Teens combat delirium in elderly patients at Holy Cross Hospital

December 1, 2013


Madison Herin, 16, says the most gratifying part of her volunteer position at Holy Cross Hospital in Fort Lauderdale, Fla., is the opportunity it gives her to make "deep personal connections" with the patients she visits.

Madison Herin converses with a patient at Holy Cross Hospital. She is one of the teen volunteers who engage senior patients in games and conversation as part of the Fort Lauderdale, Fla., hospital's program to prevent delirium.

Connor Smith, 14, says volunteering at Holy Cross has given him the chance to not only help patients and nurses, but also to meet some "totally awesome" older people, including a world-class Scrabble player, a chess champion and a U.S. Navy pilot, who served during the Korean War.

Both teens are part of an innovative program, "Tender, Loving Care-Advanced," that aims to reduce fall rates and length of hospital stays by using volunteers to help address delirium issues older adults are prone to develop during hospitalizations.

"Unlike dementia, which has a slow onset and is irreversible, delirium is an acute onset condition that is totally reversible," explains Candice Hickman, a clinical practice specialist who co-coordinates TLC-A along with nurse clinician Lynn Coopersmith. "This type of confusion is common during hospital stays — studies estimate 56 percent of older adults develop it — because of the changes patients experience in terms of environment, routines and medications."

Human touch
The TLC-A program was initiated by a conversation between Hickman and Meg Scheaffel, vice president and chief nursing officer at Holy Cross, who was looking for a way to reduce fall rates. Because the hospital, a CHE Trinity Health member, has a large volunteer program composed of approximately 700 participants, Hickman turned to Abbie Klaits, director of volunteer services, for help.

"Many of our volunteers really wanted to have more direct interaction with patients, but we had no program in place for training them," says Klaits.

When Hickman came across literature about the Hospital Elder Life Program, or HELP, developed by Yale University School of Medicine, she knew she had found a good fit. After attending a conference on it in Pittsburgh, she, Coopersmith and Klaits initiated their own pilot program at Holy Cross in October 2012 — one that has a unique twist — its corps of volunteers includes teenagers.

"Older patients love having young people around," she says. "This seemed like a great way to involve teens at the hospital."

At first, Holy Cross reached out to Northeast High School in Oakland Park, Fla., to recruit teens for an orientation and training program. "Our biggest hurdle was giving our young volunteers a tool kit to help them communicate with 80-year-olds who don't text," says Klaits. "We emphasized personal behaviors like making eye contact and using touch to help promote conversation. Then we introduced a simulation mannequin to role play how to interact with patients who might appear confused, withdrawn or cantankerous."

In keeping with Holy Cross' core values, including reverence of each person and the emphasis of teamwork to support one another, TLC-A started small, with four students, so that both patients and volunteers would feel secure. "The students volunteered twice a week, and once the nursing staff identified appropriate patients for them to see, we stayed on the unit to be available whenever needed," says Hickman.

Mental clarity
The program was a hit with both patients and volunteers. "We supplied the kids with playing cards, magnetic tic-tac-toe games, books, chess sets and so on to help engage the patients," says Hickman. "But most of the time, the favorite activity was just sitting and talking. Our patients loved to tell their life stories and offer advice to the volunteers. And the kids found new appreciation for the importance of face-to-face conversations."

Even more important, the Holy Cross nursing staff began to notice tremendous improvements in their patients' mental status. After an hour-long visit with volunteers, confused patients seemed to gain mental clarity, lonely people were smiling and engaged, and patients in pain seemed distracted from some of their discomfort.

Positive experience
In June, Holy Cross expanded the program, training six more students who volunteered for two four-hour shifts a week during their summer vacations.

That's when Herin, a student at Pine Crest School in Fort Lauderdale, got involved. "I was interested in TLC-A for two reasons. First, I'm hoping to become a doctor, so I wanted to volunteer in a medical setting. And second, I suffer from fibromyalgia and arthritis myself, so I thought I would be good at connecting with patients because I could understand the pain they experience," she says.

Her time at Holy Cross was so positive that Herin has continued to volunteer now that school is back in session. "TLC-A really works," she says. "I've seen patients who are delirious become much less agitated when I can get them focused on an activity, even one like reading the newspaper together. If you can connect with someone, you can help get their mind off of what is bothering them."

Though Smith, a freshman at Boca Raton Community High School, has no interest in a career in health sciences — he says he wants to be a U.S. Navy officer instead — he calls his summer volunteer experience at Holy Cross "both humbling and gratifying."

"I would most certainly do this again. I felt like I not only helped the nurses and patients, but also concerned family members who couldn't be at the hospital for one reason or another. They would often call to have us relay messages or to tell us about a patient's likes or interests," he says.

Luxury of time
Based on TLC-A's success, adult volunteers have been getting involved in the program as well. Joy Branyon, a former engineer who recently earned a nursing degree, says she "stumbled upon the program" in March after volunteering in other capacities at Holy Cross.

"It really appealed to me because I saw my dad suffer from delirium," she says. "I've enjoyed it so much that I'm still volunteering, even though I'm now working full-time as an RN at another hospital. On the job, I never have this kind of time to spend with patients; there are constant interruptions and procedures to do.

"I find that older patients are by far the most interesting; they have such fascinating and often inspirational stories to tell. This experience really helped to coalesce my feelings about my new career," Branyon adds.

Now that TLC-A has ended its initial phase, Hickman says she hopes to begin gathering data that can be analyzed to quantify decreases in delirium at Holy Cross. "Though we have been able to observe changes in behavior, we'd like to be able to scientifically study fall rates, rates of use for sedative medications, and so on," she says. "We already feel that this program validates the caring philosophy that is so much a part of our mission."


Copyright © 2013 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2013 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.