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G Force

Focusing on delirium in the elderly

“We have to create different models of how we care for older patients. Delirium is a symptom of how we don’t give good hospital care to older people,” said Dr. Sharon Inouye.

Bruce Wahl/BIDMC Media Services

“We have to create different models of how we care for older patients. Delirium is a symptom of how we don’t give good hospital care to older people,” said Dr. Sharon Inouye.

WHO

Dr. Sharon Inouye

WHAT

Inouye, director of the Aging Brain Center at Hebrew SeniorLife and a gerontologist at Beth Israel Deaconess Medical Center, helped write a recent paper in the New England Journal of Medicine about delirium in older surgery patients.

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Q. What does delirium look like?

A. Patients [with delirium] have difficulty keeping track of instructions and conversation. They can appear to be very groggy, disoriented, they may not know the time of day, may not recognize people or remember recent things that happened.

Q. And delirium is far more common among people over 70 than most of us realize?

A. It can range from 20-60 percent [depending on the type of surgery]. Heart surgery, neurosurgery, and some major vascular surgeries are the highest risk. The intensive care unit is an extremely high-risk setting, occurring in as high as 85 percent of patients. Also, up to 60 percent in nursing homes.

Q. What can people do to reduce their, or their loved one’s, risk of delirium?

‘We have to create different models of how we care for older patients. Delirium is a symptom of how we don’t give good hospital care to older people.’

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A. There are 10 tips on the website, www.hospitalelderlife
program.org. The top three would be: to bring a complete list of all your medications and dosages as well as any over-the-counter medications you take — it’s even useful if you can bring in the bottle; bring the names and phone numbers of all your physicians; and bring your glasses, hearing aids, and dentures so you can hear and see and eat.

Q. Why isn't delirium better recognized in hospitals and facilities that cater to older people?

A. There's a tendency to say it's OK for older people to get confused. I think it's a dangerous way to think and it’s causing a lot of harm. This is not a necessary part of getting ill when you’re old.

Q. Do most people recover from delirium on their own?

A. For the most part, delirium tends to reverse itself once the precipitating factors are eliminated or treated. Probably less than 10 percent don't recover to their baseline. [But] the recent New England Journal of Medicine study suggests that the recovery can take much, much longer than we thought — at least 6 months and often up to 12 months.

Q. Having Alzheimer's or dementia increases the risk?

A. If someone has Alzheimer’s disease or dementia they’re about five times more likely to develop delirium in the setting of hospitalization or surgery. They're the ones who are going to turn out to be less likely to recover.

Q. What are the financial costs of delirium?

A. We're probably losing close to $7 billion just on hospital costs and up to $100 billion on post-hospital costs including nursing home stays. If we could decrease those numbers by half, we could take care of the whole health care crisis in this country.

Q. Have you ever had a personal experience with delirium?

A. My father, a physician in California, became delirious. I was already at that point a world expert in delirium. Even sitting at my father’s bedside, I could not prevent the delirium because of the fragmentation of care he was getting. They were all prescribing inappropriate care for him. It just became a nightmare.

Q. If even you couldn’t prevent delirium in your father, what can average people do?

A. We have to educate the entire health care system to make a difference. We have to create different models of how we care for older patients. Delirium is a symptom of how we don’t give good hospital care to older people. I’m working very hard to find alternatives, and how we can change the models of care.

This interview has been edited and condensed. Karen Weintraub can be reached at karen
@karenweintraub.com.
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