The current event activities. I also assisted in early

 

The
action I did for the health of the public was volunteer at the University of
Michigan Health System at the Ann Arbor UM Hospital with the Hospital Elder
Life Program. The Hospital Elder Life Program or HELP is a national clinical
program that uses trained volunteers to help prevent cognitive and functional
decline in older hospitalized adults. The program allows older adults to return
home at the maximal level of independence. HELP does this by keeping
hospitalized older people oriented to their surroundings, meeting their needs
for nutrition, fluids, and sleep and keeping them mobile within the limitations
of their physical condition. This program in relative to what we have learned
in class because increasing the physical and mental health of patients in the
hospital can prevent and postpone disability and chronic illnesses.

What I
did as my role as a volunteer was to improve the hospital care for older
patients. These elderly patients were selected to be in this HELP program
following the criteria that they are 65 and older and have at least one of the
risk factors for cognitive or functional decline. We are given a packet of the patient’s
medical information for their record and keep confidentially. In each packet
after our shift, each volunteer details the interventions done and personal
details about their life for the interview to relay that information back to
the nurses and doctors.

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I went
through the volunteer training for HELP, which consisted of 4-5 hours of
classroom training, and 12 hours of shadowing a trained volunteer to build the
skills in order to successfully complete this position. My duties were to visit
the patients who are enrolled in HELP to provide support and orienting
communication. I would participate in the therapeutic activities with the
patients by providing bedside activities such as reminiscence, trivia, and
current event activities.  I also assisted
in early mobilization program by walking active patients and performing range
of motion exercises with the bedridden patient. If needed, we would provide
feeding and companionship during meals. I would also offer a non-pharmacological
sleep protocol and hearing/vision adaptations. I was not to interfere with a
patient’s medical treatment, so we consult the patient’s room board and nurse
for information about diet and physical therapy. The outcomes of all the tasks
of a HELP volunteer are generally that visiting provides cognitive orientation,
communication, and social support. The therapeutic activities program promotes
cognitive stimulation and socialization. The non-pharmacologic sleep protocol
promotes relaxation and sufficient sleep.

            The issue of physical activity is a
big problem that I saw and is important in dealing with chronic illness among
older adults. In hospitalized elderly adults, low level of physical activity is
common and is associated with worse prognosis. What contribute to the drop in physical activity is
the muscle mass and muscle strength that are reduced with aging (Kleinpell,
Fletcher, Jennings, 2008). Studies
show that cognitive-based interventions
were significantly effective at changing the behavior for physical activity
among older adults subjects. (Chase,
2013). The theoretical concept of self-efficacy can be used to develop interventions
to help improve the physical activity of elderly patients in the hospital. The
Elder Life Program does this by talking with the patient about their
accomplishments and verbally persuades them to follow the physical therapists’
instructions and show them that they can do it on their own. (Chase, 2013). Preventing falls have been
a major issue and about 1 in 10 falls results in a serious injury that can lead
them to a hospital (Schneider, 2014, pg. 511). The CDC recommends that older
people can prevent falls and readmissions by exercising regularly; if older
adults start to strengthen their muscle with either range of motion exercises
or walking, it can significantly increase their mobility, strength, and balance
(Schneider, 2014, pg. 511). This improvement in health is for the patient’s
safety to promote injuries when transitioning out of the hospital and into
their own homes.

Functional
decline is seen as the leading complication of hospitalization for the elderly (Kleinpell,
Fletcher, Jennings, 2008).
The impairment in cognitive status of the hospitalized
elderly can be associated with changes in functional status (Kleinpell,
Fletcher, Jennings, 2008). When
someone leaves the hospital, their families expect their loved ones to be fully
recovered from their illnesses and go back to their normal living state with optimal
health. However, more than two million elderly Americans will foster delirium
and/or functional decline during their hospitalization this year (Fong,
Tulebaev, & Inouye, 2009). These complications can result in increased
morbidity and mortality, prolonged hospital stays, increased provider
liability, a greater likelihood of needing long-term care, and excess health
care costs (Fong, Tulebaev, & Inouye, 2009). HELP can aid this inevitable
situation. The Hospital Elder Life Program has been successful at returning
older adults to their previous living situations with maintained or improved
ability to function by recognizing delirium before it progresses.

Delirium is
a sudden change in mental status that develops over hours or days, but is
preventable; it is different from dementia, which is a chronic state that
progresses over time  (Fong, Tulebaev,
& Inouye, 2009). Delirium impacts a person’s ability to maintain awareness
of his or her own surroundings. The symptoms of hallucinations, paranoia,
rambling speech, or jumbled thoughts can come and go during the course of the
day (The Hospital Elder Life Program, 2017). Being trained in geriatric care,
the Hospital Elder Life Program is the solution to this issue that I saw. The
HELP program is used a measure to observe the signs of delirium before they
worsen such as confusion regarding day-today events. Delirium is only
recognized in about 1/3 of physicians and in about 1/3 of nurses (The Hospital
Elder Life Program, 2017). Families can help by letting healthcare
professionals know that there is a change in their loved one, but the only way
that the hospital can manage delirium and decrease its complications if people
can observe the changes in the patients’ personality. Multicomponent-targeted
interventions have been the most successful approaches to combat delirium with
the healthcare professionals, the families, and HELP working together.

The people
older than 65 years currently represent 12.5 percent of the U.S. population,
and are seen to increase to 20 percent of the population by 2030 (Kleinpell,
Fletcher, Jennings, 2008). In 2002, the elderly accounted 41 percent of
hospitalizations in the United States, and these numbers are expected to increase significantly
as the population ages (Kleinpell, Fletcher, Jennings, 2008). It is urgent for
this population to manage their health by targeting the needs of the
hospitalized elderly and having awareness of risks for illness-related
complications (Schneider,
2014, pg. 519).

There increasing
percentage of the elderly population on Medicare trying to pay for their
medical costs is a public health issue. Medicare is the federal program that covers
medical bills for the elderly in America. There have been efforts to decrease the
growth of government expenditures for their medical bills, but it means that
these elderly patients have to pay higher percentage of the costs out of pocket
(Schneider, 2014, pg. 518). The nation should care for its increasing numbers
of elderly citizens and their healthcare as there is 10% of the elderly that
live in poverty and can not afford this basic right (Schneider, 2014, pg. 518).
The greatest hope for reducing costs in the aging population is improving their
overall health. It is seen that more education correlates with better health in
the elderly. HELP provides that education for the elderly to stay active and
engage in mind-stimulating activities. For the family, HELP provides a
informative sheet that details delirium and what they can do reduce the risk. The
integrated healthcare system of the hospital staff and the HELP volunteers work
to postpone the onset of chronic infirmity by reducing risk factors such as
lack of exercise. Educating these hospitalized individuals to be more
responsible for their health can decrease the demand of medical care (Schneider,
2014, pg. 518).   

HELP is proven
to be cost-effective as well. Based on the HELP database, HELP saves about
$10,000 per patient per year in healthcare costs (The Hospital Elder Life
Program, 2017). I talked with the coordinator for HELP, Amanda Schoettinger,
and she expressed to me about how length of stay or LOS is a huge thing in the
hospital that is a determinate of saving money for a patient. Anyone who stays
here longer because of something that the hospital did, Medicare will not cover
that expense. Also, if an individual is readmitted for the same diagnoses
within 30 days of their prior hospital stay for that same reason, the
government will not pay it for. From the UM Program Analysis, the average
length of stay for all of the hospital is 6.0 ± 5.9 days and for HELP, it is 3.8
± 4.7 days. The preventative services that HELP offers are huge for patients to
stay healthier and save money.

My
primary goals as a volunteer in the Hospital Elder Life Program were to maintain
cognitive and physical functioning and preventing unplanned hospital
readmissions for the health and economics of the hospitalized elderly
population. This is applicable to my career goals of becoming a nurse or
physician assistant because I hope to use my patient care experience to provide
the best management care for patients. Volunteering taught me that taking the
preventative measures health care such as educating about delirium and physical
activity can greatly reduce the patients’ risk factors for chronic illnesses
and falls. The higher quality of hospital care given is correlated with lower
rates of delirium, but not everyone can receive that care. Just by spending 20
minutes with a patient and talking with them, I can recognize symptoms of
delirium and help get treatment sooner. Recognizing this common condition is an
effective cost-saving skill for elderly patients.