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Table 4 The Hospital Elder Life Program (HELP)

From: Developing and implementing an integrated delirium prevention system of care: a theory driven, participatory research study

Inclusion criteria for the Hospital Elder Life Program
Age 70 years and older
At least one risk factor for cognitive or functional decline. Risk factors include:
Cognitive impairment
Any mobility or activity of daily living impairment
Vision impairment
Hearing impairment
Able to communicate verbally or in writing. Nonverbal patients who can communicate in writing are included.
Interventions to prevent delirium
Risk factor Preventative intervention*
Cognitive impairment • Orientation board with names of care team members and daily schedule
• Orienting communication
• Cognitive stimulation activities three times daily (e.g. discussion of current events, reminiscence, word games)
Sleep deprivation • Non-pharmacologic sleep protocol at bedtime:
Warm drink (milk or herbal tea)
Relaxation tapes or music
Back massage
• Unit-wide noise reduction strategies (e.g. quiet hallways)
• Schedule readjustments to allow uninterrupted sleep (e.g. rescheduling of medications and procedures)
Immobility • Ambulation or active range-of-motion exercises three times daily
• Minimizing immobilizing equipment (e.g., bladder catheters, physical restraints)
Vision impairment • Visual aids (e.g. glasses or magnifying lenses)
• Adaptive equipment (e.g. large illuminated telephone keypads, large print books, fluorescent tape on call bell)
• Daily reinforcement of their use
Hearing impairment • Portable amplifying devises and special communication techniques
• Daily reinforcement of these adaptations
• Earwax dis-impaction as needed
Dehydration • Early recognition of dehydration and oral volume repletion (i.e. encouragement of oral intake of fluids)
• Feeding assistance and encouragement during meals
  1. The “core” interventions to prevent delirium are supplemented by a number of clinical and educational “program interventions”.
  2. * Undertaken by Elder Life staff and volunteers.
  3. Adapted with permission from Sharon K. Inouye, M.D., MPH and the Hospital Elder Life Program, LLC.