A nurse on a geriatric unit is implementing the Hospital Elder Life Program (HELP) bundle to prevent in-hospital delirium for an 82-year-old patient admitted with pneumonia. Which combination of interventions best reflects HELP?

The Hospital Elder Life Program (HELP) is the evidence-based, nurse-driven bundle for in-hospital delirium prevention in older adults. Components: daily reorientation, sensory inputs (eyeglasses, hearing aids), early mobilization and ambulation, hydration and nutrition, sleep hygiene with reduced overnight disruption, minimization of psychoactive medications, and reduction of physical restraints. HELP is associated with reduced delirium incidence, falls, length of stay, and post-discharge institutionalization. Choices 1, 2, 3 each contain practices (restraint, benzodiazepines, deep sedation, antipsychotic prophylaxis, bedrest, family minimization) that increase delirium risk and contradict the HELP bundle.

The Hospital Elder Life Program (HELP) is the most studied and effective bundle for preventing hospital-acquired delirium in older adults. Components are nurse-driven and largely non-pharmacologic: daily reorientation with clocks and calendars, ensuring eyeglasses and hearing aids are in place, early mobilization and ambulation, adequate hydration and nutrition, sleep hygiene with reduced overnight disruption (consolidating care, dimming lights, limiting noise), and minimization of psychoactive medications including benzodiazepines, anticholinergics, and unnecessary opioids. HELP reduces delirium incidence by approximately 40 percent, with downstream reductions in falls, length of stay, and post-discharge institutionalization. Practices that increase delirium risk include physical restraints (which paradoxically increase agitation and falls), benzodiazepines, deep sedation, anticholinergics, sleep deprivation, sensory deprivation (no glasses or hearing aids), tethering (Foley catheters, IV lines without indication), and immobility. The CAM (Confusion Assessment Method) is the standard screening tool: acute onset and fluctuation, plus inattention, plus either disorganized thinking or altered consciousness.