By 2030, one in every 8 persons is expected to be age 65 or over [1,2]. Hospitals must be prepared to care for this population and minimize their complications from hospitalization as they make up almost half of all days of hospital care. One of the largest risk factors the elderly face during hospitalization is delirium. Delirium is defined by the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an acute disturbance in attention and awareness and cognition that is not better explained by a pre-existing condition . One episode of delirium can worsen functional abilities and decrease quality of life with effects lasting long after the episode has occurred.
The California Pacific Medical Center (CPMC) in San Francisco, CA, a 784 bed teaching hospital, reviewed 3 years of data, on approximately 5,000 patients from 2014-2016, to analyze the impact of the Hospital Elder Life Program (HELP), an international volunteer-centered geriatric intervention program. The primary goal was to assess impact on 30-day hospital readmissions on the 70yo and over, population. Data was also reviewed for impact on length of stay, discharge to home, and falls. Additional analysis was done on sub-categorization of age: by breaking the age groups into 70-85 and 85+ to see if the oldest old had different outcomes than the younger elderly population. This study was published in Archives of Gerontology and Geriatrics in November 2019.
The study noted that there was statistically significant benefit in the HELP population for 30-day readmission and average length of stay. And while fall rates and discharge to home rates were better in HELP vs. non-HELP, the p-value was >0.05. The 30-day readmission rate was 11.3% in the overall 70+ HELP population vs 13.5% in the non-HELP population. This was primarily from the impact on the 70-85 population, where HELP and non-HELP readmission rates were respectively 9.9% and 12.8%. HELP interventions improved ALOS across every subset of geriatric age. In the overall 70+ population, HELP ALOS was 5.6 compared to 6.2 for non-HELP. In the 70-85 group HELP ALOS was 5.7 and non-HELP was 6.3. In the very old, the difference was still statistically significant; 5.42 to 6. The data also looked at discharges to home and changes in fall rate. While showing improvements in these measures, they were not statistically significant in those two goals.
Some study limitations included large subgroups of “other” in race and language and lack of risk-adjustment for readmission risk, initiates on individual hospital floors and involvement in other teams such as case management and physical therapy. Additionally, although the study used propensity scoring, it did not use a comorbidity index.
Since this study, CPMC has continued to review the impact of HELP on older hospitalized patients. The same parameters of the study were extended to the end of 2018 and HELP continued to see statistically significant benefit in readmissions and average length of stays. For 2017 and 2018, HELP 30 day readmission rate was 9.2% and non-HELP was 15.6%. ALOS HELP was 5.2 days and non-HELP were 5.7 for the same period. Again, the majority of this benefit was in the 70-85 yo population with no statistical significance in readmission rates for the over 85.
Post-study impressions of 5 years of data for HELP are convincing in both patient days saved in the hospital and associated costs. Cost savings in average 30-day readmission rates in the 65+ population were $13,333 per patient in 2015, or ~$1.51M for our intervention group over 5 years [4-7]. Cost savings for reduction in length of stays were $7.2Mat a Medicare based cost per day of $2535.62 [4-6].