1. Elder Life Program St. Boniface General Hospital Improving the Health of the Older Adult Focus on Prevention Barbara Tallman – Clinical Nurse Specialist- Rehab and Geriatrics David Alper – Coordinator, Elder Life Program Smriti Dewan HELP Volunteer Sylvia Scott-Wortley, daughter of an Alzheimer’s patient enrolled in HELP

2. Presentation Outline What is HELP? What is HELP? Why HELP? Why HELP? Objectives of HELP Objectives of HELP How does HELP work? How does HELP work?

3. A program to prevent a loss of physical and mental abilities in older adults during their stay in hospital A program to prevent a loss of physical and mental abilities in older adults during their stay in hospital What is HELP?

4. HELP works HELP works New England Journal of Medicine, 1999 New England Journal of Medicine, 1999 Authors: Sharon Inouye et al Authors: Sharon Inouye et al Setting: General Medical service Yale- New Haven Hospital; one intervention and 2 control units Setting: General Medical service Yale- New Haven Hospital; one intervention and 2 control units –Significantly reduced the incidence of delirium in intermediate but not high-risk patients –Significant increase in orientation scores and decrease in sedative use

5. Sensitivity of Hospital Staff to Functional Impairment

6. What is Delirium? Delirium is a sudden confused state of mind Delirium is a sudden confused state of mind

7. Patient characteristics that are risk factors: Age over 70 Age over 70 Cognitive impairment/Dementia Cognitive impairment/Dementia Severe illness Severe illness Dehydration Dehydration Infections Infections Surgery Surgery Visual or Hearing Loss Visual or Hearing Loss Difficulty walking Difficulty walking Malnutrition Malnutrition Poor Sleep patterns Poor Sleep patterns

8. What HELP do we provide? Vision problems – obtain adaptive equipment and visual aids Vision problems – obtain adaptive equipment and visual aids Hearing problems – obtain hearing aids, communication strategies Hearing problems – obtain hearing aids, communication strategies Dehydration – early recognition and encouragement drinking Dehydration – early recognition and encouragement drinking

9. What HELP do we provide? Cognitive impairment/Dementia – orientation protocol and cognitively stimulating activities Cognitive impairment/Dementia – orientation protocol and cognitively stimulating activities Sleep deprivation – encouraging sleep without the use of sleeping pills Sleep deprivation – encouraging sleep without the use of sleeping pills Walking – get patients walking as soon as possible, minimize use of restraints or immobilizing equipment Walking – get patients walking as soon as possible, minimize use of restraints or immobilizing equipment

10. Welcome to 6AS Family Medicine Unit Bienvenue à l’unité de médecine familiale 6AS Hospital Elder Life Program Programme de sensibilisation aux aînés hospitalisés Room/chambre: ________ Bed/lit: ______ My doctor/Mon médecin: ________________ Today is / aujourd’hui est________________ ____________________________________ Month / Date/ Year/ mois / date / année My nurse/Mon infirmier/ière:_____________ My other team members/Les autres membres de l’équipe: ____________________________________ ____________________________________ ____________________________________

11. Word game Behind every great man there's a… Behind every great man there's a… great woman great woman You can lead a horse to water but You can lead a horse to water but you can't… make it drink you can't… make it drink An ounce of prevention is worth a An ounce of prevention is worth a … pound of cure … pound of cure The best things in life are… free The best things in life are… free

12. Who are the members of the SBGH HELP team? Volunteers- currently about 30 Volunteers- currently about 30 SBGH Volunteer coordinator SBGH Volunteer coordinator Hospital Elder Life Coordinator - one Hospital Elder Life Coordinator - one Clinical Nurse Specialist -.5 Clinical Nurse Specialist -.5 Geriatrician- as consulted Geriatrician- as consulted Other team members: Nurses, health care aides, physiotherapists, occupational therapists, dietician, physicians Other team members: Nurses, health care aides, physiotherapists, occupational therapists, dietician, physicians

13. Elder life program: Implementation of Program Patient Assessment for risk/ Enrolment Patient Assessment for risk/ Enrolment Interventions Interventions Referrals to members of the Interdisciplinary team Referrals to members of the Interdisciplinary team Alert team members of patient care issues Alert team members of patient care issues Involvement in Interdisciplinary rounds Involvement in Interdisciplinary rounds Evaluation Evaluation

14. Process Identifying the Patient-All members of the team Identifying the Patient-All members of the team –Assessment of risk factors and predisposing factors by Elder Life Coordinator/ Clinical Nurse Specialist : Mini-Mental State Examination Mini-Mental State Examination Sleep Sleep Nutritional issues Nutritional issues Functional assessment Functional assessment Pain Pain Sensory problems (hearing and vision) Sensory problems (hearing and vision) Bladder and Bowel issues Bladder and Bowel issues –Interventions: Volunteers, Hospital Elder Life Program Coordinator Volunteers, Hospital Elder Life Program Coordinator

15. Satisfaction with Program Specific questions: Specific questions: –What was helpful with volunteers: Friendly visits and activities: 95% Friendly visits and activities: 95% Answering questions: 85% Answering questions: 85% Assisting with meals: 60% Assisting with meals: 60% Assisting with exercise and walking: 72% Assisting with exercise and walking: 72% Qualitative comments: Qualitative comments: “Program is extremely beneficial” “Staff and volunteers provide excellent care” “I was not satisfied, nobody came when I rang the bell”

16. Conclusions The elderly make up a significant proportion of our in-hospital population. The elderly make up a significant proportion of our in-hospital population. They are at higher risk of adverse events. They are at higher risk of adverse events. 50% of these are preventable. 50% of these are preventable. Practical tools are needed to assist staff in elder care – “HELP” is a promising program Practical tools are needed to assist staff in elder care – “HELP” is a promising program

17. Bibliography The Hospital Elder Life Program: A model of care to prevent cognitive and functional decline in older hospitalized patients. 2000. Inouye SK, Bogardus ST, Baker DI, Leo-Summers L, Cooney LM. Journal of the American Geriatrics Society. 48: 12 (1697-1706) The Hospital Elder Life Program: A model of care to prevent cognitive and functional decline in older hospitalized patients. 2000. Inouye SK, Bogardus ST, Baker DI, Leo-Summers L, Cooney LM. Journal of the American Geriatrics Society. 48: 12 (1697-1706) After Adoption: Sustaining the Innovation: A Case Study of Disseminating the Hospital Elder Life Program. 2005. Bradley EH, Webster TR, Baker D, Schlesinger M, Inouye SK. Journal of the American Geriatrics Society. 53: 9 (1455-61) After Adoption: Sustaining the Innovation: A Case Study of Disseminating the Hospital Elder Life Program. 2005. Bradley EH, Webster TR, Baker D, Schlesinger M, Inouye SK. Journal of the American Geriatrics Society. 53: 9 (1455-61) Dissemination of the hospital elder life program: implementation, adaptation, and successes. 2006. Inouye SK, Baker DI, Fugal P, Bradley EH. Journal of the American Geriatrics Society. 54: 10 (1492-9) Dissemination of the hospital elder life program: implementation, adaptation, and successes. 2006. Inouye SK, Baker DI, Fugal P, Bradley EH. Journal of the American Geriatrics Society. 54: 10 (1492-9) Here's HELP to prevent delirium in the hospital. 2006. Sandhaus S, Harrell F, Valenti D. Nursing. 36: 7 (60-2) Here's HELP to prevent delirium in the hospital. 2006. Sandhaus S, Harrell F, Valenti D. Nursing. 36: 7 (60-2) Replicating the Hospital Elder Life Program in a community hospital and demonstrating effectiveness using quality improvement methodology. 2006. Rubin F, Williams J, Lescisin D, Mook W, Hassan S, Inouye SK. Journal of the American Geriatrics Society. 54 (969-974) Replicating the Hospital Elder Life Program in a community hospital and demonstrating effectiveness using quality improvement methodology. 2006. Rubin F, Williams J, Lescisin D, Mook W, Hassan S, Inouye SK. Journal of the American Geriatrics Society. 54 (969-974)

18. Bibliography The roles of senior management in improving hospital experiences for frail older adults. 2006. Bradley EH, Webster TR, Schlesinger M, Baker DI, Inouye SK. Journal of Healthcare Management. 51: 5 (323-36) The roles of senior management in improving hospital experiences for frail older adults. 2006. Bradley EH, Webster TR, Schlesinger M, Baker DI, Inouye SK. Journal of Healthcare Management. 51: 5 (323-36) The meaning of acute confusional state from the perspective of elderly patients. 2002. Andersson EM, Hallberg IR, Norberg A, Edberg AK. International Journal of Geriatric Psychiatry. 17: 7 (652-663) The meaning of acute confusional state from the perspective of elderly patients. 2002. Andersson EM, Hallberg IR, Norberg A, Edberg AK. International Journal of Geriatric Psychiatry. 17: 7 (652-663) Temporary confusion: A fearful experience. 2002. Fagerberg I, Joenhagen M. Journal of Psychiatric & Mental Health Nursing. 9: 3 (339-346) Temporary confusion: A fearful experience. 2002. Fagerberg I, Joenhagen M. Journal of Psychiatric & Mental Health Nursing. 9: 3 (339-346) For more information on HELP, go to their website at: For more information on HELP, go to their website at: http://elderlife.med.yale.edu/public/public-main.php http://elderlife.med.yale.edu/public/public-main.php