The Hospital Elder Life Program

The Hospital Elder Life Program (HELP), which was established at Tallahassee Memorial Healthcare, Inc. in February 2007, is an innovative model of care designed to prevent functional and cognitive decline of older persons during hospitalization. The original model was conducted at Yale University, and the results were published in the New England Journal of Medicine in 1999. The HELP model has been replicated in twenty-five community and teaching hospitals across the United States. The goals of HELP are to:

• maintain cognitive and physical functioning of high-risk older
• adults throughout hospitalization;
• maximize patients' independence at discharge;
• assist patients with the transition from hospital to home; and
• prevent unplanned hospital re-admissions.

Patients aged 70 years or greater on specified units are screened on admission for six risk factors:

• Cognitive impairment
• Sleep deprivation
• Immobility
• Dehydration
• Vision
• Hearing impairment

Targeted interventions for these risk factors are implemented by an interdisciplinary team-including a geriatric nurse specialist, Elder Life Specialists, trained volunteers, and geriatricians-who work closely with primary nurses. Other experts provide consultation at twice-weekly interdisciplinary rounds. Quality assurance procedures and performance reviews are an integral part of the program.

Interventions are carried out by a skilled interdisciplinary team and trained volunteers. HELP staff - an Elder Life Specialist and Elder Life Nurse Specialist - assess older hospital patients to identify risks and determine which interventions are appropriate, based on each patient's needs. Patients receive personalized interventions that evolve to match their changing needs throughout the course of hospitalization.

Trained HELP volunteers provide assistance to counter the effects of immobility. Examples of interventions performed by trained volunteers include taking patients for walks; reducing their need for sleep sedatives by giving them warm milk and back rubs, and playing relaxation recordings at night; and helping to keep them mentally active by playing word games and discussing current events. Nurses monitor patients for signs of delirium and work with patients' physicians and other providers to provide evidence-based geriatric care.

HELP is supported by information technology designed to prompt and document recommended interventions, track patient progress, and report clinical and financial performance.