Changes in Intensive Care Practices Could Help Lower Delirium Risk in Elders

  • Throughout the years I've spent writing and answering questions on elder care, I've gotten many questions from readers about the condition of an elder after hospitalization. The notes tell sad stories about an elderly person going into the hospital for surgery only to return home with dementia. Sometimes the dementia would improve, but other times the downward spiral had started, and full-blown Alzheimer's was the result.


    My dad's situation was an extreme example. He went into surgery to have a shunt put in his brain. The shunt was to drain fluid that was building up behind scar tissue from a World War II brain injury. This is generally a fairly safe and useful surgery. However, in dad's case, for whatever reason, it backfired, and he came out of surgery with severe dementia from which he never recovered.

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    This dementia could have been caused by the surgery itself, the anesthesia or the trauma of hospitalization. Researchers, aware that situations like my dad's and others whose family members have written to me are not uncommon, are studying this issue.


    An article at titled, "Changing Intensive Care to Improve Life Afterward," looks into some changes being made in intensive care units with these negative outcomes in mind.


    The article states that, "Intensive-care units have long kept critically ill patients immobilized, heavily sedated and on a breathing machine...Studies show that prolonged heavy sedation, for example, can trigger or exacerbate delirium, a temporary state of acute brain injury that has been linked to higher rates of death and dementia."


    "Changing Intensive Care" describes a five-step plan that may help improve the ICU experience for everyone in that type of situation. However, the article also emphasizes the role of family members in assessing the patients.


    As a person who has been the primary family advocate for many family members, most of them elders, I couldn't agree more. Families often can spot signs of non-medical types of abnormal behavior in an individual before medical people can, simply because they know their loved one.


    A number of the people who have written to ask about their elder's changed behavior have said the dementia symptoms occurred shortly after the person came home. This isn't surprising to me, since most of these hospitalized elders were sedated and still under the influence of some medications, often for pain, when they were sent home.


    "Abnormal" behavior may at first be chalked up to this effect. Then, as the medications are withdrawn and/or changed, family members begin to see that changes are not due to medication side effects, but are due to some change in brain function or other trauma.


    The program that is being looked at to change ICU care is a good start. For a direct link, go to the's "Changing Intensive Care to Improve Life Afterward." However, in my opinion, more needs to be done.


    Whether elders are subjected to emergency room treatment, ICU stays or prolonged hospitalizations, many suffer disorientation because they are traumatized by the noisy surroundings they don't understand, the cold atmosphere, being away from familiar people and mediation side effects that go unnoticed.


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    Certainly, some hospitalizations are necessary, including ER and ICU exposure. However, whenever we, as caregivers, can make a choice, I would generally choose the least exposure to hospital settings possible.


    Many elders in nursing homes can be treated effectively in their home, saving the elder from significant trauma. For elders living in situations that offer less medical care than nursing homes, some in-home care agencies offer nursing care. Whenever possible, we'll want to protect our elders from hospital stays. Meanwhile, for the sake of those who must be hospitalized, let's hope more progress is made toward keeping the damage to a minimum. Elderly people are already at risk for dementia. Whatever we can do to spare them more risk, should be done.


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Published On: February 16, 2011