The Hospital Elder Life Program © 2000,
Sharon K. Inouye, MD, MPH
HELP Project Planning Tool
In this section think about….
 What will the screening process at your site look like?
 Fidelity to the original inclusion and exclusion
criteria?
 What will you include in your baseline assessment ?
 Which units will you choose to start HELP on?
The Hospital Elder Life Program © 2000,
Sharon K. Inouye, MD, MPH
Where To Start…
Every patient aged 70 years and older admitted to the HELP
unit(s) is screened for enrollment into the program. The
purpose of screening is threefold.
1) First, screening helps to verify that the patient has at least
one risk factor for cognitive or functional decline that will
allow him/her to benefit from the program.
2) Second, screening verifies that the patient does not have
exclusion criteria that make interventions difficult or
inappropriate.
3) Third, the risk factors that are identified during screening
trigger specific intervention protocols by the HELP team.
The Hospital Elder Life Program © 2000,
Sharon K. Inouye, MD, MPH
Important to note…
Each patient should be screened and
enrolled within 24-48 hours of
admission or transfer to a HELP unit.
The Hospital Elder Life Program © 2000,
Sharon K. Inouye, MD, MPH
ENROLLMENT CRITERIA FOR HOSPITAL ELDER LIFE PROGRAM
PATIENTS
• Age 70 years and older and on HELP unit
• At least one risk factor for cognitive or functional decline.
Risk factors include:
• Cognitive impairment –SMMSE <24/30 (or equivalent ratio)
• Any new mobility or ADL impairment
• Vision impairment: <20/70 best corrected vision
• Hearing impairment: < 3 of 6 whispers in each earWhisper test
• Dehydration: Urea x10/Cr >0.7
• Able to communicate verbally or in writing. Nonverbal
patients who can communicate in writing are included.
The Hospital Elder Life Program © 2000,
Sharon K. Inouye, MD, MPH
Exclusion Criteria
• Coma
• Mechanical ventilation
• Aphasia (expressive and/or receptive) if communication
ability severely impaired
• Terminal condition with comfort care only, death imminent
• Combative or dangerous behavior
• Severe psychotic disorder that prevents patient from
understanding/participating in interventions
• Severe dementia (e.g., unable to communicate; SMMSE = 0).
For patients with severe impairment (SMMSE <10), decision
to enroll will be made on a case-by-case basis depending on
their ability to participate in interventions.
The Hospital Elder Life Program © 2000,
Sharon K. Inouye, MD, MPH
Exclusion Criteria
cont’d
• Airborne precautions (e.g., tuberculosis).
• Neutropenic precautions
• Discharge firmly anticipated within 48 hours of
admission
• Refusal by patient, family member (if patient is
incompetent), or Physician
The Hospital Elder Life Program © 2000,
Sharon K. Inouye, MD, MPH
Staff Frequently Request
 Palliative
 ALC
 Delirious on admission
 Admitted for over 48 hours
 Under age 70
 Language barrier
The Hospital Elder Life Program © 2000,
Sharon K. Inouye, MD, MPH
Case Scenario #1
 84-year old lady, living in a retirement home (RH) for past 8 years
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following a stroke. She has Type II Diabetes and hypertension
Active in her RH, using her walker, a little more forgetful and
repetitive, and this has been progressive. Uses bilateral hearing aids,
and bifocals.
Came into ER after being found on the floor in her RH. C/O chest
and abdominal pain
In the ER, she is disoriented to time and place,
and repeating herself often. Staff need to
speak slowly and repeat instructions often.
Family state that is how she is at home.
The Hospital Elder Life Program © 2000,
Sharon K. Inouye, MD, MPH
Case Scenario #2
 83-year old lady living alone
 PMHx – CHF, HTN, Glaucoma, MCI
 Patient fell in the night.
 Found by daughter 12 hours later
 In ER – x-ray shows fractured right femur, made NPO for
surgery – no time scheduled yet – morphine, Gravol,
Ativan ordered.
 Report from ER states that patient has been disoriented
to time/person/place – pulled out IV, patient had trouble
focusing and was inconsistent with following commands.
The Hospital Elder Life Program © 2000, Sharon
K. Inouye, MD, MPH
Case Scenario #2
cont’d
 Alternates between being very restless, attempting to
climb out of bed and being very lethargic
 Urine tested positive for e-coli, relevant labs include:
elevated WBC, elevated urea and creatinine
 Report from family – patient was managing well at home –
independent with ADLs and family assisting with IADLs
 Family state that patient is saying strange things (i.e. “why
is it so busy in this mall?”). At times she does not make
sense, and rambles in conversation.
The Hospital Elder Life Program © 2000, Sharon
K. Inouye, MD, MPH
SCREENING PROCEDURE
1. ELS reviews patient list on HELP
units
2. Chart Review
3. HELP Program Description and
Patient Consent
4. Baseline Assessment
The Hospital Elder Life Program © 2000, Sharon
K. Inouye, MD, MPH
The Hospital Elder Life Program © 2000, Sharon
K. Inouye, MD, MPH
Sample Assignment Sheet
The Hospital Elder Life Program © 2000,
Sharon K. Inouye, MD, MPH
Alternative to Screening
HELP Referral Process
 Growth of the program may require a built-in referral
system to allow the units to identify those at risk and
increase efficiency
 HHS is in process of rolling out a Meditech Referral
The Hospital Elder Life Program © 2000, Sharon
K. Inouye, MD, MPH
The Hospital Elder Life Program © 2000, Sharon
K. Inouye, MD, MPH
Where to Start
 Identify unit
 Estimate eligible pt numbers using decision support
data (over 70, with risk factors , greater than 48 hours
LOS )
 Recruit and build volunteers to meet need
 Prioritize who to serve
The Hospital Elder Life Program © 2000,
Sharon K. Inouye, MD, MPH