delirium, HELP program, older adults, hospital readmission, medication
Background: Delirium is an acute change in mental status commonly seen in hospitalized older adults. Although the occurrence of delirium is serious and is associated with adverse outcomes, patients with delirium may be prescribed antipsychotics/benzodiazepines, which may lead to potential side effects and other complications. The Hospital Elder Life Program (HELP) is a national evidence-based program designed to prevent delirium and functional decline. Research demonstrates that HELP decreases the onset and/or length of delirium episodes, functional decline in hospitalized older adults, and readmission rates, promotes nonpharmacological interventions, and is a cost-effective method for improving outcomes.
Purpose: To evaluate 30-day readmission percentage and assess the prevalence of newly prescribed antipsychotic/benzodiazepine medication prior to discharge among HELP-enrolled patients at a large medical center.
Methods: We conducted a retrospective study of patients ≥ 65 years of age who were admitted and enrolled into 1 of the 8 HELP units in 2016 or 2017. Patient characteristics were described using basic descriptive statistics. Odds ratios were calculated as the odds of having antipsychotics/benzodiazepines prescribed at admission versus those who were not. Chi-squared tests were performed to detect statistical differences among nominal variables. A P-value less than 0.05 was deemed significant.
Results: 1400 patients (mean age: 80; range: 65–100) were enrolled into HELP. Overall, 25% (n = 355) of patients were recorded to have been readmitted within 30 days of initial discharge from a HELP unit. This number was not significantly associated with antipsychotic/benzodiazepine prescription at admission (P = 0.8575). Yet, when examining sex differences, females patients were more likely to receive a new antipsychotic/benzodiazepine prescription at admission (P < 0.0001). Similarly, having a mental illness diagnosis at the time of admission made one more likely to have antipsychotics/benzodiazepines prescribed (P < 0.0001).
Conclusion: One-quarter of patients in HELP were readmitted within 30 days of discharge. Moreover, patients enrolled in HELP with a mental illness diagnosis prior to admission were more likely to receive antipsychotic/benzodiazepine prescription at admission. Further studies could assist defining steps to decrease high-risk medications prescribed to HELP-enrolled patients with a history of mental illness.
Macias Tejada JA, Klumph M, Manansala R, Kram JJ, LeGros CR, Khan A. Hospital Elder Life Program: a retrospective quality improvement project of a delirium prevention program. J Patient Cent Res Rev. 2018;5:320-1.