Hospital Elder Life Program in Long-Term Care (HELP-LTC): A Cluster Randomized Controlled Trial

Area of Science:

• Gerontology
• Geriatric Medicine
• Nursing Home Care

Background:

• The Hospital Elder Life Program (HELP) is effective in preventing delirium in hospitalized older adults.
• Adapting HELP for long-term care (HELP-LTC) aimed to reduce delirium risk factors like cognitive impairment, immobility, dehydration, and malnutrition in nursing home residents.

Purpose of the Study:

• To evaluate the efficacy of the HELP-LTC intervention in preventing delirium among long-term care residents.
• To assess the impact of HELP-LTC on delirium severity and hospitalization rates.

Main Methods:

• A cluster randomized controlled trial was conducted in a 514-bed academic urban nursing home.
• 219 long-term residents were randomized to either HELP-LTC (n=105) or usual care (n=114).
• HELP-LTC involved daily interventions by certified nursing assistants targeting delirium risk factors and medication recommendations.

Main Results:

• The average age of participants was 81.7 years, with 65.3% being female.
• No significant differences were found in delirium incidence or severity between the HELP-LTC and usual care groups after adjusting for baseline cognitive function.
• Hospitalization rates did not differ significantly between the two groups.

Conclusions:

• The HELP-LTC intervention did not effectively prevent delirium or reduce its severity in long-term nursing home residents.
• Potential reasons for null findings include baseline cognitive differences, unexpected improvements in both groups, and adaptations to the intervention.