TY - JOUR
T1 - Hospital Elder Life Program in Long-Term Care (HELP-LTC)
T2 - A Cluster Randomized Controlled Trial
AU - Boockvar, Kenneth S.
AU - Judon, Kimberly M.
AU - Eimicke, Joseph P.
AU - Teresi, Jeanne A.
AU - Inouye, Sharon K.
N1 - Funding Information:
This study was supported by grants from the National Institute on Aging (NIA) (Grant Nos. R21AG049289 and R24AG054259). Partial support for analysis was provided by the Mount Sinai Pepper Older Americans Independence Center (NIA Grant No. 1P30AG028741). Kenneth S. Boockvar holds the Anna A. Greenwall Chair. Sharon K. Inouye holds the Milton and Shirley F. Levy Family Chair. The authors have declared no conflicts of interest for this article. Study concept and design. Boockvar, Teresi, and Inouye. Acquisition of subjects and/or data: Boockvar and Judon. Analysis and interpretation of data: Boockvar, Teresi, and Eimicke. Preparation of manuscript and final approval of the version to be published: All authors. Kenneth S. Boockvar and Jeanne A. Teresi had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The sponsor had no role in the design, methods, subject recruitment, data collection, analysis, or preparation of the article.
Funding Information:
This study was supported by grants from the National Institute on Aging (NIA) (Grant Nos. R21AG049289 and R24AG054259). Partial support for analysis was provided by the Mount Sinai Pepper Older Americans Independence Center (NIA Grant No. 1P30AG028741). Kenneth S. Boockvar holds the Anna A. Greenwall Chair. Sharon K. Inouye holds the Milton and Shirley F. Levy Family Chair.
Publisher Copyright:
© 2020 The American Geriatrics Society
PY - 2020/10/1
Y1 - 2020/10/1
N2 - BACKGROUND/OBJECTIVES: The Hospital Elder Life Program (HELP) has been shown to prevent delirium in hospitalized older adults. The objective of this study was to test the efficacy of HELP adapted to long-term care (HELP-LTC). DESIGN: Cluster randomized controlled trial. SETTING: A 514-bed academic urban nursing home. PARTICIPANTS: A total of 219 long-term nursing home residents who developed an acute illness or change in condition were randomly assigned to HELP-LTC (n = 105) or usual care (n = 114) by unit. INTERVENTION: HELP-LTC is a multicomponent intervention targeting delirium risk factors of cognitive impairment, immobility, dehydration, and malnutrition. Two certified nursing assistants (CNAs) delivered HELP-LTC components twice daily 7 days per week. In addition, recommendations were given to primary providers to reduce medications associated with delirium. MEASUREMENTS: Delirium (primary outcome) and delirium severity were ascertained each weekday by a research assistant blinded to group assignment, using the Confusion Assessment Method (CAM) and CAM severity score (CAM-S), respectively. Cognitive function was determined using the Cognitive Performance Scale (CPS). Hospitalization was ascertained by chart review. RESULTS: Participants were 81.7 years of age on average and 65.3% female. At baseline, usual care group participants had better cognitive function than intervention group participants (CPS = 1.33 vs 2.25; P =.004). Delirium symptoms declined over the course of the episode (mean CAM-S = 3.63 at start vs 3.27 at end). Overall, 33.8% of the total sample experienced incident delirium. After adjusting for baseline cognitive function, no significant differences were found in delirium or delirium severity between intervention and usual care groups. Hospitalization was not significantly different between groups. CONCLUSION: An intervention targeting delirium risk in long-term nursing home residents did not prevent delirium or reduce delirium symptoms. Baseline differences in cognitive function between groups, greater than expected improvements in both groups, quality-enhancing practices such as consistent assignments delivered to both groups, and adaptations of the intervention may have biased results toward null. J Am Geriatr Soc 68:2329–2335, 2020.
AB - BACKGROUND/OBJECTIVES: The Hospital Elder Life Program (HELP) has been shown to prevent delirium in hospitalized older adults. The objective of this study was to test the efficacy of HELP adapted to long-term care (HELP-LTC). DESIGN: Cluster randomized controlled trial. SETTING: A 514-bed academic urban nursing home. PARTICIPANTS: A total of 219 long-term nursing home residents who developed an acute illness or change in condition were randomly assigned to HELP-LTC (n = 105) or usual care (n = 114) by unit. INTERVENTION: HELP-LTC is a multicomponent intervention targeting delirium risk factors of cognitive impairment, immobility, dehydration, and malnutrition. Two certified nursing assistants (CNAs) delivered HELP-LTC components twice daily 7 days per week. In addition, recommendations were given to primary providers to reduce medications associated with delirium. MEASUREMENTS: Delirium (primary outcome) and delirium severity were ascertained each weekday by a research assistant blinded to group assignment, using the Confusion Assessment Method (CAM) and CAM severity score (CAM-S), respectively. Cognitive function was determined using the Cognitive Performance Scale (CPS). Hospitalization was ascertained by chart review. RESULTS: Participants were 81.7 years of age on average and 65.3% female. At baseline, usual care group participants had better cognitive function than intervention group participants (CPS = 1.33 vs 2.25; P =.004). Delirium symptoms declined over the course of the episode (mean CAM-S = 3.63 at start vs 3.27 at end). Overall, 33.8% of the total sample experienced incident delirium. After adjusting for baseline cognitive function, no significant differences were found in delirium or delirium severity between intervention and usual care groups. Hospitalization was not significantly different between groups. CONCLUSION: An intervention targeting delirium risk in long-term nursing home residents did not prevent delirium or reduce delirium symptoms. Baseline differences in cognitive function between groups, greater than expected improvements in both groups, quality-enhancing practices such as consistent assignments delivered to both groups, and adaptations of the intervention may have biased results toward null. J Am Geriatr Soc 68:2329–2335, 2020.
KW - delirium
KW - intervention
KW - nursing homes
KW - randomized controlled trial
UR - http://www.scopus.com/inward/record.url?scp=85088480052&partnerID=8YFLogxK
U2 - 10.1111/jgs.16695
DO - 10.1111/jgs.16695
M3 - Article
C2 - 32710658
AN - SCOPUS:85088480052
SN - 0002-8614
VL - 68
SP - 2329
EP - 2335
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 10
ER -