The Hospital Elder Life Program: A model of care to prevent cognitive and functional decline in older hospitalized patients

OBJECTIVES: To describe the Hospital Elder Life Program, a new model of car e designed to prevent functional and cognitive decline of older persons dur ing hospitalization. PROGRAM STRUCTURE AND PROCESS: All patients aged greater than or equal to 7 0 years on specified units are screened on admission for six risk factors ( cognitive impairment, sleep deprivation, immobility, dehydration, vision or hearing impairment). Targeted interventions for these risk factors are imp lemented by an interdisciplinary team-including a geriatric nurse specialis t, Elder Lift: Specialists, trained volunteers, and geriatricians -who work closely with primary nurses. Other experts provide consultation at twice-w eekly interdisciplinary rounds. INTERVENTION: Adherence is carefully tracked. Quality assurance procedures and performance reviews are an integral part of the program. PROGRAM OUTCOMES: To date, 1507 patients have been enrolled during 1716 hos pital admissions. The overall intervention adherence rate was 89% fur at le ast partial adherence with all interventions during 37,131 patient-days. Ou r results indicate that only 8% of admissions involved patients who decline d by 2 or more points on MMSE and only 14% involved patients who declined b y 2 or more points on ADL score. Comparative results for the control group from the clinical trial were 26% and 33%, and from previous studies 14 to 5 6% and 34 to 50% for cognitive and functional decline, respectively. Effect iveness of the program for delirium prevention and of the program's nonphar macologic sleep protocol have been demonstrated previously. CONCLUSIONS: These results suggest that the Hospital Elder Life Program suc cessfully prevents cognitive and functional decline in at-risk older patien ts. The program is unique in its hospital-wide focus; in providing skilled staff and volunteers to implement interventions; and in targeting practical interventions toward evidence-based risk factors. Future studies are neede d to evaluate cost-effectiveness and long term outcomes of the program as w ell as its effectiveness in non-hospital settings.