En español | Before you're admitted to a hospital for surgery or another procedure, you probably think about what to do (or what to avoid doing) and what to bring (or not bring) to optimize your comfort, safety and the treatment results. That's all well and good, but there's an emerging consideration that may not be on your radar screen: Taking precautions to prevent delirium — sudden change in your thinking, mood or behavior — from occurring while you're there.
Admittedly, delirium can strike someone at any age, but it's most common among older adults, affecting as many as 50 percent of people 65-plus following a hospital admission in the U.S., according to the just-released Global Council on Brain Health (GCBH) report.
Fortunately, the condition is preventable in as many as 40 percent of cases. But “right now we do not inform older patients when they come for surgery that delirium or post-operative cognitive decline is a possible complication,” says Roderic Eckenhoff, M.D., Austin Lamont Professor of Anesthesia and vice chair for research and faculty development at the University of Pennsylvania Perelman School of Medicine. There's a move to make this notification mandatory — and to encourage people to take simple steps to reduce their risk of getting delirium and protect their brain health for the long haul.
In the meantime, here's what you should do.
Before you go to the hospital
Health care providers are increasingly recommending prehabilitation (aka prehab) for any planned hospitalization, which is basically like rehabilitation that's performed before a surgical procedure rather than after. The idea is to prepare for surgery as if you are training for a sporting event by building up your physical and mental stamina and resilience. “Physical and cognitive health are linked — if your cardiovascular function improves, then your cognitive health may improve,” Eckenhoff says.
The key components of prehab include improving cardiovascular and muscle strength and endurance with regular exercise that's appropriate for your condition; sticking with a balanced, healthy diet; curbing your alcohol intake; staying well-hydrated; avoiding smoking; and getting plenty of good, quality sleep (at least eight hours per night). All of these measures contribute to improving circulation, reducing systemic inflammation and promoting a healthy microbiome, each of which is beneficial for brain health, Eckenhoff notes.
In particular, “sleep is critical because that's when junk and waste from the day are removed from the brain through the glymphatic system,” says E. Wesley Ely, M.D., codirector of the Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center at Vanderbilt University in Nashville, Tennessee. Besides being important for overall cognitive function, getting sufficient sleep also may help you stay better-oriented to your surroundings and be less susceptible to becoming confused while you're at the hospital.
Meanwhile, to improve mental agility, it may help to engage in cognitively challenging activities — such as doing crossword puzzles, word puzzles and Sudoku, or playing backgammon, Ely says. In other words, keep your brain active to help yourself stay sharp and alert.
Before having surgery, spend time reviewing your medication protocol — including any over-the-counter drugs and dietary supplements you take — with your physician “to make sure there's nothing onboard that increases the risk for delirium or other cognitive disorders,” Eckenhoff says. “Something doctors often give with a knee-jerk reflex is Benadryl, but we need to be careful with it for older patients.”
Indeed, before having surgery, your doctor may advise you to avoid taking certain antihistamines, sedatives, narcotics, benzodiazepines, anticholinergics and other psychoactive drugs that can harm sleep and increase confusion.
"Psychoactive medications increase the risk of delirium when they're associated with the stress of a hospital stay,” Eckenhoff says. Moreover, there's a concern that “those drugs alter your brain's neurotransmitters, and when neurotransmitters are out of balance, that's when you go into delirium,” Ely adds. But don't go off any prescribed medication without getting your doctor's OK.
With any medication you're taking, talk to your doctor about whether it's safe for you to continue taking it up until and through the hospitalization. In some instances, “if the regimen gets altered, that may contribute to delirium,” says Ronald Petersen, M.D., director of the Mayo Clinic Alzheimer's Disease Research Center in Rochester, Minnesota.
Also, be sure to tell your physician if you have a previous history of delirium episodes, cognitive impairment, trauma to the head, seizures or depression, because any of these conditions can increase the risk of delirium. If the health care team is aware of this history, it may alter the medications you're given or monitor you more closely, Petersen says.
At the hospital
Make a plan ahead of time for how and when you'll get your glasses, hearing aids or dentures back after the procedure or treatment. This will help improve your ability to perceive and interact with your environment after an illness or injury, Eckenhoff says.
Make an effort to personalize your room. If you bring photographs, reading material, music you like or other familiar items from home to your hospital room, having these things nearby will help you feel more connected to your regular life. Similarly, having family members and friends keep you company can help prevent delirium, Eckenhoff says. “Keep someone familiar with you at all times” — even overnight. Besides being a valuable source of assistance and support, having family members or friends with you can help you stay oriented to the here and now.
After surgery or another procedure, try to get back to a normal routine — eating healthy foods; drinking water; going to the bathroom regularly; and sleeping regularly, in particular — as soon as possible. Also, try to get mobilized by going for a walk (with assistance) in the hospital. And expose yourself to sunlight, even if it means sitting by a sun-drenched window during the day, because “sleep-wake cycles can get all messed up in the hospital,” Petersen warns.
Taking these steps can help you return to the proper day-night schedule and feel oriented to where you are — so that you can get on with the business of recovering.