Hospital Elder Life Program (HELP)

An investigation of the Hospital Elder Life Program system of care to prevent delirium

Background

Delirium (also called acute or toxic confusion) is the most frequent, but often unrecognised, complication of hospitalisation for older people, affecting about one third of older patients admitted to medical wards. The development of delirium is associated with mortality rates of 25–33%, increased morbidity, functional decline and increased need for institutional care.

There is evidence that delirium could be prevented in about one third of patients using multi-component interventions, but unfortunately these are not yet routinely available in the NHS.

Previous research in the USA has led to the development of a successful delirium prevention system of care called the Hospital Elder Life Program (HELP). However, the research team believe that the uncritical transposing of a US health system model of care to NHS hospitals with a different organisation of care is unlikely to be successful without thorough review and appropriate modification.

Aim & Objectives

To improve delirium prevention for older people admitted to NHS acute hospitals through a programme of linked projects to investigate the feasibility, acceptability, potential effectiveness and cost-effectiveness of a delirium prevention system of care.

Objectives:

  1. Develop a multi-component delirium prevention system of care suitable for use in NHS acute wards using the Hospital Elder Life Program (HELP) and the National Institute for Health and Care Excellence (NICE) delirium clinical guidelines as starting points.
  2. Identify strategies to support the implementation of the delirium prevention system of care.
  3. Determine the optimum methods to deliver the delirium prevention system of care in routine care.
  4. Conduct a feasibility study to assess the implementation and acceptability of the delirium prevention system of care, refine the content and delivery of the delirium prevention system of care, determine preliminary estimates of effectiveness and cost-effectiveness, assess feasibility of conducting a definitive trial and gather data to inform its design.

Methods

The programme consists of the following three projects:

Project 1: Development of the Prevention of Delirium (POD) Programme (1 December 2009 – 31 May 2011)
Using case studies in three general hospitals, we reviewed HELP and NICE clinical guidelines and developed the Prevention of Delirium (POD) Programme, a multi-component prevention of delirium system of care designed to be integrated into ward routines.

Project 2: pilot to test implementation feasibility and acceptability of the POD Programme (1 June 2011 – 31 July 2013)
We used further case studies in five hospitals to investigate the feasibility and acceptability of POD to provide a realistic assessment of the practical, professional and cultural issues associated with POD implementation.

Project 3: preliminary testing of the POD delirium prevention system of care (1 October 2013 – 30 September 2015)
We are conducting a cluster randomised, controlled, feasibility study in 16 wards in eight hospitals to test for preliminary evidence of effectiveness and cost-effectiveness and to gather data to inform recruitment, appropriate outcome measure selection and sample size to design a large scale trial.

Partners & Collaborators

Professor John Young, University of Leeds
Professor Anne Forster, University of Leeds
Dr John Green, University of Leeds
Mrs Amanda Farrin, University of Leeds
Dr Claire Hulme University of Leeds
Dr Keith Hurst, University of Leeds
Dr Najma Siddiqi, University of Leeds
Professor Dawn Brooker, University of Worcester
Dr Alex Brown, Bradford Teaching Hospitals NHS Foundation Trust
Professor Francine Cheater, Glasgow Caledonian University
Dr Jim George, North Cumbria Acute hospitals NHS Trust
Professor Sharon Inouye, Harvard Medical School

Funding

Funding agency: National Institute for Health Research (NIHR) Programme Grant for Applied Research

Grant value: £2,022,089

Project period: 1 December 2009 to 30 September 2015

For further information contact John Green.

This summary presents independent research commissioned by the National Institute for Health Research (Research for Patient Benefit Programme, An investigation of the Hospital Elder Life Program (HELP) system of care in NHS acute trusts to prevent delirium, RP-PG-0108-10037). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.