Nursing

Six Tips to Reduce Post-Surgery Confusion in Older Patients

Nurse Leader Insider, March 15, 2018

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By John Commins

The American Society of Anesthesiologists has developed a list of pre- and post-surgery tips to limit confusion for older patients.

"The aging brain is more vulnerable to anesthesia, but there is research that provides guidance to decrease these risks," said ASA President James Grant, MD.

"Older patients should talk with their physician anesthesiologist prior to surgery about their entire medical history and any memory problems they’ve had in the past, so an anesthesia plan can be developed," he said.

In particular, older patients are more susceptible to two anesthesia-related surgery risks, Grant said.

Postoperative delirium is temporary and causes the patient to be confused, disoriented, unaware of their surroundings, and have problems with memory and paying attention. It may not start until a few days after surgery, may come and go, and usually disappears after about a week.

Postoperative cognitive dysfunction is a more serious condition that can lead to long-term memory loss and make it difficult to learn, concentrate and think. Because some of these problems are already common in elderly people, the only way to determine if a patient actually has POCD is to conduct a mental test before surgery, Grant said.

Conditions such as congestive heart failure, lung disease, Alzheimer’s disease, Parkinson’s disease and having had a previous stroke, increase the risk for POCD. 

ASA has put forward six tips that older patients and clinicians can take to reduce post-surgery confusion:
 

  1. The physician should conduct a pre-surgery cognitive test of the patient and use the results as a baseline for comparison after surgery.
  2. A caregiver or family member should stay with patients as they recover to observe physical and mental activity after surgery and report problems to the physician.
  3. Physicians should know beforehand which medications a patient is taking after surgery, especially those medications that can affect the nervous system.
  4. If the patient wears hearing aids or glasses, they should be made available as soon as possible after the procedure.
  5. When possible, the patient should be in a recovery room with a window so they can tell whether it's day or night.
  6. If the patient stays overnight in the hospital, they should pack a family photo, a clock and a calendar, or other familiar objects from home to help readjust.



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