With unfortunate frequency, elderly patients go to the hospital for a surgery or other treatment and quickly become confused, bewildered, and sometimes agitated or totally disoriented. This is called delirium and while it apparently affects between 10 and 50 percent of patients over 65, it’s only recently been studied in depth. Sharon K. Inouye, director of Harvard’s Aging Brain Center, is leading the charge to understand delirium, its impact on patients’ longterm cognitive faculties, and how to prevent it. From Scientific American:
[Delirium] is the phenomenon, sadly familiar to many families, of Grandpa never being quite the same after an operation…
The consequences of delirium, if it lasts more than a few days and especially if it is followed by cognitive decline, are enormous. “It’s a house of cards,” Inouye says. “Patients start getting treated with medications for agitation or disruptive behavior, and those medications lead to complications. Or they are very sedated, and that leads to complications.” Delirious patients may choke on their food or pills and die of aspiration pneumonia. They may wind up in bed for long periods and suffer fatal blood clots. Once up, they are prone to falling. It’s a downward spiral and a costly one. Delirium adds more than $183 billion a year to U.S. health care costs, outstripping congestive heart failure.
Fortunately, basic steps can be taken to prevent delirium or shorten its course, such as making sure the patient is well hydrated, has access to eyeglasses and hearing aids if he or she uses them, gets out of bed and walks as soon as possible, has adequate sleep, and is socially engaged by hospital staff and loved ones. These are some of the measures included in the Hospital Elder Life Program (HELP), first developed by Inouye and her colleagues in 1993 and now in use in hundreds of hospitals around the world. Studies show it reduces the risk of delirium by 30 to 50 percent, shortens its course when it does occur and cuts the rate of falls by 42 percent.
“It’s Time to Take Delirium Seriously” by Claudia Wallis (Scientific American)
image credit: detail of lithograph by Eugene Burnand (Wellcome Collection, CC BY 4.0)