Browsing by Author "Lai, I-Rue"

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Development and Evaluation of a Modified Hospital Elder Life Program
(2012-03-01)
Chen, Cheryl Chia-Hui
;
Chen, Chiung-Nien
;
Lai, I-Rue
;
Huang, Guan-Hua
;
統計學研究所
Background: Older hospitalized patients often experience geriatric syndromes that may be prevented using complex interventions. For example, the Hospital Elder Life Program (HELP) was shown to be successful, but sites with limited resources might find HELP costly. Thus, modifying HELP to include only key components might prove more cost-effective. Objectives: The aim of this study was to develop and evaluate a modified HELP intervention derived from a conceptual model of shared geriatric risk factors for older hospitalized patients undergoing major abdominal surgery. Method: The modified HELP intervention was developed and evaluated in Taiwan, based on the UK Medical Research Council evaluation framework. According to this 4-phase framework, HELP (Phase 1) was modified based on a theoretical model of shared risk factors, and HELP's feasibility and efficacy (Phases 2 and 3) were evaluated between August 2007 and April 2009 in a preintervention and post-intervention pilot trial. Participants were 179 patients enrolled as the control (n = 77) and intervention (n = 102) groups. Results: The modified HELP intervention targeting 3 shared risk factors (cognitive, functional, and nutritional status) was developed and implemented successfully on a surgical ward. By hospital discharge, patients in the intervention group experienced significantly less risk for five geriatric syndromes: functional dependence, malnutrition, in-hospital weight loss 95%, depression, and sleep disturbance (adjusted odds ratio = 0.01-0.39; p<.05). These results were independent of patients' baseline malnutrition, education, periampullary diagnosis, and duration of surgery. Conclusions: The positive findings of this pilot trial support continued development of modified HELP. The next logical step in testing its effectiveness and long-term benefit is a randomized controlled trial.
Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery A Cluster Randomized Clinical Trial
(2017-09-01)
Chen, Cheryl Chia-Hui
;
Li, Hsiu-Ching
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Liang, Jin-Tung
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Lai, I-Rue
;
Purnomo, Jerry Dwi Trijoyo
IMPORTANCE Older patients undergoing abdominal surgery commonly experience preventable delirium, which extends their hospital length of stay (LOS). OBJECTIVE To examine whether a modified Hospital Elder Life Program (mHELP) reduces incident delirium and LOS in older patients undergoing abdominal surgery. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial of 577 eligible patients enrolled 377 older patients (>= 65 years of age) undergoing gastrectomy, pancreaticoduodenectomy, and colectomy at a 2000-bed urban medical center in Taipei, Taiwan, from August 1, 2009, through October 31, 2012. Consecutive older patients scheduled for elective abdominal surgery with expected LOS longer than 6 days were enrolled, with a recruitment rate of 65.3%. Participants were cluster randomized by room to receive the mHELP or usual care. INTERVENTIONS The intervention (implemented by an mHELP nurse) consisted of 3 protocols administered daily: orienting communication, oral and nutritional assistance, and early mobilization. Intervention group participants received all 3 mHELP protocols postoperatively, in addition to usual care, as soon as they arrived in the inpatient ward and until hospital discharge. Adherence to protocols was tracked daily. MAIN OUTCOMES AND MEASURES Presence of delirium was assessed daily by 2 trained nurses who were masked to intervention status by using the Confusion Assessment Method. Data on LOS were abstracted from the medical record. RESULTS Of 577 eligible patients, 377 (65.3%) were enrolled and randomly assigned to the mHELP (n = 197; mean [SD] age, 74.3 [5.8] years; 111 [56.4%] male) or control (n = 180; mean [SD] age, 74.8 [6.0] years; 103 [57.2%] male) group. Postoperative delirium occurred in 13 of 196 (6.6%) mHELP participants vs 27 of 179 (15.1%) control individuals, representing a relative risk of 0.44 in the mHELP group (95% CI, 0.23-0.83; P = .008). Intervention group participants received the mHELP for a median of 7 days (interquartile range, 6-10 days) and had a shorter median LOS (12.0 days) than control participants (14.0 days) (P = .04). CONCLUSIONS AND RELEVANCE For older patients undergoing abdominal surgery who received the mHELP, the odds of delirium were reduced by 56% and LOS was reduced by 2 days. Our findings support using the mHELP to advance postoperative care for older patients undergoing major abdominal surgery.
Effects of a Modified Hospital Elder Life Program on Frailty in Individuals Undergoing Major Elective Abdominal Surgery
(2014-02-01)
Chen, Cheryl Chia-Hui
;
Chen, Chiung-Nien
;
Lai, I-Rue
;
Huang, Guan-Hua
;
Saczynski, Jane S.
ObjectivesTo test the effects of a modified Hospital Elder Life Program (mHELP) on frailty. DesignMatched and unmatched analyses of data from a before-and-after study. SettingHospital, inpatient. ParticipantsParticipants aged 65 and older (n=189) undergoing major elective abdominal surgery at a medical center in Taiwan. InterventionThe mHELP included three nursing interventions: early mobilization, oral and nutritional assistance, and orienting communication. MeasurementsFrailty rate and transitions between frailty states from hospital discharge to 3months after discharge using Fried's phenotype criteria categorized as nonfrail (0 or 1 criteria present), prefrail (2 or 3 criteria present), and frail (4 or 5 criteria present). ResultsIn matched pairs, participants who received the mHELP interventions were significantly less likely to be frail at discharge (19.2%) than matched controls (65.4%) (adjusted odds ratio (AOR)=0.10, 95% CI=0.02-0.39). Transitions to states of greater frailty during hospitalization were more common for participants in the control group. Three months after discharge, participants who received the mHELP intervention during hospitalization were less likely to be frail (17.3%) than matched controls (23.1%) (AOR=0.73, 95% CI=0.21-2.56), although this difference did not achieve statistical significance. ConclusionThe mHELP intervention is effective in reducing frailty by hospital discharge, but the benefit is diminished by 3months after discharge. Thus, the mHELP provides a useful approach to manage in-hospital frailty for older adults undergoing major abdominal surgery.
Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial
(2019-05-01)
Chen, Cheryl Chia-Hui
;
Yang, Yi-Ting
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Lai, I-Rue
;
Lin, Been-Ren
;
Yang, Ching-Yao
Objective: To evaluate the effects of the modified Hospital Elder Life Program (mHELP) comprising 3 nurse-administered protocols in older patients undergoing gastrointestinal (GI) surgery. Design: Cluster randomized trial. Setting: Two 36-bed GI wards at a university-affiliated medical center in Taiwan. Participants: Older patients (>= 65 years, N = 377) were recruited if they were scheduled for elective GI surgery with an expected length of hospital stay > 6 days. After transferring to the GI ward after surgery, participants were randomly assigned to the mHELP or control group (1: 1) by room rather than individually because most patient units are double-or triple-occupancy rooms. Intervention: The mHELP protocols (early mobilization, oral and nutritional assistance, and orienting communication) were administered daily with usual care by a trained nurse until hospital discharge. The control group received usual care only. Measures: Outcomes were in-hospital nutritional decline, measured by body weight and Mini-Nutritional Assessment (MNA) scores, and Fried's frailty phenotype. Return of GI motility was examined as a potential mechanism contributing to observed outcomes. Results: Participants (mean age = 74.5 years; 56.8% male) primarily underwent colorectal (56.5%), gastric (21.2%), and pancreatobiliary (13.8%) surgery. Participants who received the mHELP [for a median of 7 days (interquartile range = 6-10 days)] had significantly lower in-hospital weight loss and decline in MNA scores (weight -2.1 vs -4.0 lb, P = .002; score -3.2 vs -4.0, P =.03) than the control group. The mHELP group also had significantly lower rates of incident frailty during hospitalization (12.0% vs 21.7%, P = .022), and persistent frailty (50.0% vs 92.9%, P = .03). Participants in the mHELP group had trends toward an accelerated return of GI motility. Conclusion and Implications: The mHELP effectively reduced nutritional decline, prevented new frailty, and promoted recovery of frailty present before admission. These nurse-administered protocols might be useful in other settings, including conditions managed at home or in nursing facilities. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.