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Going to the hospital? HELP is on the way

You can take measures to keep yourself or a loved one from becoming confused and disoriented during hospitalization.

HELP hospital delirium
Arranging for support from family and friends is one of the most important things you can do when planning a hospital stay.
Image: monkeybusinessimages/Thinkstock

During hospital stays, about half of people over 65 have episodes of delirium (a sudden change in mental status), according to several major studies. Those who do are at increased risk for developing cognitive impairment and dementia after their release.

It’s easy to understand why hospitalization can be disorienting—even if you are young and generally healthy. Your daily routine is overturned, you are introduced to a stream of new caregivers, and it’s hard to sleep through the night. Anesthetics or sedative medications can also affect your mental state. As we age, it becomes even more difficult to adapt to sudden disruptions.

Decades ago Dr. Sharon Inouye, professor of medicine at Harvard Medical School, recognized that delirium in older patients isn’t an inevitable consequence of hospitalization. She and her colleagues pinpointed factors that increase the risk that a hospital patient will develop delirium, developed a method of identifying those who are at greatest risk, and tested measures to prevent delirium. They designed a delirium-prevention program—the Hospital Elder Life Program (HELP)—based on the strategies proven to be effective in clinical trials.

HELP during hospitalization

HELP involves identifying patients at risk for delirium when they enter the hospital and designating them to receive special care to minimize six major risk factors associated with delirium—cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration. Studies have shown that HELP is associated with significant reductions in the percentage of patients who develop delirium, fall while hospitalized, experience mental or physical declines, or require nursing home care.

HELP is available in 200 hospitals in the United States. If you or a loved one is scheduled for a hospital stay, ask whether your hospital has HELP or another program for preventing delirium. If not, there are several things you can do as a patient or caregiver, Dr. Inouye says. They include many of the measures incorporated in HELP, such as the following:

Assemble your records. Prepare a “medical information sheet” listing all your allergies, the names and phone numbers of your physicians, your usual pharmacy, all your medical conditions, and all the drugs you take—both prescription and over-the-counter. Also, be sure all your pertinent medical records are forwarded to the doctors who will be caring for you.

Bring the essentials. You’ll need your glasses, hearing aids and fresh batteries, and dentures. You’ll do better if you can see, hear, and eat.

Learn what else you can bring. If the hospital allows, bring a few familiar things like family photos, a good book, or an MP3 player with your favorite music or relaxation exercises.

Set up a support team. Arrange for relatives and friends to visit you regularly during your stay.

Spread the word. Give the hospital feedback, both during the hospital stay and after discharge. Be sure to fill out the patient satisfaction survey you will receive shortly after your discharge. You might also let your physicians know about HELP if it wasn’t available to you. You can find more information about HELP at the program’s website, .

How can you help

To help a hospitalized loved one, try the following:

  • Keep communication simple. In a calm reassuring voice, state one fact at a time. Do not overwhelm or overstimulate the person.

  • Help orient the person. If necessary, remind your loved one where he or she is and why.

  • Try a hands-on approach. Gently massage or stroke the person if he or she finds that soothing.

  • Be a companion. Stay with the hospitalized person as much as possible. Arrange with family and friends to visit in shifts so someone can be present around the clock, if necessary.

  • Work with the staff. If allowed, encourage the person to eat, hydrate, and participate in rehabilitation therapy. If you can, accompany him or her on walks down the hospital corridor.

  • Be vigilant. If you detect new signs of possible delirium—confusion, memory problems, personality changes—discuss them with the nurses or physicians as soon as you can. Family and friends are often the first to notice subtle changes.

Posted by: Dr.Health

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