Modified Intervention Program can Help Prevent Postoperative Delirium in Older Patients

In older patients, major surgery can increase the risk of postoperative delirium. An intervention program called modified Hospital Elder Life Program reduced the risk.

Older patients who undergo major abdominal surgery are likely to experience delirium. An intervention that includes nutritional assistance and early mobilization can prevent delirium and reduce the duration of hospital stay, according to a new study.

Older patients who experience preventable delirium, which extends their hospital length of stay (LOS). The study published in JAMA Surgery found that implementing effective interventions to prevent delirium and reduce LOS is a clinical priority. Guan-Hua Huang, Ph.D., of National Chiao Tung University, Hsinchu, Taiwan, and colleagues randomly assigned 377 patients (65 years of age or older) undergoing abdominal surgery for a malignant tumor to an intervention (n = 197) or usual care (n = 180).

Delirium is a Deadly Threat to Long-Term Care Residents
It is unclear whether delirium causes deterioration in brain that can result in premature death, or if it is a symptom indicating a mind and body already in decline.

‘The intervention program called modified Hospital Elder Life Program (mHELP) helps prevent the risk of delirium and reduce hospital length of stay for older patients.’

The intervention, modified Hospital Elder Life Program (mHELP), consisted of three protocols administered daily by a nurse: orienting communication (such as inquiring about the information in the context of the present day to reinforce orientation); oral (including brushing teeth) and nutritional assistance; and early mobilization. Intervention group participants received all three mHELP protocols postoperatively, in addition to usual care, as soon as they arrived in the inpatient ward and until hospital discharge.

Postoperative delirium occurred in 6.6 percent of mHELP participants vs 15.1 percent of control individuals (odds of delirium reduced by 56 percent). Intervention group participants received the mHELP for a median of 7 days, and they had a median LOS that was two days shorter (12 vs 14 days).

Several limitations of the study are noted in the article, including that data on postoperative complications were not collected, which are important risk factors for delirium and might have also been affected by mHELP and contributed to the study findings.

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Elderly surgical patients are more likely to suffer from debilitating post-operative delirium if they have diabetes, undergo longer surgery or respond poorly to stress.

"The key to the effectiveness of the 3 mHELP components is their consistent and daily application, with high adherence rates. Medical centers that want to advance postoperative care for older patients might consider mHELP as a highly effective starting point for delirium prevention," the authors write.

Source-Eurekalert

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