As COVID-19 appeared on the scene, hospitals put new precautions into place to protect patients and staff. One step was to limit visitors, whether a patient had been admitted for complications of COVID-19, another illness or surgery.
Experts note that when seniors are hospitalized, family and supportive friends aren’t just “visitors.” They are caregivers and advocates, and their presence lowers the risk that a senior patient will develop hospital delirium. A study from University College London estimated that 25% of patients hospitalized with COVID-19 develop delirium. While weighing the risks, many healthcare organizations are again allowing at least one family member to be present in the hospital.
What is delirium?
Delirium is a type of perioperative neurocognitive disorder, which means changes in memory and thinking that happen during and immediately after hospital treatment. Patients with delirium act strangely and out of character. They have trouble thinking. They might have hallucinations and lash out in anger and paranoia. This agitation is the most commonly recognized symptom of delirium, but patients also might be lethargic and apathetic.
How long does delirium last?
Delirium is most often temporary, but the effects can take time to clear up. “Some patients describe having what they call ‘brain fog,’ which can last for weeks to months, but then generally clears up after that,” said Dr. Roderic G. Eckenhoff of the American Society of Anesthesiologists (ASA). “They’ll say, ‘I can’t do the crossword puzzle anymore,’ or ‘I can’t find my car anymore.’” ASA experts also note that delirium sometimes persists even for years, causing disability and loss of independence.
What causes delirium?
Delirium is most common among patients older than 65. Those with memory loss are at especially high risk. But the causes of delirium are not entirely understood.
Experts say the effects of anesthesia are certainly a top factor, and the inflammatory response also is involved. The hospital environment in general can cause disorientation. Said Dr. Marie Bernard of the National Institute on Aging, “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.”
What can hospitals do to lower the risk?
To reduce the incidence of delirium, doctors are making changes. They are refining their anesthesia protocols and focusing on ensuring adequate oxygen levels. If possible, they evaluate a patient’s risk before surgery with blood tests and a medication review. They also treat any present infections before the hospitalization.
The hospital environment, too, is receiving a makeover. Following the advice of the American Delirium Society, hospitals are improving nutrition and hydration during patient stays, 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 especially designated for older patients.
What is the role of family in preventing and identifying delirium?
The sooner doctors spot signs of delirium, the sooner it can be addressed—but the diagnosis can be tricky! The American Geriatrics Society reports that hospital personnel identify fewer than half of all delirium cases in older patients. Perhaps when you’ve accompanied a loved one to the hospital, a nurse or anesthesiologist came into the waiting room after the procedure to ask about behavior they’ve noticed. Hospital personnel have most likely never met your loved one before, so they don’t know your loved one’s “normal.” They might mistake agitation or lethargy for dementia or depression. You are the best one to note that something’s not right. You have valuable information that the medical staff need.
In fact, your support can lower the risk of the long-term effects of delirium at every step of the way. If your loved one is going in for a planned surgery or other procedure, help them prepare. In the days leading up to the procedure, encourage your loved one to eat well and drink enough fluids. In the hours before check-in, assist them in following the 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.
During and after the procedure, spend as much time with your loved one as you are allowed, even overnight. Many studies show that the presence of a family member or friend in the hospital is a top factor in lowering the risk of delirium. Talk to and reassure your loved one. Experts say this promotes communication between nerve cells as the brain wakes up after surgery or a severe illness.
Once your loved one comes home, they may need quite a bit of help as they recover from their surgery or illness and any cognitive aftereffects. They may need assistance with personal care, nutrition, and adhering to the doctor’s instructions and their rehabilitation regimen. Your assistance can reduce the chance of a return trip to the hospital.
Professional in-home care can help.
A trained caregiver can assist with all the tasks above. The caregiver can coordinate your loved one’s aftercare and provide transportation to appointments. They can stay with your loved one when you need a break, providing companionship, supervision and mental stimulation. To learn more, visit the Right at Home RightTransitions page. And for peace of mind these days, Right at Home caregivers are following protocols to prevent exposure to COVID-19 as clients shelter at home.