patients' mental decline in hospitals
Yale researchers have designed a cost-saving program that helps prevent older patients from declining physically and mentally while hospitalized.
The problem of functional and mental decline is increasingly important since patients aged 65 and older account for more than 48% of all hospital days, says Dr. Sharon Inouye, associate professor of internal medicine and geriatrics at the School of Medicine. She is principal investigator of the study published in the December issue of the Journal of the American Geriatric Society about the new Hospital Elder Life Program.
"Moreover, this problem is likely to grow in the future with the aging of the U.S. population," Inouye says. "Models of geriatric care designed to prevent functional decline in the acute care setting are greatly needed."
The Hospital Elder Life Program involves entire hospital units, provides skilled staff and trained volunteers to implement interventions for all patients, and targets interventions to specific risk factors.
Under the program, patients age 70 and older are screened on admission for six delirium risk factors: cognitive impairment, sleep deprivation, immobility, dehydration, vision or hearing impairment. Targeted interventions for these risk factors are implemented by an interdisciplinary team, which includes a geriatric nurse specialist, elder life specialists, trained volunteers and a geriatrician. All work closely with the primary nurses. Other experts provide consultation at twice-weekly interdisciplinary rounds.
Adherence to the recommended interventions is carefully tracked. And quality assurance procedures and performance reviews are an integral part of the program.
To date, 1,507 patients have been enrolled during 1,716 hospital admissions. The overall intervention adherence rate was 90% for at least partial adherence with all interventions during 37,131 patient days.
Among those patients enrolled in the program, 8% of the hospital admissions involved patients who declined more than 2% when assessed by the Mini-Mental State Examination (MMSE) and 14% declined more than 2% by the Activities of Daily Living (ADL) score, which measures physical disability.
In comparison, of those patients not enrolled in the program, 26% of hospital admissions involved patients who declined more than 2% by the MMSE assessment, and 33% declined more than 2% by the ADL scale.
Preliminary, unpublished results show that the program reduces overall hospital costs by $1,500 per patient. Start up costs for the program include the equivalent of 1.7 full-time paid staff and equipment costs estimated to be about $3,000 for one or two hospital units totaling 35 to 70 beds. The figure includes an optional computer expense of $1,500 for patient enrollment, volunteer assignments, and tracking of adherence and program outcomes.
Inouye says the effectiveness of the program for delirium prevention and insomnia has been demonstrated previously. Other benefits include providing cost effective care, gaining recognition as a center of excellence, enhancing patient satisfaction, improving community outreach and serving as an educational site for acute geriatric care.
Unlike other elder care programs, she says, the Hospital Elder Life Program provides skilled staff to carry out interventions and is designed to be applied throughout the hospital, making a dedicated unit unnecessary.
Co-authors of the paper include Dr. Sidney Bogardus, assistant professor of internal medicine and geriatrics and medical director of the Adler Geriatrics Assessment Center; Dorothy Baker, research scientist in the Department of Epidemiology and Public Health (EPH); Linda Leo-Summers, programmer-analyst, EPH; and Dr. Leo Cooney, professor and section chief, general internal medicine.
The study was funded by the National Institute on Aging, The Commonwealth Fund, the Retirement Research Foundation, the Community Foundation for Greater New Haven and the Yale-New Haven Hospital Auxiliary.
-- By Jacqueline Weaver
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