標題: Modified Hospital Elder Life Program: Effects on Abdominal Surgery Patients
作者: Chen, Cheryl Chia-Hui
Lin, Ming-Tsan
Tien, Yu-Wen
Yen, Chung-Jen
Huang, Guan-Hua
Inouye, Sharon K.
統計學研究所
Institute of Statistics
公開日期: 1-八月-2011
摘要: 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. STUDY DESIGN: 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. (J Am Coll Surg 2011;213:245-252. (C) 2011 by the American College of Surgeons)
URI: http://dx.doi.org/10.1016/j.jamcollsurg.2011.05.004
http://hdl.handle.net/11536/20793
ISSN: 1072-7515
DOI: 10.1016/j.jamcollsurg.2011.05.004
期刊: JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
Volume: 213
Issue: 2
起始頁: 245
結束頁: 252
顯示於類別:期刊論文


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