title: Modified hospital elder life program: effects on abdominal surgery patients.
abstract: BACKGROUND
  Postsurgical functional decline is common in older patients and can lead to frailty and increased mortality. Comprehensive interventions such as the Hospital Elder Life Program (HELP) have been shown to be effective, but modifying the HELP to include only 3 key interventions might prove cost-effective for surgical patients.
  
  
  METHODS
  Consecutive patients from August 2007 through April 2009 (n = 179) were enrolled if they had undergone common elective abdominal surgical procedures, such as gastrectomy, cholecystectomy, and Whipple surgery. A modified HELP intervention consisting of early mobilization, nutritional assistance, and therapeutic (cognitive) activities implemented by a trained nurse was introduced on a surgical ward in May 2008. Patients enrolled before May 2008 received usual care and served as controls (n = 77). Those enrolled after the modified HELP intervention constituted the experimental group (n = 102). Changes in performance of activities of daily living, nutritional status, and cognitive function between admission and discharge were the primary end points.
  
  
  RESULTS
  Independent of baseline functions, education, periampullary diagnosis, comorbidity, surgical procedure, and duration of surgery, patients in the HELP group declined significantly less on activities of daily living performance and nutritional status (p < 0.001) than controls. The delirium rate was also significantly lower in the HELP group (0%) than in the control group (16.7%) (p < 0.001).
  
  
  CONCLUSIONS
  The modified HELP intervention effectively reduced older surgical patients' functional decline and delirium rates by hospital discharge. This program, conducted by a trained nurse, was not costly but did require commitment and ongoing cooperation between physician and nursing leadership to achieve compliance with the protocols.
authors.affiliation: Department of Nursing, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan. cherylchen@ntu.edu.tw
authors.forename: Cheryl Chia-Hui
authors.initials: CC
authors.lastname: Chen
authors.forename: Ming-Tsan
authors.initials: MT
authors.lastname: Lin
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Tien
authors.forename: Chung-Jen
authors.initials: CJ
authors.lastname: Yen
authors.forename: Guan-Hua
authors.initials: GH
authors.lastname: Huang
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000203:Activities of Daily Living; D000368:Aged; D003071:Cognition; D003693:Delirium / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D018529:Nutritional Support / Q000451:nursing; D011182:Postoperative Care / Q000451:nursing; D011183:Postoperative Complications / Q000451:nursing / Q000517:prevention & control*