Hospitals fight delirium with volunteer help

Paula Duncan saw how quickly it could happen with her father-in-law. When he was hospitalized with pneumonia at age 80, his personality changed. Almost overnight, he became aggressive and combative.

As a hospital nurse, Duncan knew that older patients sometimes become delirious. She just didn't know how common it was — or that anything could be done about it.

Now, she heads a program at Park Nicollet's Methodist Hospital that's trying to fend off these sudden, frightening bouts of confusion.

Surprisingly, it relies on a small army of volunteers and a little friendly conversation. What they discovered, Duncan says, is that a steady dose of "high touch, low tech" activities — doing crossword puzzles, reminiscing, talking about their grandchildren — can engage the minds of patients when they're most vulnerable.

And research shows it's helping elderly patients leave the hospital sooner and in better shape than their peers.

In the hospital world, it's no secret that older patients are prone to abrupt changes of behavior, Duncan says. They may seem perfectly normal at home, but once they're in the hospital, they may forget where they are, try to pull out their tubes, hallucinate.

For years, doctors and nurses tended to shrug off the problem, said Dr. Nima Desai, a staff doctor at Methodist. "It was kind of like, 'Oh, this is what happens in the hospital.' " Unlike dementia, it often clears up in a matter of days.

But in 1999, a groundbreaking study at Yale University found that delirium was far more widespread — and hazardous — than people realized, especially in intensive care units, where up to 85 percent of patients may be affected.

The causes can range from the profound to the mundane: a drug side effect, a change in routine, sleepless nights, a sense of isolation and depression. And it can complicate their treatment and recovery, as well as terrifying their families.

The study's author, Dr. Sharon Inouye, concluded that delirium was, in fact, often preventable; she came up with the Hospital Elder Life Program (HELP). Methodist, in St. Louis Park, is the first hospital in Minnesota to adopt it, said Duncan.

'Out of body' experience

Mandi Shimek, 34, is one of the purple-shirted volunteers who can be seen pushing HELP carts through the halls of Methodist. The carts are loaded with tools of the trade: puzzle books, stress balls, lens cleaners and special headsets to amplify voices. "If you can't hear, or you can't see," explains Duncan, "confusion can become really profound."

Shimek, who is finishing a master's degree in psychology, may understand the problem better than most. When she was 31, she was hospitalized after an accident. She started yelling, screaming and "trying to rip out my IV," she said. "It was like an out-of-body experience." In her case, the delirium was the side effect of an anti-anxiety drug.

Now, as a volunteer, she spends four-hour shifts visiting patients who are mostly 70 and older, the main group considered at risk for delirium.

On Thursday morning, Shimek checked in on Duane Jones, 79, who had gotten a hip replacement two days earlier. This wasn't their first visit, but she began by asking if he knew what day it was (he did), where he was ("Room 717") and who's the president (right again).

She sat down next to his bed as he lay propped up against some pillows, and they chatted about his favorite place to travel (San Diego). After a few minutes, she asked if there was anything she could do for him.

"I want a pass out of here and I want a beer," he teased her.

Those are the two most common requests, she told him, and she can't grant either.

Jones, a retired organic chemist from Brooklyn Park, said he's confident he's in full "control of his faculties," but he enjoys the visits anyway. "This could be kind of down place if nobody came and nobody talked to you," he said.

Patients don't have to participate, but few turn it down, Duncan says. Methodist recently expanded it to almost all units of the hospital.

Shorter stays

The results, Desai says, have been "pretty impressive." In a 2011 study of nearly 1,000 patients 70 and older, Methodist found that only 2.5 percent of those in the HELP program developed delirium, compared to 8 percent in a control group.

Another hospital — the Howard Young Medical Center in Woodruff, Wis. — reported even more dramatic results at a conference last week hosted by Minnesota's Institute for Clinical Systems Improvement. It found that the HELP program reduced the average hospital stay for elderly patients by nearly a full day and cut their fall rate to almost zero.

One reason, Desai said, is that delirious patients take longer to recover. Delirium makes it harder, for example, to do physical or occupational therapy and "get them stronger to get out of the hospital."

Delirium isn't just an inconvenience, says Dr. Fred Rubin, a geriatric specialist at the University of Pittsburgh School of Medicine, who has collaborated on the national HELP program. It not only makes people weaker, he said, but it can take months for people to fully recover — if ever.

"Every hospital ought to do this," he said. "But it's a culture change, and it's a financial commitment." Although it runs on volunteers, he notes, the hospitals need staff to coordinate and train them.

At Methodist, Desai said, they know they can't prevent delirium entirely. But if they can spot it early, they can intervene sooner. Either way, she said, "you're really going to have better outcomes."

For more information on the HELP program, go to www.startribune.com/a2255.

Maura Lerner • 612-673-7384