Development and Evaluation of a Modified Hospital Elder Life Program

Abstract

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.