Background Research and Outcomes

The Hospital Elder Life Program was tested in a clinical trial, the Yale Delirium Prevention Trial. The interventions were proven successful using a multi-component strategy to prevent delirium in hospitalized older patients. In the Yale Delirium Prevention Trial, eight hundred and fifty-two older patients (70+) were enrolled, half received the HELP intervention, while the remainder received usual hospital care.

HELP interventions were implemented by an interdisciplinary team (see Geriatric Team), and a complement of trained volunteers (see Volunteer Staff ).

The intervention resulted in:

A significant reduction in the development of delirium (9.9% of intervention patients vs. 15% of usual care patients, odds ratio = 0.60, P=0.02). New England Journal of Medicine 1999;340:669-76
A significant reduction in total number of days with delirium (105 vs. 161 in usual care, P=0.02).
A significant reduction in total number of delirium episodes (62 vs. 90 in usual care, P=0.03).
A significant reduction in functional decline (14% in intervention patients vs. 33% in usual care patients). Journal of the American Geriatrics Society 2000;48:1697-1706
A reduction in use and costs of hospital services. The program was demonstrated to be cost effective for the 73% of intervention patients who were at intermediate risk of developing delirium. The costs of implementing the program were offset by the cost savings from the program. Medical Care 2001;39:740-752
A dose-response relationship between adherence with the interventions and delirium reduction. Higher levels of adherence resulted in reduced rates of delirium in a directly graded fashion. Archives of Internal Medicine 2003;163:958-964
A reduction in use of long-term nursing home services. Intervention was associated with a 15.7% decrease in long-term nursing home costs, and average savings of $9446 per long-term nursing home patient. Journal of the American Geriatrics Society. 2005;52:405-409

The Hospital Elder Life Program (HELP) was created by Professor Sharon K. Inouye, M.D., M.P.H., at Yale University School of Medicine. Documented in the above publications, beneficial outcomes and cost-effectiveness were demonstrated for the HELP model.

Since 2001, the Yale University team has focused on dissemination of the HELP model to other hospitals nationally and internationally.

Research and articles related to HELP Dissemination Sites:

Cross-sectional survey of 13 HELP sites. Describes real-world implementation, adaptations, successes and insights for program implementation. Journal of the American Geriatrics Society 2006;54:1492-1499
A pretest-posttest quality improvement study evaluating the replication of HELP in a community hospital. Delirium rate decreased by 14.4% (35.3% relative risk reduction), P=.002. Total costs reduced by $1.25 million over one year. High rate of nursing and family satisfaction. Journal of the American Geriatrics Society 2006;54:969-974
Two before-after studies examining HELP effectiveness. Demonstrated lower delirium incidence (6% vs 38%, P=.03) and lower severity. Decreased use of nursing assistants with HELP, with overall cost savings of $121,425 (US). Demonstrates effectiveness and cost-effectiveness of Australian replication of HELP Program. Internal Medicine Journal 2007;37:95-100
In 2008, Centers for Medicare and Medicaid Services (CMS) implemented payment changes designed to encourage the prevention of life-threatening conditions acquired by hospitalized patients, including hospital falls and trauma. Their inclusion in the initiative implies that falls occur as the result of lapses in the health care system delivery and that they can be reasonably prevented through the application of evidenced-based guideline. However, unlike other conditions selected by CMS, falls and injuries can occur even when hospitals provide the best possible care. Furthermore, efforts to prevent falls may result in unintended, negative consequences such as increased restraint use. New England Journal of Medicine 2009;360:2390-93

The Hospital Elder Life Program: Background and Overview

A Power Point Presentation covering the hazards of hospitalization for older people, delirium as a quality indicator and the effectiveness of the Hospital Elder Life Program in preventing delirium.

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advanced Welcome Older Adults/Caregivers For Clinicians The HELP Program HELP Goals HELP Background Geriatric Team Core Interventions Volunteer Staff Starting a Program Key References Building Local Support Challenges Testimonials Business Tools HELP News FAQ CAM Bibliography Registered HELP Sites Become a HELP Site How to use this Site Print this Page Contact Us The HELP Team Glossary
		Background Research and Outcomes The Hospital Elder Life Program was tested in a clinical trial, the Yale Delirium Prevention Trial. The interventions were proven successful using a multi-component strategy to prevent delirium in hospitalized older patients. In the Yale Delirium Prevention Trial, eight hundred and fifty-two older patients (70+) were enrolled, half received the HELP intervention, while the remainder received usual hospital care. HELP interventions were implemented by an interdisciplinary team (see Geriatric Team), and a complement of trained volunteers (see Volunteer Staff ). The intervention resulted in: A significant reduction in the development of delirium (9.9% of intervention patients vs. 15% of usual care patients, odds ratio = 0.60, P=0.02). New England Journal of Medicine 1999;340:669-76 A significant reduction in total number of days with delirium (105 vs. 161 in usual care, P=0.02). A significant reduction in total number of delirium episodes (62 vs. 90 in usual care, P=0.03). A significant reduction in functional decline (14% in intervention patients vs. 33% in usual care patients). Journal of the American Geriatrics Society 2000;48:1697-1706 A reduction in use and costs of hospital services. The program was demonstrated to be cost effective for the 73% of intervention patients who were at intermediate risk of developing delirium. The costs of implementing the program were offset by the cost savings from the program. Medical Care 2001;39:740-752 A dose-response relationship between adherence with the interventions and delirium reduction. Higher levels of adherence resulted in reduced rates of delirium in a directly graded fashion. Archives of Internal Medicine 2003;163:958-964 A reduction in use of long-term nursing home services. Intervention was associated with a 15.7% decrease in long-term nursing home costs, and average savings of $9446 per long-term nursing home patient. Journal of the American Geriatrics Society. 2005;52:405-409 The Hospital Elder Life Program (HELP) was created by Professor Sharon K. Inouye, M.D., M.P.H., at Yale University School of Medicine. Documented in the above publications, beneficial outcomes and cost-effectiveness were demonstrated for the HELP model. Since 2001, the Yale University team has focused on dissemination of the HELP model to other hospitals nationally and internationally. Research and articles related to HELP Dissemination Sites: Cross-sectional survey of 13 HELP sites. Describes real-world implementation, adaptations, successes and insights for program implementation. Journal of the American Geriatrics Society 2006;54:1492-1499 A pretest-posttest quality improvement study evaluating the replication of HELP in a community hospital. Delirium rate decreased by 14.4% (35.3% relative risk reduction), P=.002. Total costs reduced by $1.25 million over one year. High rate of nursing and family satisfaction. Journal of the American Geriatrics Society 2006;54:969-974 Two before-after studies examining HELP effectiveness. Demonstrated lower delirium incidence (6% vs 38%, P=.03) and lower severity. Decreased use of nursing assistants with HELP, with overall cost savings of $121,425 (US). Demonstrates effectiveness and cost-effectiveness of Australian replication of HELP Program. Internal Medicine Journal 2007;37:95-100 In 2008, Centers for Medicare and Medicaid Services (CMS) implemented payment changes designed to encourage the prevention of life-threatening conditions acquired by hospitalized patients, including hospital falls and trauma. Their inclusion in the initiative implies that falls occur as the result of lapses in the health care system delivery and that they can be reasonably prevented through the application of evidenced-based guideline. However, unlike other conditions selected by CMS, falls and injuries can occur even when hospitals provide the best possible care. Furthermore, efforts to prevent falls may result in unintended, negative consequences such as increased restraint use. New England Journal of Medicine 2009;360:2390-93 The Hospital Elder Life Program: Background and Overview A Power Point Presentation covering the hazards of hospitalization for older people, delirium as a quality indicator and the effectiveness of the Hospital Elder Life Program in preventing delirium.