I get a big kick of this video every time I see it. It’s a YouTube about people who are 100 years old who are funny, wise, and talented. It’s included on the SSM Health St. Mary’s Hospital YouTube channel. St. Mary’s Hospital is in Madison, Wisconsin. I worked as a psychiatrist there very briefly a long time ago.
However, the other thing this video brings to mind is something sad. I see patients half my age (nowhere near 100) almost every day in the hospital who are delirious, sometimes for prolonged periods of time. According to the medical literature, they will be at risk for developing dementia and not infrequently do. In fact, research tends to show that for every day someone spends delirious, the risk for developing dementia goes up 35%. That makes delirium a life-limiting condition which can happen to anyone at any age.
I got delirious after a routine colonoscopy, a procedure to screen for colon cancer and other pre-cancerous tumors that used to be routinely recommended for those who reach 50. It was the worst 50th birthday present a guy could ever get.
I was delirious probably because I got sedated with a combination of Versed and Demerol. The worst part of the condition probably lasted only a couple of hours at most following the procedure. But I was sure wiped out the rest of the day.
I would have a tough time picking out the worst part of the whole process, the bowel prep (guzzling a big jug of GoLytely which should be called GoHeavily) or enduring the post-procedure delirium. It was probably the latter.
I don’t remember much. My wife tells me that I kept repeating something about not taking NSAIDs. I think there was something about that in the informed consent and education materials that got sort of stuck in one of my neurons. I kept sliding down in bed while I was in the recovery room, which I was in for a little while longer than is usually expected.
Preventing delirium is a vital job for health care professionals everywhere. We can’t prevent each and every case, but there are definitely things we can do to mitigate the problem. One of the most important goals is to try to minimize or avoid the use of certain offending drugs such as anticholinergic and sedative-hypnotic agents.
It’s also good to remember that the population at highest risk for getting delirious is the elderly and those who already may have cognitive impairment.
Preventing delirium, based on current literature, means first implementing non-pharmacologic multicomponent interventions. These may require a large cadre of volunteers. The best example is the Hospital Elder Life Program (HELP) at Yale, which is copyrighted by Dr. Sharon Inouye. Six of the most important features to address:
–Normalizing electrolytes such as sodium and keeping patients well-hydrated
–Mobilizing patients as much as possible, including getting immobilizing devices such as foley catheters removed as early as you can
–Making sure sensory aids such as eyeglasses and hearing aids are available
–Ensuring that medications are monitored so as to minimize exposure to drugs that are anticholinergic or sedating.
Anyway, working on preventing delirium and minimizing its impact is an ongoing challenge. Keep the goal in mind: We want as many people as possible to live well to 100.