Modified Hospital Elder Life Program: Effects on Abdominal Surgery Patients
Modified Hospital Elder Life Program: Effects on Abdominal Surgery Patients
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DOI：
10.1016/j.jamcollsurg.2011.05.004
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发表时间：
2011-08-01
影响因子：
5.2
通讯作者：
Inouye, Sharon K.
中科院分区：
文献类型：
--
作者：
Chen, Cheryl Chia-Hui;Lin, Ming-Tsan;Inouye, Sharon K.
背景：术后功能下降在老年患者中很常见，可导致虚弱和死亡率增加。综合干预措施，如医院老年生活计划（HELP）已被证明是有效的，但修改帮助，只包括3个关键干预措施可能证明对手术患者具有成本效益。研究设计：从2007年8月至2009年4月，连续入组接受过常见选择性腹部手术（如胃切除术、胆囊切除术和惠普尔手术）的患者（n = 179）。2008年5月，一项改良的HELP干预由一名训练有素的护士实施，包括早期动员、营养援助和治疗（认知）活动。2008年5月前入组的患者接受常规护理，并作为对照组（n = 77）。经改良HELP干预后入组的为实验组（n = 102）。入院和出院期间日常生活活动表现、营养状况和认知功能的变化是主要终点。结果：与基线功能、教育程度、壶腹周围诊断、合病、手术方式和手术时间无关，HELP组患者的日常生活能力和营养状况的下降明显小于对照组（p < 0.001）。HELP组谵妄率（0%）明显低于对照组（16.7%）（p < 0.001）。结论：改良HELP干预可有效降低老年外科患者出院时的功能衰退和谵妄发生率。该项目由一名训练有素的护士进行，费用不高，但确实需要医生和护理领导之间的承诺和持续合作，以实现协议的遵守。[J]中华医学杂志，2011;21(3):245-252。(C) 2011年由美国外科医师学会发布)
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)