We as a country have known for quite some time that people who go to the hospital, particularly to the Intensive Care Unit (ICU), have a tendency to develop a form of mental dysfunction commonly called ‘hospital delirium.’ By ‘have a tendency,’ we mean that somewhere around one-third to one-half of all patients who come into the ICU develop hospital delirium at some point during their stay.
What we have not known until just recently is exactly how many of those people are able to recover. Then a series of studies came out in several different countries that revealed the frightening fact that about one-third of patients with hospital delirium recover completely, another one-third stabilize but have life-long cognitive impairments (due to hospital delirium), and another third continue to deteriorate after their release.
Hospital delirium is not itself deadly, but having it increases your chances of dying of something else by a significant margin (studies ranged from +25% to +70% in all-causes mortality rates), and the effects continued for at least a year after release.
Furthermore, there is a direct relationship between how long you spend delirious and the severity of your lasting symptoms. According to an intensive care specialist at the Vanderbilt University Medical Center, “Every day you’re delirious you have about a 35 percent increased risk of this dementia…three days of delirium, [it’s] almost a sure thing you’re going to have some elements of the dementia.”
The patients at the greatest risk for hospital delirium are the ones who are oldest, and the ones who have to spend the longest amount of time in the ICU.
Preventing Hospital Delirium
If your honored elder ends up rushed to the ICU for a medical emergency, it is on you to talk to the hospital staff and make sure they understand that your loved one needs some special care to prevent them from experiencing hospital delirium. Here is what the hospital can do:
- Get them out of bed at least three times every day, with nurses’ assistance if necessary. Even to the bathroom and back is enough. This single intervention is the most effective way to prevent hospital delirium. On a similar note, keeping restraints down to an absolute minimum helps, too.
- Do not deprive them of their senses. Keep their eyeglasses, hearing aids, and dentures handy, and give them something to watch, listen to, smell, and taste; especially if it is something familiar and comforting.
- Having something to remind them of themselves at all times is another good way to ward off delirium. Family photos, a favorite sweater, their music playing, whatever the hospital will allow that will trigger positive memories.
- Do not sedate them unnecessarily, and if necessary, try to avoid sedatives known for making delirium worse, such as benzodiazepines (Xanax, Ativian, Valium, etc.). Similarly, do not give them anything but the most strictly necessary doses of anticholinergic drugs or diuretics, both are known to increase the chances of delirium.
- If the patient is on a ventilator but can survive off of it, take them off once a day and allow them to breathe on their own, even for just a few minutes.
- Do allow the patient to get a good night’s sleep every night. This means keeping rooms lit during the day and dark at night, keeping noise low during sleeping time, and waking them up only when strictly necessary (unless it is breakfast time, of course).
- Enable and encourage them to engage in cognition-oriented games like crosswords, cribbage, Scrabble, or similar.
Perhaps one of the most important things you can do, however, starts the moment you meet your honored elder’s nurse: tell the head nurse all about them. The nurse needs to be aware of how functional, emotionally stable, and modest your loved one is, so that they can tell when they are starting to act contrary to their normal behavior.
Recovering from Hospital Delirium
If you discover after the fact that your venerable family member did (or currently does) have hospital delirium, it is not necessarily too late. Once they get out of the hospital, you can help them recover at home.
Once they are home, go through the list above and make sure that you are doing all of that. But since they are at home now, you can take steps 3 and 7 up a few notches.
Do not just give them a familiar sweater, give them friends and family to talk to and interact with. Do not just give them a crossword puzzle to do, sit down and play a thought-provoking game like Clue or Trivial Pursuit with them. For top marks, sit down and play a thought-provoking and social game with them and their friends, such as Apples to Apples or Wits and Wagers.
Nothing can guarantee that your honored elder will not end up among the two-thirds of hospital delirium sufferers who do not improve. But by following these steps and doing other things to help provide cognitive and social stimulation, you can significantly reduce the chances of a worst-case scenario.