It seems that I’m seeing the word delirium all over the place. Um, could that mean that I’m having some – issues? Well, perhaps. I prefer to say that it’s because I’ve been researching this sometimes tragic result of hospitalization, especially with elders, and it’s been on my mind a lot.
Jane E. Allen wrote a piece for the Los Angeles Times, dated October 20, 2003. The reason I’m quoting this piece is that it is so thorough, without being obtuse and difficult to digest. Her piece is titled “Delirium takes a toll in the ICU” and I found it on the Global Action on Aging site. There are many other studies and papers, but for our purposes, Ms. Allen’s piece seems very suitable.
When my dad had brain surgery to drain fluid that was building up in his brain due to a World War II brain injury, he went into surgery kind of fuzzy because of the fluid, but came out totally demented. His nurse, whose name was Brad (as was my father’s), was a wonderful young man and he and Dad got along famously – before surgery.
After surgery, Dad kept pulling me aside and telling me to get him out of there, because Brad had tried to kill him in the shower, the night before. Dad would, after the surgery, take out his dentures and tell me to put them in my purse, because they were trying to take them away. He was terrified, paranoid and impossible to settle down. All in all, I’d lost my dad, as he had been. And I never got him back.
We chalked up Dad’s behavior to the surgery. At first, we thought it was just swelling or something and it would get better. The paranoia did improve, once they got him off of some of the drugs, but Dad spent the next 10 years in a psychic hell. We, the family, have always felt it was because the scar tissue caused problems for the surgeon and, well, brain surgery is very precise. We tried to understand. Dad’s last ten years took a huge emotional toll on everyone in the family, but life is like that, sometimes.
After what I’ve been reading lately, I’m feeling that maybe, just maybe, some of Dad’s post surgery behavior was delirium from the trauma of the hospitalization, coupled with drugs. The surgery itself may have been part of it – likely it was. However, just read some of these quotes from Jane E. Allen’s article:
“...as more people survived their intensive-care stays, doctors began recognizing patterns in these terribly weakened patients. Many became uncharacteristically quiet and withdrawn. Others developed hyperactivity and confusion. Even after their bodies recovered enough to leave the ICU, some didn't bounce back mentally, or their physical recuperation lagged.
"Something about their hospital stays was changing patients' ability to speak, reason and relate to their loved ones. This combination of confusion and disorientation, often accompanied by paranoia and delusions, is called delirium.”
“...By some estimates, 80% of elderly intensive-care patients develop the condition, which frequently leads to nursing home stays and a hastened death.
"Unfortunately, delirium is often a spiral downhill," says Dr. Sharon K. Inouye, a Yale geriatrician and leading delirium researcher. "Because people are so fragile at that age, it's like a house of cards."
The article goes on to examine some of the drugs used, some tests that can be given to patients to keep an eye out for delirium, and some of the hospital environments that may contribute to this dementia-like response to an ICU stay.
Other studies and articles I’ve read have stressed the fact that we must lessen the “hospital atmosphere.” Does this sound familiar? Good nursing facilities are working toward that very goal. Plants, animals, music, home-like settings. Obviously a hospital can’t allow Fido to run the hallways, but they can change the way their dinging bells, intercoms and other machinery overtake the environment.
One of our local hospitals recently put millions of dollars into redesigning their children’s wing, to make it a wonderland. Yes, it’s a hospital and unpleasant things happen. However, medical people realize that children need to have an environment that is as soothing as possible.
Get rid of as much of the scariness of the environment, enrich their imaginations in a positive way, and you will have a child that gets well more quickly.
Wouldn’t this make sense with elders? If hospitals could make more of an effort to soften the surroundings of an elder, during a hospital stay; if they could have bulletin boards near beds so families could post pictures and familiar objects; perhaps paint the rooms a soothing color and have quiet music if the patients want that; allow a family member or friend to sleep on a cot nearby - who knows?
Along with watching drug combinations and training staff to be attentive, keeping the elder engaged mentally, rather than letting him or her lie in terror, created by their thoughts – maybe we’d find that some of this dementia that occurs after a hospital stay is delirium that could be avoided, or at the very least, lessened. Could it hurt to give hospitalized elders the same consideration we do hospitalized children? It’s something to consider.
Published On: June 29, 2007