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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15 Replies to “Delirium After Surgery is Common in the Elderly”
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!
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.
Hi..I read your email from some time ago. My mom had a knee replacement 17 days ago and on the second day, we noticed a big change in her behavior and personality. She is 84 years old. She doesn’t have the desire to eat or move. Now she may have sepsis. What was supposed to be a wonderful thing to possibly walk again with no pain, turns out to be a nightmare.
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.
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 @ firstname.lastname@example.org PLEASE HELP!!
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.
My mom had a total shoulder replacement surgery 5 days ago and everything went beautifully, and they released her the following day, She lives with us so I have been helping her along, everything has been going good until this morning she was confused and thinking that nothing seemed real and was talking and babbling about the 1940s.. She is 76 years old and for the most part never had these kind of things happen. I remember after her knee surgery a few years back she had an episode and we thought she was having a TIA or stroke, The confusion, and not being able to form her words. I called 911 and she was transported to the ER where many test were done, all showing that nothing had happened that they could tell, TIA’s dont always show up on a Cat Scan… She is on blood thinners so there is always the risk of strokes, and all precautions were taken to prevent strokes with her medications before and after surgery. She was released as is back home, she lives with us so am able to really watch her and observe her. I think she has had a case of this Post Surgery episode, She is mostly normal after today but still not acting like herself. This is a real thing, and I believe this is what she is having. Never knew it even existed but will follow up Monday with her Care Provider.
My brother-in-law had bypass surgery about 2 years ago and was without oxygen for a few min he started seeing things when he came to and has not stopped seeing things, It is not fun to watch them go through that kind of torment. The Doctor has given him meds to try and stop him from seeing what he sees but nothing has helped so far.
Hi All I manage a 50 bed home for those living with dementia. I have a Masters Degree in Dementia Studies my mom had an emergency Gall bladder operation last week and is acting like any resident that I would have sectioned. I’d never heard of this post operative delirium so I’m now at a loss as to what to do. So strange how this just happens over night. Sorry can’t help but need help.
Check the medicines they are giving your loved ones, Protonix (a stomach med) did this to my mother, I told them none of these new type of meds as they are putting ssri’s and snri’s or other strange mind altering stuff in meds now and she had same reaction to another stomach med. It is hard to find information but you can find in the clinical trials or fda.gov, look for side effects of dementia, confusion, depression, hallucinations. Also beware, many meds are the same under different names. Stomach meds causing dementia, yes, also causing Parkinson’s, if commercials say “may cause suicide” pay attention.
I have read all of the post op delirium (POD) stories here, thanks for sharing. Now I feel compelled to share mine. I am a geriatric social worker, have always taken care of people, mainly my mother who is now 87. She has a long psych history of depression…fast forward she had a knee replacement 5days ago. She blew us and the docs away with her agility and 60°range of motion by the 2nd day. Unfortunately the 1st mishap was the nurse mistakenly administered one of her morning meds to her at night. Omg, I flipped out as it was Ritalin which kept her up ALL night, causing her worse ado with trying to keep her days and nights straight. Fyi this is not your typical 87 yr old. My mom was sharp as a tack, texted regularly on her iphone, was a writer for Dallas Morning News for 45years, edited several published books and journals so her mind was very busy, retired at 85 . 3rd day post op, she was completely, over the top delusional. I noticed they added several pain meds to her regimen… Lyrica, Toradol and Celebrex…I did my own research, asked them to stop them all except the Celebrex as I couldn’t find any contraindications with it, only ramifications of Lyrica and Toradol in conjunction with her other meds. By 4pm on day 5 after plenty of juices (no water as her sodium was low, potassium and creatnine high) she was 85% better, still confused when asked date of birth, where she was and why. Then, her BP was 178/97, so the nurse asked if she had ever had Clonidine, used as needed to reduce BP spikes. I told her yes but really didn’t want to add anything else at this point but then the fear of a stroke crept in as she has had TIAs so she took it. Omg, the delirium was back within 30mins and is still here 6hrs later. My personal opinion for the cause of my mother’s POD is being in a foreign place, lack of hydration &mobility, anesthesia, pain meds, wacky labs, constipation and visitors coming and going. She is unable to relax, sewing with imaginary thread, rolling her gown upwards, climbing out of bed, talking jibberish, pulling on her catheter, the list goes on. She is finally resting, will continue to hydrate, praying for the best possible outcome for my precious mom.
When I was 71 I suffered a heart attack went into hospital and was stented – didn’t work so was booked in a week later when it was possible to get the funds out of my bank for a triple by pass and a stricture operation about a 6 hour op. When I came out of the anaesthetic I had like cockroaches, large ones on the outside and smaller ones framing my vision, going around and around. Did not panic. After this time was not specific but I was sent home. I was very sleep deprived and had no appetite and lost 15kg in 2 weeks. Anyway I then suffered hallucinations – my balcony was full of wild animals very vivid. All the balconies of my neighbouring apartments were full of wild animals. I could live with these. But worse of all were the nightmares which made me afraid to go to sleep. Some were like death defying, very real and terrifying. Anyway the psychiatrist prescribed Rispersal and just after one tablet all this nastiness was gone. Believe me what an incredible relief. I think all medics should ask their patients if they are suffering hallucinations and/or nightmares, because in my experience it was simply put right with just one tablet. Good luck.
My mom went psycho after surgery. She called me vile names and would not allow me in her hospital room. However, when my brother and his family came to see her, she was as nice as could be. When I tried to go into her room with them, she screamed for me to leave. She did the same thing years earlier following another surgery. I will never completely forgive her because of the horrible things she called me. I really don’t care whether she was out of her mind or not. When people act horribly to you, they always blame it on sickness, drugs, or alcohol like that will make it all right. It doesn’t.