Family-involved interventions reduce postoperative delirium


Background: Postoperative delirium is common in older patients undergoing surgery and often leads to complications including longer length of stay (LOS), increased mortality, functional decline, and dementia. The volunteer-based Hospital Elder Life Program (HELP) is one of the most widely implemented prevention tools to reduce POD; however, different cultures may not use volunteers in their hospital systems.

Study design: Randomized clinical trial.

Setting: West China Hospital in Chengdu.

Synopsis: This Chinese-based clinical trial evaluated 281 patients aged 70 years or older who underwent elective surgery and were randomized to either t-HELP units or usual-care units. t-HELP patients received three universal protocols that included family-driven interventions of orientation, therapeutic activities, and early mobilization protocols, as well as targeted protocols based on delirium risk factors, while control participants received usual nursing care. The incidence of POD was significantly reduced in the t-HELP group, compared with the control group (2.6% vs. 19.4%), which was also associated with a shorter LOS. Patients were also noted to have less cognitive and functional decline that was sustained after discharge.

Bottom line: For hospitals that do not use volunteers in delirium prevention, involving family appears to be effective in reducing POD and maintaining physical and cognitive function post operatively.

Citation: Wang YY et al. Effect of the Tailored, Family-Involved Hospital Elder Life Program on postoperative delirium and function in older adults: A randomized clinical trial. JAMA Intern Med. 2019 Oct 21. doi: 10.1001/jamainternmed.2019.4446.

Dr. Ciarkowski is a hospitalist and clinical instructor of medicine at the University of Utah, Salt Lake City.

Recommended Reading

Risk associated with perioperative atrial fibrillation
The Hospitalist
Complications and death within 30 days after noncardiac surgery
The Hospitalist
A standardized approach to postop management of DOACs in AFib
The Hospitalist
Limiting antibiotic therapy after surgical drainage for native joint bacterial arthritis
The Hospitalist
Cardiac rehab after cardiac valve surgery associated with reduced mortality
The Hospitalist
   Comments ()