Delirium Leading to Dementia One Surgery Risk

Caregiver, patient expert

As people age, surgery becomes a greater risk to their overall health than the same surgery would be for younger people. Older people often have less robust immune systems so they are more at risk for general infections and they are more at risk for pneumonia. However, one of the most frightening risks for older people is post-surgical delirium.

Delirium is described as an acute state of confusion that often affects older adults following surgery or serious illness. A recent study led by researchers at Beth Israel Deaconess Medical Center (BIDMC) has found that inflammation most likely plays a key role in the onset on-set of delirium.

The BIDMC study found that a frightening 64 percent of hospitalized seniors can suffer from delirium after surgery. Scarier yet, this delirium is associated with what is termed a “two-to three-fold increase in the subsequent development of dementia.”

How bad can post-surgical delirium get?

My dad’s post-surgical nightmare was a prime example of the horrors that can await some elderly people who undergo surgery. Dad had suffered from a brain injury during World War II but eventually recovered to lead a normal life. However, in his 70s, brain fluid started to build behind the old scar tissue in his brain. The decision was made to insert a shunt into his brain to harmlessly drain the fluid off into his chest cavity.

This type of surgery is generally successful. However, Dad went into surgery somewhat fuzzy from occasional fluid buildup but came out with delirium that quickly escalated into full-blown dementia.

An article on this study showing the role of inflammation in delirium was published on Medical News Today. The article quoted co-senior author of the study Edward Marcantonio, MD, Director of the Aging Research Program in the Division of General Medicine and Primary Care at BIDMC and Professor of Medicine at Harvard Medical School (HMS) as saying, "Delirium complicates hospital stays for millions of elderly individuals in the United States each year.”

Marcantonio described delirium as possibly an inflammatory response gone awry.

Is this what happened to my Dad? His experience is one reason that I’ve entered the field of publically activating for people with dementia. Throughout the years I’ve blamed the anesthetic used during the operation since older people do suffer more consequences from anesthetics than others.

I’ve blamed the old scar tissue and the fact that the doctor may have been thrown off by a microscopic piece of tissue, as well. Now, I’m wondering if inflammation was at the bottom of that nightmare. Not that it matters for Dad, but I’d like to know that progress is being made so that possibly fewer seniors will suffer the same fate.

Meanwhile what do older people faced with surgery do?

As a daughter who cared for her dad for ten years after he was thrown into dementia, I’m perhaps overly cautious when it comes to surgery for elders. I don’t, however, think that I’m out of line in advising people to think carefully before undergoing surgery.

Excruciating pain stemming from an arthritic hip can be removed through highly successful hip replacement. Would otherwise healthy 70-year-olds refuse hip replacement, sentencing themselves to perhaps decades of worsening pain and eventually being wheelchair bound because surgery carries some risk? Probably not.  When I’m asked about such a case, I say that in my opinion the risk is worth taking.

However, should an 85-year-old man who has slow-growing prostate cancer, or for that matter a woman of the same age with cervical cancer, risk his or her brain health for a surgery that may never be of benefit? That’s a decision that must be made by the patient, his or her loved ones, and the doctor or doctors involved.

Patients need to be fully informed before deciding to have surgery of any kind, and older patients need to carefully weigh their increase risk for serious cognitive issues against the need for surgery.

This is a highly individual matter without a clear cut answer. I’m hoping that this new knowledge about the role of inflammation in post-surgical delirium will lead to pre-surgical and post-surgical intervention to prevent inflammation. I’ll be watching this issue carefully. I still want an answer to what happened to my dad.

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