Sim­ple steps help pre­vent hos­pi­tal delir­ium

Daily Freeman (Kingston, NY) - - YOUR DAILY BREAK - An­thony Ko­maroff Ask Dr. K

The last time my mother was in the hos­pi­tal, she ex­pe­ri­enced delir­ium. Given her age and state of health, it’s likely she will be hos­pi­tal­ized again. Is there any­thing I can do to pre­vent her from be­com­ing deliri­ous the next time?

About half of peo­ple over 65 ex­pe­ri­ence delir­ium — a sud­den change in men­tal sta­tus — dur­ing a hos­pi­tal stay. This trou­bling ex­pe­ri­ence in­creases their risk for cog­ni­tive im­pair­ment and de­men­tia af­ter their re­lease.

It’s easy to un­der­stand why hos­pi­tal­iza­tion can be dis­ori­ent­ing. Pa­tients’ daily rou­tines are over­turned. Sud­denly they’re deal­ing with a stream of peo­ple they’ve prob­a­bly never met be­fore. Be­cause of noise, and be­ing awak­ened for a treat­ment or a test, it’s hard to sleep through the night. Med­i­ca­tions can also af­fect their men­tal state. As we age, it be­comes even more dif­fi­cult to adapt to th­ese dis­rup­tions.

Dr. Sharon Inouye is a professor of medicine at Har­vard Med­i­cal School. Decades ago, she rec­og­nized that delir­ium in older pa­tients isn’t in­evitable. She and her col­leagues de­signed a delir­ium-prevention pro­gram called the Hos­pi­tal El­der Life Pro­gram (HELP).

HELP iden­ti­fies pa­tients at risk for delir­ium and pro­vides them with spe­cial care to min­i­mize the main risk fac­tors for delir­ium dur­ing their hos­pi­tal stay. Th­ese risk fac­tors in­clude sleep de­pri­va­tion, im­mo­bil­ity, vis­ual im­pair­ment, hear­ing im­pair­ment and de­hy­dra­tion.

HELP doesn’t just re­duce the in­ci­dence of delir­ium dur­ing hos­pi­tal­iza­tion. It also helps pre­vent falls, men­tal and phys­i­cal de­clines, and the need for nurs­ing home care. That’s be­cause it is dur­ing spells when they are deliri­ous that peo­ple climb out of bed, or slip and fall, and frac­ture bones.

If your mother is hos­pi­tal­ized again, ask whether the hos­pi­tal has a delir­ium prevention pro­gram. If not, here are sev­eral things you can do to help: • Keep com­mu­ni­ca­tion sim­ple. In a calm, re­as­sur­ing voice, state one fact at a time, as you have learned the facts from the doc­tors and nurses. Do not over­whelm or over­stim­u­late your mother with too much information.

• Help ori­ent the per­son. If nec­es­sary, re­mind your mother where she is and why. Be sub­tle about it. Don’t ask her if she knows where she is, and why she’s there. In­stead, make com­ments like “I sure like the nice big win­dows here at Gen­eral Hos­pi­tal, don’t you?” Or “You’re go­ing to feel so much bet­ter when the doc­tors here at Gen­eral Hos­pi­tal take out your gall blad­der, Mom.”

• Try a hands-on ap­proach. Gen­tly mas­sage or stroke your mother’s arm or back if she finds that sooth­ing.

• Be a com­pan­ion. Stay in the hos­pi­tal as much as pos­si­ble. Ar­range with family and friends to visit in shifts so some­one can be present around the clock.

• Work with the staff. If al­lowed, en­cour­age your mother to eat and drink. Ac­com­pany her on walks down the hos­pi­tal cor­ri­dor.

• Be vig­i­lant. If you de­tect signs of pos­si­ble delir­ium — con­fu­sion, mem­ory problems, per­son­al­ity changes — dis­cuss them with the med­i­cal staff as soon as you can. Family and friends are of­ten the first to no­tice sub­tle changes.

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