Post-Operative Delirium and Older Adults: What You Need to Know

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The doctors have alerted you that your loved one’s surgery was a success. You feel a sigh of relief, but when they return to their room, they are not the same clear-headed, rational person who went into the operating room hours ago.

They are disoriented, agitated and are even experiencing frightening hallucinations. This scenario is all too real for many—especially older adults—after surgery. It’s referred to as post-operative delirium and can last anywhere from a few days to several months.

“So many people don’t know about this, but it’s a big, big thing,” said Jennifer Howland, a speech language pathologist at AnMed Health Rehabilitation Hospital, an Affiliate Entity of AnMed Health and Encompass Health. “Elderly people are at a higher risk; they’re also at risk for it lasting longer.”

What is Delirium?

Delirium is the sudden change of a person’s mental state that results in confusion and disorientation. It is most common in older adults, especially post-surgery or during an illness.

Symptoms of delirium are similar to dementia symptoms, but Howland said there is one major difference.

“Delirium is an acute onset; dementia is progressive,” she said. “For dementia, it just continues to get worse over time. Delirium improves some days and is worse others.”

In addition to the sudden onset, delirium symptoms include:

  • Confusion
  • Disorientation
  • Agitation
  • Drowsiness
  • Impaired attention
  • Disorganized speech
  • Delusions and hallucinations

What Causes Post-Operative Delirium?

As the brain ages, it makes it more difficult to ward off the effects of the anesthesia required for surgery. This is why the older you get, the more likely you are to experience delirium after surgery.

There are also certain conditions that could increase your risk of post-operative delirium. They include heart disease, Alzheimer’s, Parkinson’s and a history of stroke, to name a few.

How Long Does Post-Op Delirium Last?

Post-op delirium can last anywhere from a few days to several months. Howland said because of that, you need to make sure your loved one has someone there to help them should they still be experiencing symptoms after they leave the hospital.

“Make sure there is someone there to help with their medications and finances and drive them around because they might not be able to do those things for a very long time,” she said.

If your loved one is experiencing a lengthy period of post-operative delirium, it is possible that it has moved from an acute condition to a chronic one. “It is possible that patients will move from acute post-op delerium to mild cognitive impairment and eventually to dementia,” Howland said. “We think this is particularly true in cases where a mild and possibly undiagnosed dementia existed before the surgery.”

Is Delirium After Surgery Preventable?

There are some steps you can take to reduce the risk or severity of delirium after surgery. Howland suggests talking with your doctor beforehand to discuss all medications, even over-the-counter ones, you are taking prior to surgery to ensure none of them will make you more susceptible to post-op delirium.

The American Geriatrics Society Clinical Guideline for Post-Operative Delirium also suggests the following after surgery:

  • Reorient your loved one multiple times a day by reminding them where they are and why.
  • Make sure they stay hydrated and drink lots of water. Dehydration in older adults can lead to or worsen delirium.
  • Make sure their pain is under control, but avoid opioids. Ask your physician about other options to manage their pain.

If your loved one is experiencing post-operative delirium, Howland said there are things you can do to reassure them and keep them comfortable.

“You can make things familiar to them,” she said. “Bring in a blanket or pillow from their home, their rosary or music. Also, make sure they have things like their glasses, dentures and hearing aids. Those things are huge. Lots of families keep them at home because they don’t want them to get lost, and that’s a real concern. If an older person can’t hear the hospital personnel, they’re going to be that much more confused.”

What to Do If It Does Become Chronic?

If the delirium lasts long enough, Howland said it may become classified as chronic. At that time, she said a speech language pathologist could work with them to improve their cognition and memory.

SLPs can also help them with managing some daily tasks, such as their finances and medication management.

The content of this site is for informational purposes only and should not be taken as professional medical advice. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding any medical conditions or treatments.