June 22, 2018
by Sandra Gordon for ASA
At the University of Utah Hospital in Salt Lake City, which is comprised of four hospitals staffed by 5,000 health care professionals, 40 trained Hospital Elder Life Program (HELP) volunteers are responsible for implementing the hospital’s HELP/Elder Life program. The program accepts 500 screened patients per year who are 70 years and older and who anticipate spending at least two days in the hospital.
Implementing a modified HELP program has been shown in a cluster of randomized trials to reduce the incidence of delirium by 56 percent and length of stay by two days in patients undergoing major abdominal surgery.
“Our volunteers are the real workforce at the bedside and the heart and soul of the program,” says Mark A. Supiano, M.D., a geriatrician and professor and chair, University of Utah Geriatrics, Supiano helped launch the program in 2008 when the cumulative delirium incidence rate at the hospital was 33 percent. Now, a decade later, it’s just 5 percent. “It’s a great outcome and why we’re so passionate about the HELP program,” Supiano says.
To administer the program and reduce the incidence of delirium at the University of Utah Hospital, Elder Life Specialist Nancy Joyce, M.S., LMT, screens patients and assigns patients to a given volunteer. Supiano and fellow geriatrician, Natalie Sanders, D.O., and Miriam Beattie, DNP, an Elder Life nurse specialist, review patient charts and make clinical recommendations about medications to avoid and other strategies to prevent delirium to the physicians caring for these patients.
Still, HELP volunteers, such as Ashley Loosle, a 23-year-old undergraduate at Brigham Young University, are key players. “If the volunteers aren’t delivering HELP protocols to the patients they’re assigned to on a given day, it doesn’t have an impact,” Supiano says. He reminds volunteers it’s akin to giving patients medication they don’t swallow.
Small Tasks with Profound Impact
“We do small things to improve patients’ health,” says Loosle, who completed two hours of online training, three days of classroom training and 12 hours of shadowing to become an Elder Life volunteer a year and a half ago.
Here’s a snapshot of what Loosle does to help prevent delirium among the four to five patients she takes care every Monday during her shift from 1:30 to 4:30 p.m. while the nursing staff works around her.
A personal touch. “I start by reading the patients’ notes to see what they like to do—whether, for example, they would like a hand massage or just talking,” Loosle says. In one patient’s chart, for example, Loosle saw that the patient had been declining Elder Life visits and hand massages even though she initially said she wanted them, but Loosle didn’t give up. “I went in and explained that hand massages are meant to help with anxiety and pain management. It’s all in how your phrase it. If I just say, ‘Hey, do you want a hand massage? Everyone will say ‘no,’” she says. For the next 40 minutes, Loosle gave the patient a hand massage while they listened to classical music. The patient ended up falling asleep. “She was happy. I won her over,” Loosle says.
Stretching the limits. If patients are able, Loosle will take them through a series of range of motion exercises that can be done sitting in a chair or in bed. Patients will go through different motions for the shoulders, elbows, wrists and knees of five, 10 or 15 repetitions. “Most patients are hesitant to do it. They think it’s physical therapy. But when I explain how easy it is and that it may be able to help them go home sooner, they’re usually willing to try it,” Loosle says.
Conversation and connection. Talking with patients is itself an intervention, especially for patients lacking visitors. “Every shift, I get a patient who doesn’t get a visitor, ever,” Loosle says. Those patients especially appreciate her visits, she says. Loosle will orient patients about the date and time and apprise them on what’s going on outside the hospital. “We have the time to spend with them and they really enjoy the extra attention,” she says.
Bonus: Career Insight
As a result of Loosle’s experience with the hospital’s HELP program, she led a survey on alumni HELP volunteers and presented it as a poster at a HELP conference day before the American Geriatric Society annual meeting in April 2018. Her survey showed that being a HELP volunteer can be a gateway to a career in medicine. In the last 10 years, at least 50 of the HELP volunteers at the University of Utah Hospital are now in medical school.
“Getting preprofessional students experience in working in Elder Life is a great way to pique their interest in caring for older adults, whether it’s in geriatric or other specialties. It may be a recruitment tool,” Supiano says. Loosle, herself, was initially considering a career in pediatrics. “Now, I want go into geriatrics,” she says.
The University of Utah Hospital is one of six Centers of Excellence nationwide that provides the HELP program for its patients.
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