ElderWeb

Yale researchers have designed a cost-saving program that helps prevent older patients from declining physically and mentally while hospitalized. The problem of functional and mental decline is increasingly important since patients aged 65 and older account for more than 48% of all hospital days, said Sharon Inouye, M.D., associate professor of internal medicine and geriatrics at Yale School of Medicine. She is principal investigator of the study published in the December issue of the Journal of the American Geriatric Society about the new Hospital Elder Life Program.

The Hospital Elder Life Program involves entire hospital units, provides skilled staff and trained volunteers to implement interventions for all patients, and targets interventions to specific risk factors. Under the program, patients 70 and older are screened on admission for six delirium risk factors: cognitive impairment, sleep deprivation, immobility, dehydration, vision or hearing impairment. Targeted interventions for these risk factors are implemented by an interdisciplinary team, which includes a geriatric nurse specialist, elder life specialists, trained volunteers and a geriatrician. All work closely with the primary nurses. Other experts provide consultation at twice-weekly interdisciplinary rounds.

To date, 1,507 patients have been enrolled during 1,716 hospital admissions. The overall intervention adherence rate was 90% for at least partial adherence with all interventions during 37,131 patient days.

Patients In Program vs Not In Program Who Declined 2%+ While in Hospital:

Decline Measured by: Mini-Mental State Examination (MMSE) 8% vs 26%
Decline Measured by: Activities of Daily Living (ADL) 14% vs 33%

Preliminary, unpublished results show that the program reduces overall hospital costs by $1,500 per patient. Start up costs for the program include the equivalent of 1.7 fulltime paid staff and equipment costs estimated to be about $3,000 for one or two hospital units totaling 35 to 70 beds. The figure includes an optional computer expense of $1,500 for patient enrollment, volunteer assignments, and tracking of adherence and program outcomes. The program is effective for delirium prevention and insomnia. Other benefits include providing cost effective care, gaining recognition as a center of excellence, enhancing patient satisfaction, improving community outreach, and serving as an educational site for acute geriatric care.

Co-authors of the paper include Sidney Bogardus, M.D., assistant professor of internal medicine and geriatrics and medical director of the Adler Geriatrics Assessment Center; Dorothy Baker, research scientist in the Department of Epidemiology and Public Health (EPH); Linda Leo-Summers, programmer-analyst, EPH, and Leo Cooney, M.D., professor and section chief, general internal medicine. The study was funded by the National Institute on Aging, The Commonwealth Fund, the Retirement Research Foundation, the Community Foundation for Greater New Haven and the Yale New Haven Hospital Auxiliary.