Delirium--a state of confusion that develops suddenly, often following an acute illness or hospitalization--is estimated to impact more than 2.5 million older adults in the U.S. every year, though it often goes undetected. Post-operative delirium, or delirium that sets in after a surgical procedure, impacts as many as 50% of elders at an estimated cost of $164 billion per year.
Having studied delirium for more than 30 years, I often hear from patients' families that after a surgery, their loved one was "never the same". "They went into the hospital, they became very confused, and they never recovered."
Perhaps most troubling, new research has revealed a possible link between post-operative delirium and long-term dementia in some patients. In our recent work, we have found that a small but significant proportion of patients who experienced post-operative delirium after surgery had a higher rate of long-term cognitive decline--a result that may suggests a link between delirium and triggering of progressive, long-lasting effects possibly related to dementia.
The good news? My research has also shown that there are steps families and caregivers can take to help prevent or reduce risk factors for delirium in older hospitalized patients.
- Bring a complete list of all medications (with their dosages), as well as over-the-counter medicines to the hospital. It may help to bring the medication bottles as well.
- Prepare a "medical information sheet" listing all allergies, names and phone numbers of physicians, the name of the patient's usual pharmacy, and all known medical conditions.
- Forward pertinent medical records to the doctors who will be caring for the patient.
- Bring glasses, hearing aids (with fresh batteries), and dentures to the hospital. Older persons do better if they can see, hear and eat.
- Bring in a few familiar objects from home. Things such as family photos, a favorite comforter or blanket for the bed, reading materials and relaxation tapes can be quite comforting.
- Help orient the patient throughout the day. Speak in a calm, reassuring tone of voice and tell the patient where he is and why he is there.
- When giving instructions, state one fact or instruct in one simple task at a time. Do not overwhelm or over stimulate the patient.
- Massage (hand, foot, back) can be soothing for some patients.
- Stay with the hospitalized patient as much as possible to be an advocate and to provide comfort and reassurance. During an acute episode of delirium, relatives should try to arrange shifts so someone can be present around the clock.
- If you detect new signs that could indicate delirium symptoms -- confusion, memory problems, personality changes -- it is important to discuss these with the nurses or physicians as soon as you can. Family members are often the first to notice subtle changes.
As we age, hospitalizations and surgeries cannot always be avoided. But planning ahead, for yourself and your loved ones, can make a tremendous difference--not only in the short-term, but potentially for their long-term cognitive and physical health as well.
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