What Surgical Patients Should Know About Delirium
What Surgical Patients Should Know About Delirium Brain Health & Wellness
In the meantime, here's what you should do.
With any medication you're taking, talk to your doctor about whether it's safe for you to continue taking it up until and through the hospitalization. In some instances, “if the regimen gets altered, that may contribute to delirium,” says Ronald Petersen, M.D., director of the Mayo Clinic Alzheimer's Disease Research Center in Rochester, Minnesota. Also, be sure to tell your physician if you have a previous history of delirium episodes, cognitive impairment, trauma to the head, seizures or depression, because any of these conditions can increase the risk of delirium. If the health care team is aware of this history, it may alter the medications you're given or monitor you more closely, Petersen says.
How to Prepare for a Hospital Stay to Prevent Delirium
Planning and packing tips to help protect your brain health
Getty Images Before you're admitted to a hospital for surgery or another procedure, you probably think about what to do (or what to avoid doing) and what to bring (or not bring) to optimize your comfort, safety and the treatment results. That's all well and good, but there's an emerging consideration that may not be on your radar screen: Taking precautions to prevent delirium — sudden change in your thinking, mood or behavior — from occurring while you're there. Admittedly, delirium can strike someone at any age, but it's most common among older adults, affecting as many as 50 percent of people 65-plus following a hospital admission in the U.S., according to the just-released Fortunately, the condition is preventable in as many as 40 percent of cases. But “right now we do not inform older patients when they come for surgery that delirium or post-operative cognitive decline is a possible complication,” says Roderic Eckenhoff, M.D., Austin Lamont Professor of Anesthesia and vice chair for research and faculty development at the University of Pennsylvania Perelman School of Medicine. There's a move to make this notification mandatory — and to encourage people to take simple steps to reduce their risk of getting delirium and protect their brain health for the long haul.In the meantime, here's what you should do.
Before you go to the hospital
Health care providers are increasingly recommending prehabilitation (aka prehab) for any planned hospitalization, which is basically like rehabilitation that's performed before a surgical procedure rather than after. The idea is to as if you are training for a sporting event by building up your physical and mental stamina and resilience. “Physical and cognitive health are linked — if your cardiovascular function improves, then your cognitive health may improve,” Eckenhoff says. The key components of prehab include improving cardiovascular and and endurance with regular exercise that's appropriate for your condition; sticking with a balanced, healthy diet; curbing your alcohol intake; staying well-hydrated; avoiding smoking; and getting plenty of good, quality sleep (at least eight hours per night). All of these measures contribute to improving circulation, and promoting a healthy microbiome, each of which is beneficial for brain health, Eckenhoff notes. In particular, “ because that's when junk and waste from the day are removed from the brain through the glymphatic system,” says E. Wesley Ely, M.D., codirector of the Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center at Vanderbilt University in Nashville, Tennessee. Besides being important for overall cognitive function, getting sufficient sleep also may help you stay better-oriented to your surroundings and be less susceptible to becoming confused while you're at the hospital. Prepare for surgery as if you are training for a sporting event by building up your physical and mental stamina and resilience. Meanwhile, to improve mental agility, it may — such as doing crossword puzzles, word puzzles and Sudoku, or playing backgammon, Ely says. In other words, keep your brain active to help yourself stay sharp and alert. Before having surgery, spend time reviewing your medication protocol — including any over-the-counter drugs and dietary supplements you take — with your physician “to make sure there's nothing onboard that increases the risk for delirium or other cognitive disorders,” Eckenhoff says. “Something doctors often give with a knee-jerk reflex is Benadryl, but we need to be careful with it for older patients.” Indeed, before having surgery, your doctor may advise you to avoid taking certain antihistamines, sedatives, narcotics, benzodiazepines, anticholinergics and other psychoactive drugs that can harm sleep and increase confusion. "Psychoactive medications increase the risk of delirium when they're associated with the stress of a hospital stay,” Eckenhoff says. Moreover, there's a concern that “those drugs alter your brain's neurotransmitters, and when neurotransmitters are out of balance, that's when you go into delirium,” Ely adds. But don't go off any prescribed medication without getting your doctor's OK.With any medication you're taking, talk to your doctor about whether it's safe for you to continue taking it up until and through the hospitalization. In some instances, “if the regimen gets altered, that may contribute to delirium,” says Ronald Petersen, M.D., director of the Mayo Clinic Alzheimer's Disease Research Center in Rochester, Minnesota. Also, be sure to tell your physician if you have a previous history of delirium episodes, cognitive impairment, trauma to the head, seizures or depression, because any of these conditions can increase the risk of delirium. If the health care team is aware of this history, it may alter the medications you're given or monitor you more closely, Petersen says.