- A tailored hospital elder life programme that involves family (t-HELP) reduced the risk for postoperative delirium in older adults by 86%.
Why this matters
- Postoperative delirium is associated with declines in cognitive function.
- Incidence of postoperative delirium: 2.6% with intervention vs 19.4% with usual care (relative risk, 0.14; 95% CI, 0.05-0.38).
- Only 5.9 patients needed to be treated to prevent 1 case of postoperative delirium.
- At discharge, vs usual care, intervention yielded:
- Less decline in activities of daily living (median, −5 vs −20; P<.001>
- Less decline in instrumental activities of daily living (median, −2 vs −4; P<.001>
- Lower incidence of decline in cognitive function on Short Portable Mental Status Questionnaire (level 1, 0.8% vs 7.0%; P=.009).
- Chinese cluster–randomised controlled trial on 6 surgical floors.
- 281 patients randomly assigned to nursing units providing intervention or usual care.
- Intervention: 7 days, with family involvement in 3 universal protocols (orientation, therapeutic activities, early mobilisation)+8 targeted protocols tailored to delirium-related risk factors.
- Main outcome: postoperative delirium (Confusion Assessment Method).
- Funding: National Key Research and Development Program of the Ministry of Science and Technology of China; others.
- Possible compromise of blinding.
- Unknown generalisability.
- Long-term benefits not assessed.