What is the research about?
Delirium is a common and life-threatening complication of hospitalization and major surgery for older adults, often leading to loss of independence and considerable healthcare costs. It also causes distress for patients, families, and clinicians. Delirium can be prevented in nearly half of cases by approaches that help protect the brain and avoid medications, such as providing orienting communication, walking and exercise, nutrition and fluids, adequate sleep, and vision and hearing aids if needed. One approach applying these strategies has been used in hospitals for over 20 years and is called the Hospital Elder Life Program (HELP). This program has been proven to be effective in over 20 studies to date. However, it is not known whether involving family members along with hospital staff in HELP might be better to prevent delirium. The research team wants to compare two ways of preventing delirium. One way is HELP, and the other way involves HELP plus family involvement in a new program called FAM-HELP.
Who can this research help?
Hospital, health insurance, and national leaders can use the results to decide about effective delirium prevention programs to put into place in hospitals. Patients and families may choose hospitals based on the availability of these programs. National groups might judge the quality of hospital care based on the presence of these programs.
What is the research team doing?
The research team is working with eight hospitals across the country to enroll 3,000 adults aged 70 and older when they are admitted to the hospital for medical or surgical care. In half of the group, the team will also enroll their family members into the FAM-HELP program. The team is assigning patients by chance to HELP alone or FAM-HELP.
HELP is already in place as standard care in the eight participating hospitals and uses hospital staff and trained volunteers to provide interventions to help protect the brain. These interventions include reviewing daily orientation boards, providing fun activities that the patient chooses to stimulate the brain (like word games, crossword puzzles, iPad games, current events, or crafts), offering walking and exercises, helping with meals, encouraging sleep at bedtime without medications (with relaxation, massage, and warm milk), and encouraging use of glasses, magnifiers, or hearing aids as needed.
FAM-HELP will involve educating and training family members about delirium, so they can recognize it early, and so they can help to prevent it. Family members will be trained to assist with all of the HELP interventions and will also provide an extra layer of emotional comfort, social support, and daily communication. A nurse at each hospital will be available to guide and support the family members as needed.
The research team will track patients every day in the hospital with a simple test twice a day to see if they develop delirium. Patients and family members will also answer questions about their stress level and quality of life at hospital discharge and one month later. Families will be asked about their satisfaction and confidence in hospital care. The team will also check medical records for any falls in the hospital, how long patients stay in the hospital, whether they are able to return home, and whether they return to the hospital or die within one month.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.