HELP program brings real results
The year−old Hospital Elder Life Program at Northumberland Hills Hospital is one where the results can be seen, the hospital board heard at its April meeting.
It's a comprehensive program designed to prevent delirium and functional decline in older patients, based on a 20−year−old Yale study that demonstrated both clinical effectiveness and cost−effectiveness through lower resource use during hospitalization, clinical nurse specialist Bev Ryan−James said. "A year ago tomorrow, the first person was enrolled," Ryan−James added, and the process has improved the geriatric skills of staff throughout the hospital.
Target patients would be over the age of 70 with a length of hospital stay exceeding two days.
"Through daily interventions, the goal is to maintain physical and cognitive functioning to maximize independence at discharge, and assist with an appropriate discharge from hospital to home or other discharge setting," she said.
The interventions are daily visits to assess the physical and cognitive situation, with therapeutic activities as needed.
A few standard practices are observed, such as early mobilization. After all, Ryan-James said, studies have shown that the more quickly a patient gets moving, the better the outcome.
Sleep is encouraged through a non−pharmacological protocol.Hearing and vision are assessed. With the family's help, they can replace ill−fitting hearing aids or dentures or glasses made from outdated prescriptions. Specific activities might include providing someone with a daily newspaper, encouraging the resumption of old hobbies, scheduling phone calls and letters to keep up old friendships, offering frequent small snacks for someone who seems undernourished or scheduling daily tea time for someone who seems dehydrated.
It's a positive experience for the patient, who gets lots of attention, encouragement and support on a daily basis.
Of the first year's participants, 75% were over the age of 80. As well, 75% came into the hospital from their own home, and 75% already had an existing dementia. Some 90% had a documented history of cardiovascular disease, which is one of the key risk factors for developing dementia, and 25% had a mental−health issue.
With more than 150 participants to date who have been involved in the program in varying time frames from one day to five or six months, they have seen an 80% decrease in the use of geri chairs and a significant decrease in what Ryan−James termed responsive behaviours − a general term for unfavourable responses, including violence.
Last March, there would be an average of seven violence reports a month. That figure fell to two by September, and remained at two in December.
Participants tend to maintain or improve their cognitive skills and see an early resolution of deliria, with increased orientation within a day or two (it used to take about 45 days to see progress, Ryan−James said). There is a decreased use of chemical and physical restraints.
There are people who, a year and a half ago, would have been in a geri chair in a nursing station were playing cares and puzzles and walking in the halls and eating and drinking much more independently," she said.
"A lot of patients who weren't doing well when they came in, and some had completely lost their independence. When they left, many were functioning at 50% to 75% of their capacity."
The program relies on volunteers, she noted, and more are always needed. Their existing volunteers rage in age from 15 to the early 80s − "people who are interested in being involved with others. One young girl who wants to be a nurse comes down from Courtice every other Saturday and spends three hours. Her older sister, who is in university, spends four hours a day with us over Christmas and March break.
"These are people who want to do something they feel is meaningful and want to interact with people."
A 32−hour training course is provided, followed by shadowing. If someone would like further training or shadowing time, that is provided."
The on−ramp for volunteering is through the hospital website, where there is contact information.
This story appears in the May 17, 2012 edition of Northumberland Today - see www.northumberlandtoday.com - written by Cecilia Nasmith and is reprinted with permission from Northumberland Today.
The HELP program at Northumberland Hills Hospital is funded by the Central East LHIN and is a model for similar programs available in other Central East LHIN hospitals and across the province. For more information on these and other Central East LHIN programs that support seniors, please visit the "Get Connected with Care" and the "Behavioural Supports Ontario" pages on this website.