Over the past five years, Dr. Inouye and her colleagues have developed a comprehensive program aimed at helping elderly patients maintain their grip on reality. There, a team of Elder Life specialists, trained volunteers, and geriatric nurse specialists intervene with patients to make the strange, sterile hospital environment as familiar and normal as possible. Geriatricians, nurses, physical therapists, chaplains, dietitians, pharmacists, and recreational therapists support the effort. Most of the program's interventions are amazingly simple and yet they subtly change the whole hospital culture. Instead of handing patients who can't sleep a sleeping pill, the Elder Life team will offer a cup of herbal tea or warm milk, relaxation tapes and soothing music, or a back massage.
Nurses keep the ward quiet at night by using vibrating beepers and silent pill crushers.
And volunteers engage patients' minds by talking about current events, playing word games, and coaxing them to share their life stories. Because immobility puts patients at increased risk of delirium, the team does everything it can to keep patients moving. Bladder catheters and other devices that hamper movement are removed as soon as possible and volunteers help patients walk the floors. The results have been significant. In a randomized clinical trial of 852 patients, Dr. Inouye and her colleagues compared delirium rates in elders enrolled in the program with those who got standard nursing care in another ward of the hospital.