Protecting the brain after surgery and hospitalization | Alzheimer's Prevention Registry

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May 20, 2020

Protecting the brain after surgery and hospitalization

By Alzheimer's Prevention Bulletin

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There’s a good chance you’ve watched an older friend or relative struggle with delirium. Perhaps they had trouble recovering after surgery, exhibiting signs of confusion or changes in thinking. Or maybe a move from home to assisted living brought on behavior that was strange or unusual for them.

Your friend or relative was most likely experiencing delirium. The Global Council on Brain Health defines delirium as a serious medical condition that results in a sudden change in thinking and behavior. It is different from dementia or Alzheimer’s since it comes on suddenly and not over a long period of time like dementia.

The Global Council on Brain Health (GCBH) convened a group of experts to explore the impact of delirium on people age 50 and older. Their review of current research led to recommendations for patients, caregivers and medical professionals to reduce the risk of delirium.

What is delirium?

Delirium can affect people of all ages, but it is most common in older adults. In fact, as many as half of all Americans 65 and older will experience delirium during or after a hospital stay, especially after surgery or severe illness. Risk factors include age, dementia, Parkinson’s, cognitive impairment, heart disease and depression.

Delirium causes the brain to work differently, often as a response a physical trauma such as surgery, infection or illness. In older adults it can also occur from a change in medication or a move from one location to another.

The symptoms can include confusion, inattention, agitation, hallucinations and a temporary change in personality. People often feel frightened or disoriented or just don’t seem themselves. Many people recover but the experience can have a long-term effect on memory and thinking skills and psychological health. This is especially true for those with Alzheimer’s or other forms of dementia. 

Delirium can be a sign of other health conditions. It doesn’t just happen in the hospital; it can occur at home or in a care facility. Delirium can lead to problems such as difficulty with self-care, falls, loss of independence, long-term declines in memory and thinking, and even death.

The GCBH report shows there is good news in the delirium story. More than 40 percent of cases can be prevented by taking simple steps to prepare for hospital visits.

Reducing risk before a hospital stay

  • Build up your physical and metal resilience by eating well, exercising and getting adequate sleep.
  • Ask your doctor about your delirium risk.
  • Before surgery, tell your doctor about all the medications you are taking.
  • While in the hospital:
    • Bring a list of all medications including vitamins and supplements.
    • Bring hearing aids, dentures and prescription glasses.
    • Ask a friend or family member to stay with you at all times, even through the night.
    • Bring familiar, comforting objects like a favorite pillow or music.
    • Try to establish a normal routine of eating, drinking water and sleeping.
    • Get some exposure to sunlight.
    • Keep your room quiet by closing the door.
    • Ask for help whenever you need it.
    • Ask your nurse if you can get moving as soon as possible by sitting up, walking and using the bathroom.

Recommendations for caregivers

  • Be an advocate for your loved one. Speak up if you notice a change in behavior or mental status.
  • Help your loved one keep as close to a normal schedule as possible.  Talk to them about where they are, what day and time it is, and why they are in the hospital.
  • Help them move as much as is allowed.
  • Ask questions about prescribed medications.
  • Delirium can last beyond the hospital stay. Look for sudden changes in behavior after your loved one has returned home.
  • Don’t argue or correct a person with delirium as it can increase agitation. Try not to overwhelm them. Keep instructions simple and only ask them to do one thing at a time.

Medical professionals are more aware of delirium than ever before. But more research is needed to understand why and how delirium occurs, how to prevent it and what can be done to lessen the severity and duration.  In the meantime, recommendations from the GCBH report can help reduce the incidence of delirium now.

As the GCBH report concludes: “If we can learn to prevent or at least ward off the negative effects of delirium we may be able to alleviate the suffering of millions of people around the world, help protect them from serious and sometimes long-lasting harm, and save billions of healthcare dollars.”