HELP is on its way

Taureef Mohammed

IT WAS just after 4 pm and I was leaving the Acute Care of the Elderly ward at Grand River Hospital in Kitchener-Waterloo, Canada, when the young man gingerly walked in. He was pushing a cart stacked with some random items – newspapers, lemonade, tea, coffee, books, board games, word search books, markers – and wearing a T-shirt with the word HELP printed at the back.

It was a strange sight for me: a young man – I would learn he was an undergraduate student – gingerly pushing a cart – a cart not like the typical hospital cart stacked with drugs and other medical paraphernalia – into an acute medical ward for older people.

He told me he was a volunteer with HELP – the Hospital Elder Life Program – and he was just about to start his three-hour shift. He looked too eager to bore with further questions. But he would have seen about five patients, who were not really patients to him as he would have known nothing about their medical history or why they were admitted to hospital.

He would have ensured each patient knew the date, the time, their location. He would have pointed out the alarm bell and the phone. He would have engaged them cognitively through conversation, games, books. He might have offered them a seasonal drink – lemonade on these hot summer days – and taken them for a walk.

The following day, I had tracked down the lead of the programme at the hospital who had told me more about it. Sarah Bourbonniere is an elder life specialist, a position, she said, was made up specifically for HELP. As the lead, she was responsible for the day-to-day operations, screening patient referrals, and recruitment and co-ordination of volunteers.

First described in the US in 1993, HELP is a comprehensive, volunteer-driven programme, globally recognised as an effective intervention to prevent delirium in hospitalised patients.

Occurring more frequently in older patients, delirium is a fatal sign. An acute change in mental status – most of the time simplified as confusion, although sometimes that is too vague a description – caused by an acute illness, delirium carries a high mortality risk: about 20 per cent of people with delirium die six months later.

Nobody really knows what exactly happens in a delirious patient’s brain. We know that something is triggered and some people – for example, a person with dementia – are triggered more easily. There are no effective treatments for delirium, other than identifying and treating the trigger.

As a doctor on-call, you hope and pray not to get called about a delirious patient. But your prayers hardly get answered: some studies report rates as high as 50 per cent among hospitalised patients.

Each delirious patient costs the healthcare system thousands of dollars. In the US, delirium alone accounts for over US$180 billion in healthcare costs.

So, for everybody’s sake we need to prevent delirium, and that’s where Bourbonniere and her team of 41 volunteers, comprising mostly undergraduate students from the University of Waterloo and Wilfrid Laurier University, come in. After all, up to 40 per cent of cases of delirium are preventable!

“It is prescriptive. Each patient referred to us is visited three times per day – ideally, seven days per week. Currently, we are able to do every weekday, but only mornings on weekends.

“Because it is volunteer-driven, it is very cost effective. I have a colleague running a programme in a smaller hospital with $300 per year!”

A qualified recreational therapist, Bourbonniere visits nearby campuses quarterly, setting up a table in cafeterias, to recruit volunteers. Before starting, volunteers needed to complete 16 hours of mandatory training.

“I have been blown away by their kindness, their intelligence and dedication. There is hope for the future for sure!

“We see in HELP how little things can make a big difference.” And the research backed her up: the HELP model has been shown to lower the risk of delirium by over 50 per cent!

A few days later, on rounds, we spoke about a patient in her 80s who had dementia. “She loves HELP. The volunteers love her and she likes them too,” the nurse practitioner said.

“That’s wonderful. Ask her to keep a diary of their visits. We need to encourage her to use her brain,” the geriatrician said. If you don’t use it, you lose it – no rocket science there.

Taureef Mohammed is a graduate of UWI and a geriatric medicine fellow at Western University, Canada