (Boockvar, Teresi, Eimicke), and preparation of manuscript (all). All authors gave final approval of the version to be published. Drs. Boockvar and Teresi had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. |
ISSN: | 0002-8614 1532-5415 |
DOI: | 10.1111/jgs.16695 |