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En español | In June 2018, Julia Herzenberg learned that her 73-year-old father was scheduled to have his gallbladder taken out and stones removed from his pancreas. So she flew from her home in northern California to New York to be at his side and serve as his advocate in the hospital.
The surgery went well and her dad seemed fine afterward, so Herzenberg and her brother slipped out for lunch while a friend stayed with their dad. When she got back an hour later, she noticed her father's shoes were up on the windowsill rather than on the floor.
"He was convinced that ants were crawling in his shoes and that the nurses were lying to him,” recalls Herzenberg, a project manager at Kaiser Permanente in Oakland, California. “He had become argumentative with them, which was unusual for him. His behavior was a little scary to me.”
Herzenberg quickly realized that her father was experiencing delirium, a potentially serious condition that involves a sudden change in thinking and behavior; it is the most common surgical complication for older adults, according to a just-released Global Council on Brain Health (GCBH) report. She immediately let the nurses know and they decreased his pain medication. She also gave him his glasses to help him become better oriented to where he was and what was happening around him. Within a couple of hours, her father was back to his usual self.
As Herzenberg discovered, having a family member experience delirium can be an upsetting experience — and one that requires prompt action. Fortunately, she knew the signs to look for, which experts say is crucial, especially because hospital staff members may not recognize delirium right away. Caregivers know their family members far better than anyone on the health care team does, so it's important for loved ones to be attuned to early signs of delirium.
Know the signs, know how to respond
"What you want to look for are changes in your relative's alertness, ability to focus and pay attention, and track with you in a conversation, compared to how they usually are,” says geriatrician Jason Karlawish, a professor of medicine at the University of Pennsylvania School of Medicine and codirector of the Penn Memory Center.
There are two main types of delirium: the hypoactive form, which is characterized by lethargy, drowsiness and inattentiveness; and the hyperactive form, which is characterized by restlessness, agitation, hypervigilance, mood changes, and sometimes delusions or hallucinations. Complicating matters, some people develop a mixed type of delirium, in which they switch back and forth between being lethargic and agitated.
Sometimes these symptoms may not emerge until a patient is discharged from the hospital, according to the GCBH report. If you see any of these changes in your loved one, notify a medical professional right away.
"Caregivers should not be bashful — they should have a low bar for contacting a medical professional about this,” says pulmonologist E. Wesley Ely, codirector of the Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center at Vanderbilt University in Nashville.
Once hospital staff members become aware of these changes, “politely question what's currently being done for the patient and what they're going to do about the delirium,” Karlawish advises. A medical professional should review the medications and treatments that are being administered to your loved one to see which might be contributing to the delirium, and check for electrolyte imbalances, dehydration, infection, or exacerbation of a lung or heart disease, any of which can trigger delirium.
How to help a loved one come back from delirium
In the meantime, focus your efforts on reorienting your loved one to time and place: Make sure your family member has their glasses, hearing aids and mobility devices (such as a cane) handy; then calmly ask questions such as, “Do you know what day it is?” and “Do you know where you are and why you're here?” To help your loved one feel connected to their life, you might share news about other family members and friends or show pictures of people they're close to.
Stay with your loved one. “Someone with delirium should never be left alone,” Karlawish says. “The presence of someone familiar is quite valuable in and of itself.”
If it's safe for your loved one to walk around, help them to do so — or at least move from the bed to a chair. If your loved one is hungry, help them eat or have fluids. “The sooner you can normalize that person's behavior and environment, the better the chances are of minimizing the length of the [delirium] episode,” says neurologist Ronald Petersen, director of the Mayo Clinic Alzheimer's Disease Center in Rochester, Minnesota.
Watch for signs
In the days and weeks that follow, keep a close eye on your loved one, and remember that symptoms of delirium may recur, especially in the evenings. To prevent complications down the road, encourage your loved one to get back to a steady eating regimen and consistent sleep-wake schedule, and to reengage in activities (such as playing word games, doing puzzles or watching game shows on TV) that they used to enjoy.
"Pay particular attention to cognitive activities such as managing finances and driving, which are the most likely to be impacted” by delirium, Karlawish says.
If you notice that your loved one hasn't fully bounced back, cognitively speaking, “tell the person that it's extremely common to have a little detriment to cognitive function after surgery and that they might feel depressed or have some nightmares,” Ely says.
Talk with the patient and with health care providers
"Encourage the person to talk about these things and not keep them bottled up,” he adds. But also follow up with your loved one's physician or a post-hospital clinic to see if their medications should be adjusted or if he or she would benefit from other services.
In the future, make sure every medical professional who treats your loved one knows about the delirium. “If they know of a prior episode, the health care team might alter the doses and types of medications or the dose of anesthesia that's given to the patient,” Petersen says, with the hope of preventing another one.
Herzenberg is well aware of this issue. “I'm afraid of my dad having any procedure with anesthesia without my being there,” she says, “because he's susceptible to having this happen again.”