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. 2024 Jan;72(1):14-23.
doi: 10.1111/jgs.18631. Epub 2023 Nov 1.

Optimizing delirium care in the era of Age-Friendly Health System

Min Ji Kwak  1 , Sharon K Inouye  2   3 , Donna M Fick  4 , Alice Bonner  5   6   7 , Terry Fulmer  8 , Emily Carter  9 , Victor Tabbush  10 , Kerri Maya  11 , Nicholas Reed  12   13 , Christine Waszynski  14 , Esther S Oh  7   15   16   17
Affiliations

Optimizing delirium care in the era of Age-Friendly Health System

Min Ji Kwak et al. J Am Geriatr Soc. 2024 Jan.

Abstract

Delirium is a significant geriatric condition associated with adverse clinical and economic outcomes. The cause of delirium is usually multifactorial, and person-centered multicomponent approaches for proper delirium management are required. In 2017, the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) launched a national initiative, Age-Friendly Health System (AFHS), promoting the use of a framework called 4Ms (what matters, medication, mentation, and mobility). The 4Ms framework's primary goal is to provide comprehensive and practical person-centered care for older adults and it aligns with the core concepts of optimal delirium management. In this special article, we demonstrate how a traditional delirium prevention and management model can be assessed from the perspective of AFHS. An example is the crosswalk with the Hospital Elder Life Program (HELP) Core Interventions and the 4MS, which demonstrates alignment in delirium management. We also introduce useful tools to create an AFHS environment in delirium management. Although much has been written about delirium management, there is a need to identify the critical steps in advancing the overall delirium care in the context of the AFHS. In this article, we suggest future directions, including the need for more prospective and comprehensive research to assess the impact of AFHS on delirium care, the need for more innovative and sustainable education platforms, fundamental changes in the healthcare payment system for proper adoption of AFHS in any healthcare setting, and application of AFHS in the community for continuity of care for older adults with delirium.

Keywords: Age-Friendly Health System; Hospital Elder Life Program; delirium.

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Conflict of interest statement

Dr. Min Ji Kwak received funding from the US Deprescribing Research Network (National Institute on Aging R24AG064025) and a consult fee from the Institute for Healthcare Improvement and Endocrine & Diabetes Plus Clinic of Houston. Dr. Sharon Inouye’s time was covered in part by grant R33AG071744 from the National Institute on Aging. Dr. Inouye is the Editor in Chief of JAMA Internal Medicine, and the creator of the Hospital Elder Life Program; however, she has no financial COIs with the program. The American Geriatrics Society (AGS) holds the exclusive licensing rights to HELP as AGS CoCare HELP. Dr. Nicholas Reed serves for the advisory board for Neosensory. Dr. Esther Oh receives funding from the National Institute on Aging/National Institutes of Health (R01AG057725, R01AG076525 and R01AG057667). Other authors do not report any conflict of interest.

Figures

Figure 1.
Figure 1.. Crosswalk of HELP protocols with 4Ms
*AGS CoCare®: HELP Program January 2023: https://help.agscocare.org †IHI Age-Friendly Health Systems January 2023: http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Documents/IHIAgeFriendlyHealthSystems_GuidetoUsing4MsCare.pdf Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA). Figure used with permission from IHI-AFHS. ‡NICE = National Institute for Health and Care Excellence
Figure 2.
Figure 2.. Steps of using ROI calculator
The resulting estimate of Return on Investment (ROI) is found to be higher when the following conditions prevail: i) The incremental cost of providing Age-Friendly care is smaller; ii) the incidence of delirium prior to the introduction of Age-Friendly care is higher; iii) the effectiveness of such care in avoiding and reducing this incidence is greater; iv) The daily cost of a hospital stay is more expensive. https://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/Resources.aspx
Figure 3.
Figure 3.
Optimal Delirium Management with Age-Friendly Health System 4M’s
See this image and copyright information in PMC

References

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