Title: An investigation of the Hospital Elder Life Program (HELP) system of care in NHS acute trusts to prevent delirium
Funder: Department of Health (England)

Abstract: AIMS AND OBJECTIVES Aim: To improve delirium prevention for older people admitted to NHS acute hospitals through a programme of linked projects to investigate the feasibility, acceptability, potential effectiveness and cost-effectiveness of a delirium prevention system of care. Objectives: 1. Review and adapt the Hospital Elder Life Program (HELP) for use in the UK. HELP is an existing, standardised and manualised North American multi-component system of care that has been demonstrated to prevent the development of delirium in hospitalised older patients in the USA. It is delivered by specially trained hospital staff and volunteers. 2. Identify strategies to support the implementation of HELP. 3. Determine the optimum methods to deliver HELP in routine care. 4. Conduct a feasibility study to assess the implementation and acceptability of HELP, refine the content and delivery of HELP, determine preliminary estimates of effectiveness and cost-effectiveness, assess feasibility of conducting a definitive trial and gather data to inform its design. BACKGROUND Delirium (also called acute or toxic confusion) is the most frequent complication following hospitalisation for older people. Evidence suggests it could be prevented in about one third of patients using multi-component interventions but these are not yet routinely available in the NHS. IMPORTANCE The issue of delirium has been recognised as a priority area (NSF for Older People). Delirium occurs in about a third of patients admitted to medical wards and is associated with longer lengths of stay, increased mortality, incomplete functional recovery and increased need for institutional care. NEED FOR RESEARCH There is no generalisable system of care in the UK capable of reliably preventing delirium. PAST AND CURRENT RESEARCH There has been only limited international research but multi-component prevention interventions have been associated with a reduction in delirium of about one third. WORK UNDERTAKEN We have presented HELP to local hospital voluntary services managers and have conducted workshops with local voluntary services and nurse managers, ward staff, hospital volunteers and our consumer group. The proposed new roles for staff and volunteers have been positively received. RESEARCH PLANS Project 1: Review and adapt HELP for use in the UK Using case studies in three general hospitals, we will review and adapt HELP and identify potential implementation and delivery strategies. Each case study will comprise a HELP development team and staff from an orthopaedic or elderly care ward. Project 2: Pilot to test implementation feasibility and acceptability of HELP We will use further case studies in at least three different hospitals to investigate feasibility and acceptability of HELP to provide a realistic assessment of the practical, professional and cultural issues associated with HELP implementation. Project 3: Preliminary testing of the HELP delirium prevention system of care We propose to conduct a cluster randomised, controlled, feasibility study in six centres to test for preliminary evidence of effectiveness and cost-effectiveness and to gather data to inform recruitment, appropriate outcome measure selection and sample size to design a large scale trial. RESEARCH TEAM Our research team includes national and international leaders in delirium (including the chair and members of the NICE Clinical Guideline Development Group for delirium) and elderly care research and experts in the development and evaluation of complex interventions, research to improve nursing practice, health economics, statistics, clinical trials, quantitative and qualitative research methods, workforce planning, NHS management. RESEARCH ENVIRONMENT The Academic Unit of Elderly Care & Rehabilitation, University of Leeds, is based in Bradford and has a record of more than 15 years of health services research using multi-method research designs including randomised control trials, systematic reviews and qualitative and health economic studies. We will be supported by a nationally accredited Clinical Trials & Research Unit and the pioneer of HELP in the USA. OUTPUTS AND IMPACT Our work across at least 12 NHS sites will substantially raise awareness about delirium. We will produce a transferable system of care with the potential to reduce delirium in patients admitted to hospital. PUBLIC INVOLVEMENT An existing Older People’s Forum has provided an external viewpoint for the research programme and will assist with the design and conduct of the work. ETHICAL IMPLICATIONS We will adopt ethical procedures that are consistent with our target population; ie, older people who have cognitive and physical frailty. JUSTIFICATION FOR RESOURCES REQUESTED This is a complex, mixed methods research programme to be conducted over 12 NHS sites that will require a project manager, qualitative researchers for Projects 1 and 2, research nurses/assistants for Projects 2 and 3.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH;NEUROLOGICAL