Hospital elder life program: systematic review and meta-analysis of effectiveness
Open accessAbstract
Background Delirium, defined as an acute disorder of attention and cognition with high morbidity and mortality, can be prevented by multicomponent nonpharmacological interventions. The Hospital Elder Life Program (HELP) is the original evidence-based approach targeted to delirium risk factors, which has been widely disseminated.Objective To summarize the current state of the evidence regarding HELP and to highlight its effectiveness and cost savings.Methods Systematic review of Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from 1999 to 2017, using a combination of controlled vocabulary and keyword terms.Results Of the 44 final articles included, 14 were included in the meta-analysis for effectiveness and 30 were included for examining cost savings, adherence and adaptations, role of volunteers, successes and barriers, and issues in sustainability. The results for delirium incidence, falls, length of stay, and institutionalization were pooled for meta-analyses. Overall, 14 studies demonstrated significant reductions in delirium incidence (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.37-0.59). The rate of falls was reduced by 42% among intervention patients in three comparative studies (OR 0.58, 95% CI 0.35-0.95). In nine studies on cost savings, the program saved $1600-$3800 (2018 U.S. dollars) per patient in hospital costs and over $16,000 (2018 U.S. dollars) per person-year in long-term care costs in the year following delirium. The systematic review revealed that programs were generally successful in adhering to or appropriately adapting HELP (n = 13 studies) and in finding the volunteer role to be valuable (n = 6 studies). Successes and barriers to implementation were examined in 6 studies, including ensuring effective clinician leadership, finding senior administrative champions, and shifting organizational culture. Sustainability factors were examined in 10 studies, including adapting to local circumstances, documenting positive impact and outcomes, and securing long-term funding.Conclusion The Hospital Elder Life Program is effective in reducing incidence of delirium and rate of falls, with a trend toward decreasing length of stay and preventing institutionalization. With ongoing efforts in continuous program improvement, implementation, adaptations, and sustainability, HELP has emerged as a reference standard model for improving the quality and effectiveness of hospital care for older persons worldwide.
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People with delirium without known dementia are more likely to be diagnosed with dementia in the future than others, either because of pre-existing undiagnosed dementia or cognitive impairment, present in 20.7% (95% CI 11.9-29.5) and 37.8% (27.3-88.3) respectively of one cohort, or because delirium has neurotoxic effects and so precipitates dementia.
“People with delirium without known dementia are more likely to be diagnosed with dementia in the future than others, either because of pre-existing undiagnosed dementia or cognitive impairment, present in 20·7% (95% CI 11·9–29·5) and 37·8% (27·3–88·3) respectively of one cohort, or because delirium has neurotoxic effects and so precipitates dementia.283”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [283]
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Flagged first, then by citations
Research works printed but not linked: 3
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Dementia prevention, intervention, and care: 2020 report of the Lancet Commission
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“289 The Hospital Elder Life Program 290 — an intervention to prevent delirium in those admitted to hospital—reduces delirium incidence and includes people who are cognitively impaired.”
RetractedWorld guidelines for falls prevention and management for older adults: a global initiative
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- Authors
- Hshieh, T. T., Yang, T., Gartaganis, S. L., Yue, J., & Inouye, S. K.
- Affiliations
- Brigham and Women's Hospital (US)
- Sichuan University (CN)
- Hebrew SeniorLife (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Hshieh, Tammy T.
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2018-10
- Volume
- 26
- Issue
- 10
- Pages
- 1015-1033
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC6362826
- OpenAlex
- W2809845899
- Cited by
- 466
- References
- 52
- Citations by year
- 2026: 59 · 2025: 67 · 2024: 81 · 2023: 64 · 2022: 63 · 2021: 52 · 2020: 44 · 2019: 30 · 2018: 6
- FWCI
- 5.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (K07AG041835, R24AG054259)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- delirium prevention, hospitalized older adults, falls, length of hospital stay, institutionalization, cost reduction, program implementation, program sustainability, volunteer roles, non-pharmacological treatment, organizational culture change, clinician leadership, long-term care costs
- MeSH terms
- Accidental Falls, Aged, Aged, 80 and over, Cost-Benefit Analysis, Delirium, Hospitalization, Humans, Outcome and Process Assessment, Health Care, Program Evaluation, Program Development
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