When patients are hospitalized, recovering from surgery, or taking narcotic pain medicine, delirium is a potential complication that can prolong recovery. New polling by AARP shows while most health professionals understand this risk, patients are largely unaware of the symptoms or ways to prevent this unsettling condition, which can have lasting health implications.
This abrupt change in the brain can hinder thinking, remembering, sleep, and focus. People over 65 are at greater risk of experiencing delirium, as are those with heart disease, diabetes, and kidney disease.
A national survey by AARP of Americans over 50 found that only about one quarter are familiar with delirium. Those who had personal experience with delirium most often experienced it when they were in the hospital for elective surgery (41%) or illness (32%). About one-third of those who had experienced delirium reported longer hospital stays because of the disorienting brain fog. Those additional days can translate into an increase in health care spending.
Meanwhile, in an AARP companion survey, most health care providers were very familiar with delirium, but one in five were not aware that being overly sleepy or compliant was a symptom. The most common symptoms of delirium — saying things that don’t make sense and having difficulty understanding what’s going on — were frightening to 44 percent of those who experienced it and 63 percent of those watching loved ones in the state of confusion, the survey found.
Awareness Doesn’t Match Risk
One in five health care providers report at least one quarter of their patients have experienced long-term effects of delirium. Nearly four in ten adults who experienced delirium said they have lasting effects at least to a small degree. Risk factors associated with delirium include sensory impairment, uncontrolled pain, and depression.
Just 4 percent of patients report that their health care provider explained the possibility of delirium to them prior to their hospitalization. Nearly six in ten adults were either not informed about strategies to prevent delirium or were unsure they were told, AARP discovered. More than one-quarter said their loved one was not aware of any of the strategies.
The treatments that did help? The patients surveyed found the most effective practices to be having a familiar person stay with them as much as possible (41%), having the delirium episode explained (24%), or making sure they ate or drank enough (22%). Simple strategies, such as patients bringing their hearing aids and glasses with them to the hospital, can also be useful.
Providers of health care believe in noninvasive efforts to address delirium; still, the vast majority embrace medications. Four in five health care providers say the use of antipsychotic medication is at least somewhat effective. Yet, the Global Council on Brain Health cites recent studies that indicate other strategies, such as getting patients up and moving, may work just as well and with less risk of side effects.
Improvement Opportunities: Education, Standardized Practices
The AARP polling highlights the need for a better understanding of delirium. Making patients aware of risk prior to a hospitalization and taking steps to prevent or treat delirium can reduce the likelihood of long-term consequences from this potential complication.
Those who reported suffering delirium said that they believed their overall health—and their brain health—was not as good as others who had not experienced the condition. In the long term, delirium can impair memory or cause depression, confusion, or loss of motivation. Delirium sufferers are also more likely to suffer from pain and arthritis, and have mental health concerns.
Most health care providers agree that delirium is a serious complication of hospitalization or surgery (78%), according to AARP polling, and they think hospitals should implement strategies to prevent it as standard practice. Most believe hospitals should adopt measures such as the adoption of standard prevention practices, screenings, and better patient education prior to hospitalization or surgical procedures.
Adults want to know about delirium, AARP discovered. The polling found those who become aware of delirium are likely to ask their health care provider about it prior to a hospitalization or surgery.
The AARP surveys were conducted online in November 2019. Data from the 1,015 people in the general population survey of Americans ages 50 and older was weighted for gender, age, race/ethnicity, education, census region, income, home ownership, and metropolitan area. The health care provider survey included 556 physicians, physician assistants, nurse practitioners, registered nurses and therapists (speech, occupational, physical).
Mehegan, Laura, Cheryl Lampkin, and G. Chuck Rainville. 2020 AARP Brain Health and Delirium Survey: Adults Ages 50+. Washington, DC: AARP Research. https://doi.org/10.26419/res.00376.001
Lampkin, Cheryl, Laura Mehegan, and G. Chuck Rainville. 2020 AARP Brain Health and Delirium Survey: Healthcare Providers. Washington, DC: AARP Research. https://doi.org/10.26419/res.00376.002