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Hospital Delirium: What Senior Patients and Families Should Know

A senior goes in for a routine surgery and afterward, family are dismayed to see that their loved one isn’t themselves at all! Their loved one might be agitated, confused, or barely awake. They might not know where they are, or even recognize family members. Their loved one is most likely experiencing delirium, a sudden, temporary change in thinking and function that can happen after a hospital stay, most often for surgery.

Delirium is most common among people older than 65. Most experts estimate that half of senior patients will experience some degree of delirium immediately after surgery, and even for longer. “Some patients describe having what they call ‘brain fog,’ which can last for weeks to months, but then generally clears up after that,” described Dr. Roderic G. Eckenhoff of the American Society of Anesthesiologists. “They’ll say, ‘I can’t do the crossword puzzle anymore, or ‘I can’t find my car anymore.’”

According to the American Society of Anesthesiologists, delirium can sometimes persist for years. Delirium also makes it less likely that a patient will have a good outcome from their surgical procedure, and a July 2019 study released by the American College of Surgeons found that older surgery patients who experienced postoperative delirium were less like to return to living independently after surgery.

What causes postoperative delirium?

The effects of anesthesia are certainly a top factor. But that’s not all. According to Dr. Marie Bernard of the National Institute on Aging (NIA), “In the hospital, you get lots of different medications that can interact and affect the brain, and you’re also off your normal schedule—frequently awakened, for example, for blood pressure readings and other needs, and that lack of sleep can contribute to delirium. Put all those factors together and it puts one at particular risk for developing delirium.”

Can delirium be prevented?

It’s probably not possible to prevent all cases of delirium. But to reduce the problem, hospitals and doctors are making changes that include:

Evaluating a patient’s risk before surgery. Dr. Sharon K. Inouye of Harvard Medical School says that many cases of delirium could be prevented by a careful evaluation of a patient’s medications, treating infection if present, and ensuring adequate oxygen levels. Blood tests can be used to determine which patients are at higher risk.

Improved anesthesia protocols. A study published in PLOS Computational Biology noted, “Despite widespread use of anesthesia, the precise mechanism by which it causes loss of consciousness remains a mystery.” Experts are refining their understanding of how anesthesia works, and how to most safely administer it—which includes taking into account the age of patients. They’re also developing strategies to follow during and after surgeries, such as talking to and orienting patients.

A less stressful hospital environment. The American Delirium Society recommends that hospitals take preventive measures such as improving nutrition and hydration during a patient’s stay, and ensuring that patients get an uninterrupted night’s sleep, daily exercise, mental stimulation, and reality orientation activities. More hospitals today have geriatrician-designed wards and protocols designated for older patients.

Prompt diagnosis. The sooner hospital staff realize a patient is experiencing delirium, the sooner they can take steps to address the problem. This can be a challenge, because according to the NIA, fewer than half of cases are properly diagnosed! Hospital personnel may assume that a patient has dementia or depression, or that they are just sleepy.

Family play an important role.

If your loved one is hospitalized, your support can lower the risk of the long-term effects of delirium at every step of the way:

Help your loved one prepare. Discuss your loved one’s risk factors with the doctor. This might include their physical and mental state, and the medications they take.  Encourage your loved one to eat well and drink enough fluids before the surgery, and follow the all doctor’s instructions. Bring along your loved one’s eyeglasses and hearing aids—it’s hard to stay in touch with reality when one can’t hear or see clearly.

Be there during the hospital stay. Experts say having a family caregiver present is one of the best ways to lower the risk of long-term complications. Talk to your loved one. Reassure them. Stay all night if possible. Keeping your loved one oriented promotes communication between nerve cells as the brain wakes up after surgery.

In the event of an unplanned surgery, be ready to act quickly. Not every surgery is planned! Learn about delirium so you’ll be prepared if your loved one should be hospitalized for s hip fracture or emergency heart surgery. If you don’t live nearby, make arrangements for someone else to fill in—a friend, or perhaps a professional such as an aging life care professional (geriatric care manager), home care agency, or the right person at your loved one’s senior living community.

Above all, be your loved one’s advocate. Doctors can use tests to determine whether a patient is experiencing delirium—but most agree that family and friends are far and away the best source of information. You know your loved one’s “normal.” If your mentally sharp 90-year-old mom experiences delirium-related confusion, it might look like Alzheimer’s disease to a nurse. A doctor might think your dad is suffering from depression if he’s lethargic. If your normally calm and sunny-natured wife is lashing out and making accusations, report the atypical behavior! You have valuable information the doctors and nurses need.

Surgery saves the lives of so many older adults, and helps many others improve their function and level of activity. Geriatrician Dr. Tammy Hshieh of Boston’s Brigham and Women’s Hospital says, “Many older patients decide to undergo elective surgery because they want to be more functional afterwards. It is important to prevent delirium so that these patients can feasibly achieve the function they were hoping for.”

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