Delirium After Surgery is Common in the Elderly

A senior couple at home. (iStockphoto/Thinkstock)
A senior couple at home. (iStockphoto/Thinkstock)

A dictionary defines delirium as a temporary state of mental confusion resulting from high fever, intoxication, shock or other causes, and characterized by anxiety, disorientation, memory impairment, hallucinations, trembling and incoherent speech.

Delirium after surgery under general anaesthetic is common in the elderly. Approximately half of all operations performed in North America are in patients greater than 65 years of age. This number is expected to increase as the population of elderly increases. Older adults represent a unique challenge to the surgeon, often presenting with multiple medical illnesses and higher risk for post-surgical complications, says an article in the Journal of the American College of Surgeons (JACS).

The incidence of delirium in various studies varies from nine per cent to 87 per cent. The development of delirium is associated with increased death rate, increased length of stay in the hospital and an increased rate of discharge to long term care facilities. Delirium is also associated with increased risk of major medical complications including heart attack, build up of fluid in the lungs, pneumonia, and respiratory failure.

Studies have also found that post-surgical delirium predicts future cognitive (mental processes of perception, memory, judgment and reasoning) decline and an increased risk of dementia. Delirium is not always easy to recognize and may be confused with other conditions common among the elderly such as dementia or depression.

Delirium is a complex phenomenon, often involving multiple factors to trigger the problem and likely affecting multiple spheres of the central nervous system. Some of the common factors responsible for post-surgical dementia are lack of oxygen, low blood sugar level, electrolyte imbalances, body fluid depletion, infection and drug interactions.

A surgeon has to remember that pain is a common post-surgical complaint and delirious patients may not be able to effectively communicate with providers about pain. Both under treatment of pain and overuse of narcotics can make delirium worse and makes postoperative pain management a challenge.

Which elderly patient is at high risk of developing post-surgical delirium?

One study identified seven predictors that could be used preoperatively to assess an individual patient’s risk of delirium. These factors include age greater than 70 years, self-reported alcohol abuse, poor cognitive status, poor functional status, abnormalities of serum sodium, potassium or glucose, non-cardiac thoracic surgery or abdominal aneurysm surgery, says the JACS article.

The strongest predictors of postoperative delirium are the presence of preexisting cognitive dysfunction, advanced age and multiple medical comorbidities. To reduce the incidence of postoperative delirium, hospitals should identify patients at risk, have good geriatrics pre-operative consultation services and assign patients to multidisciplinary teams of providers with experience caring for elderly patients.

JACS article says that despite the best preventive efforts, a certain percentage of patients will become delirious in the postoperative period. It is important to identify and treat underlying causes, along with emphasizing non-pharmacologic interventions to decrease severity and duration of delirium.

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Comments

  1. My father’s situation is similar to those above. Do any of these people ave a positive update?

    • Hi, I have read so many of the comments posted and I can honestly say I feel everyone’s pain. My mother fell and broke her hip 2 years ago and I knew immediately after her surgery something was wrong. She was in the hospital for 12 days and the entire time she hallucinated which will send any child into a panic attack. The doctors told me that she was suffering from delerium and treated her with a drug called “Haldoz” it seemed to calm most of hallucinations down but she still continued to be completely paranoid. We brought my mom home and all of her hallucinations completely stopped “BUT” we didn’t realize how she mentally declined until we watched her count her money and she could no longer count anymore, she couldn’t write a check anymore, fold clothes, remember recipes, play cards etc…Well needless to say I took her to a Neurologist and they told me my mother developed Vascular Dementia from her surgery which is irreversible. Well I did my own research and what I discovered was my mother more likely developed Post Operative Cognitive Disorder which is when elderly patients go under anthestic and pain meds the brain can’t tolerate either of them like it used to which sadly puts them at such risk for any surgery. It has been almost two years and my mother has not improved, I wish I could shed some light on some of the comments posted, but from my experience she has remained the same since surgery. Although she still remembers everyone she comes in contact with and she still has a pretty descent memory, her COGNITIVE SKILLS have significantly declined. I do wish the best to everyone and you are in my prayers.

  2. rudy rodriguez says:

    Hello i am 19 year old and my mother ut went under a gastric bypass and after her sergery she no longer had a state of mind. she constantly say he is in pain and just say “ok, ok” nothing more nothing less she has told me she “loved me” a couple of times and has said her name once. my mother was a very sharp person and has been under many other sergerys and has never acted like this. if anyone can feed me some advice or tell me something i may not know pleae message me @ rudyrodriguez1993@yahoo.com PLEASE HELP!!

  3. My father in law (85 years old)just had knee surgery and a week later he is Continuing to have hallucinations and delusional thinking. He recognizes us but thinks the hospital is his workplace and is looking for his cheque. He seemed more lucid right after the surgery. The hospital has him on antibiotics and is talking about a possible blood transfusion. Was this suggested in any of your cases?

    • My father had a pacemaker put in. He was finr that day but that night he started hallucinating. They gave him some kind of psychotropic drug and has improved. Its been three days since the surgery.,hes better but not back to normal…scary.

  4. Anna Gastaldello says:

    I am so grateful in a way that I have read your story. Unfortunately my 86 Mother had bi-lateral knee reconstruction six weeks ago and is now in rehab. From the day after surgery we knew there was something wrong. She could not remember who had been to see her, what food she had eaten, often saying she had been left alone on her bed in the carpark without a blanket. Now six weeks on her mind is in a terrible state. She remembers her children but no-one else, often telling me she had been speaking her to dead Brother. I would love to know if anyone can give me some good news in relation to the time it takes to get back to some sort of normality. I feel your pain. What was supposed to be a life improving surgery has ended up the worst thing we ever could have done.

  5. My father is currently delirious after having shoulder surgery. He’s 74 years old and he was drinking at least 3 beers per day, as well as NyQuil each night to help him sleep. I warned the hospital before they did surgery that he was at risk for delirium, but these people just do not read charts and do as they please!! My father is now in and out of his mind, so to speak, and he’s there and then he’s not. He kept calling my son, his favorite grandson, mind you, Dustin. My son’s name is Nick…my father’s oldest grandson is Dustin! :( It’s been three weeks now and he’s still confused at times, mumbles crazy, off-the-wall stuff, and is just not acting himself at all! My father was 100% cognitively intact before the surgery. He could tell you the exact amount of money in his wallet, he knew everyone’s names, and he knew where he lived. He easily recalled things in the past – now he can’t even tell us how much his social security checks are for each month!!

    I sure wish this article included treatment/s for patients who are currently suffering delirium and how long it could possibly last. My father is in rehab now because his legs got so weak after the surgery that he can’t even go to the bathroom by himself. I tried to handle him myself for a few days, but I just could not do the diaper changes and washes that he required, in addition to feeding him and making him drink fluids. I just have too many kids (6 in all; two of them are CPS kids), and am currently 11 weeks pregnant. Home nursing costs 300 per week and that’s for only 4 hours per day (not including weekends!!).

    If anyone has information regarding how to help get my father cognitively (back) intact, I would be forever grateful!

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