Inclusion criteria for the Hospital Elder Life Program | |
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Age 70 years and older | |
At least one risk factor for cognitive or functional decline. Risk factors include: | |
Cognitive impairment | |
Any mobility or activity of daily living impairment | |
Vision impairment | |
Hearing impairment | |
Dehydration | |
Able to communicate verbally or in writing. Nonverbal patients who can communicate in writing are included. | |
Interventions to prevent delirium | |
Risk factor | Preventative intervention* |
Cognitive impairment | • Orientation board with names of care team members and daily schedule |
• Orienting communication | |
• Cognitive stimulation activities three times daily (e.g. discussion of current events, reminiscence, word games) | |
Sleep deprivation | • Non-pharmacologic sleep protocol at bedtime: |
○ Warm drink (milk or herbal tea) | |
○ Relaxation tapes or music | |
○ Back massage | |
• Unit-wide noise reduction strategies (e.g. quiet hallways) | |
• Schedule readjustments to allow uninterrupted sleep (e.g. rescheduling of medications and procedures) | |
Immobility | • Ambulation or active range-of-motion exercises three times daily |
• Minimizing immobilizing equipment (e.g., bladder catheters, physical restraints) | |
Vision impairment | • Visual aids (e.g. glasses or magnifying lenses) |
• Adaptive equipment (e.g. large illuminated telephone keypads, large print books, fluorescent tape on call bell) | |
• Daily reinforcement of their use | |
Hearing impairment | • Portable amplifying devises and special communication techniques |
• Daily reinforcement of these adaptations | |
• Earwax dis-impaction as needed | |
Dehydration | • Early recognition of dehydration and oral volume repletion (i.e. encouragement of oral intake of fluids) |
• Feeding assistance and encouragement during meals |