JAMA Internal Medicine | Original Investigation Effect of the Tailored, Family-Involved Hospital Elder Life Program on Postoperative Delirium and Function in Older Adults A Randomized Clinical Trial Yan Yan Wang, Phil: Ji-Rong Yus, MD: Dong-Mel Xin, BSN: Patricia Carter, PhiD: Quan-Lol Li, MPH, MSN, Phoc Sarah L. Gartagents, MSW, Jig Chan, MD, PhiD: Sharon K. Inouye, MD, MPH Invited Commentary page 35 IMPORTANCE Postoperative delirium (POD) ba common condition for older adults. + Supplemental content contributing to their functional decline. OBJECTIVE To Investigate the effectiveness of the Tailored. Family-Involved Hospital Elder Life Program (t-HELP) for preventing POD and functional decline in older patients after a noncardiac surgical procedure. DESIGN, SETTING, AND PARTICIPANTS A 2-arm, parallel-group. single-blind. cluster randomized clinical trial was conducted from August 24, 2015, to February 28, 2016, on 6 surgical floors (gastric. colorectal, pancreatic, billary thoracic, and thyroid) of West China Hospital in Chengdu, China. Eligible participants (n = 281) admitted to each of the 6 surgical floors were randomized into a nursing unit providing t-HELP (intervention group) or a nursing unit providing usual care (control group). All randomized patients were included in the Intention-to treat analees for the primary outcome of POD Incidence. Statistical analysis was performed from April 3. 2016. to December 30. 2017. INTERVENTIONS In addition to receiving usual care, all participants in the intervention group received the I-HELP protocols, which addressed each patient's risk factor profile. Besides nursing professionals, family members and paid caregivers were involved in the delivery of marry of the program interventions. "UN OUTCOMES AND MEASURES The primary outcome was the incidence of POD, evaluated with the Confusion Assessment Method. Secondary outcomes Included the pattern of functional and cognitive changes (activities of daily living [ADLs]. Instrumental activities of daily living [IADLs]. short Portable Mental Status Questionnaire [SPMSQ]) from hospital admission to 30 days after discharge, and the length off hospital stay (LOS)_ RESULTS Of the 475 patients screened for eligibility. 281 (171 [60.916] male, mean [50] age 74.7 (5 7] years) were enrolled and randomized to receive t-HELP (n = 152) or usual care (n - 129). Postoperative delirium occurred in 4 participants (2 6%) in the Intervention group and in 25 (19.436) in the control group. with a relative risk of 014 (95% (1 0.05-0.38). The number needed to treat to prevent i case of POD was 5.9 (95% CJ. 4.2-11.1). Participants in the Intervention group compared with the control group showed less decline in physical function (median [interquartile range] for ADLS: -5 [-10 to 0] vs-20 [-30 to -10]: P 2 58 (38.2) 50 (38.8) APACHE II score, median (IQR) 15 (12-20) 14 (12-20) Table 3. Secondary Outcomes Between Groups, by Per-Protocol Analysis t-HELP Usual Care Variable (n = 132) (n = 115) P Value Severe delirium 2 (1.5) 11 (9.6) .008 (MDAS score 218), No. (%) Change at discharge, median (IQR) ADL -5 (-10 to 0) -20 (-30 to -10) <.0010 iadl to declined on spmsq .009b at discharge no. los mean d abbreviations: adl. activity of daily living: iadl. instrumental iqr interquartile range: length hospital stay: mdas memorial delirium assessment scale: spmsq. short portable mental status questionnaire: t-help. tailored family-involved elder life program. score o with higher scores indicating more severe defined as a statistical significance calculated pearson x test. mann-whitney counts the number errors and all are adjusted by educational level: indicate normal functioning: mild cognitive impairment moderate impairment: impairment. an unpaired t test>
