Is your elderly parent very delirious following surgery and you’re scared this means the onset of dementia? Have you read that this is the first phase of permanent cognitive decline?
I’m first going to briefly tell you about my elderly mother’s postoperative delirium, and then tell you what the Department of Geriatrics and Gerontology at the Rowan University School of Osteopathic Medicine says might be the cause.
My mother was 89 when she fell and fractured her hip. The postoperative delirium in her hospital room was significant. Examples:
• Constantly demanding the catheter be removed despite being told by multiple people why it was in.
• Constantly trying to get out of bed despite being told by multiple people why this was not permitted.
• Responding back to the TV—believing TV characters were talking to her.
• Believing a table in the room was her kitchen desk.
• Short term memory impairment.
• Belligerence and hostility.
• Lack of executive reasoning, inability to sustain a rational conversation.
Can postoperative delirium in the elderly go away?
In my mother’s case it lingered over the next few months, gradually diminishing.
Fast-forward a year later: She has full command of the kitchen (food preparation, makes all sorts of dinners, cleans up, keeps things organized), shops independently (groceries, clothes, household items), organizes bridge at her home, plays Scrabble, sews, takes care of her 93-year-old husband, etc.
There are no signs of that frightening postoperative delirium and cognitive impairment.
The big question, then, is what percentage of elderly patients does my mother’s success represent?
What the Rowan University Researchers Found
Sevoflurane is a commonly used anesthetic for general anesthesia. This drug disrupts the blood-brain barrier, which regulates entry and removal of blood components in the brain.
When this happens, “Various plasma components gain access into the brain and selectively bind to pyramidal neurons,” points out Nimish K. Acharya, PhD, lead author of this study, which used animals as subjects.
“This may disrupt normal neuronal activity,” says Dr. Acharya, “and could cause onset of the symptoms that define postoperative delirium.”
As you can see, this explanation is not ground in stone. But it’s a compelling finding with Sevoflurane.
Knowing this, though, won’t subdue the alarm that you may feel over your elderly parent’s postoperative delirium.
There’s no way to predict if it means dementia is around the corner, or if whatever’s causing the delirium has permanently impaired some cognitive skills.
My mother bounced back like a superball. Maybe your parent will too. Maybe they won’t.
Much of it has to do with pre-surgery cognitive functioning and—quite very possibly—postsurgical exercise.
Before the hip fracture, my mother seemed to be experiencing some minor short term memory lapses and less-than-ideal cognitive skills, though she was fully functional.
It was one of those “She’s not where she was 10 years ago” things.
But about four months postoperatively, my mother agreed to let me give her twice-weekly, 30 minute exercise sessions.
Two and a half months later it went down to once a week. Once a week for a half an hour doesn’t sound like much, but over time, this has created significant improvements in my mother’s strength, balance and stamina.
She had been using supplemental oxygen periodically during the day at the start of all this, but eventually no longer needed it (and uses it sometimes only at night).
It’s safe to assume that the exercise has improved her heart function. And she’s in far better musculoskeletal shape now than she was pre-hip fracture.
So what does this have to do with postoperative delirium?
Everything. Her cognitive skills a year out from her postoperative delirium are markedly sharper than they were before the hip fracture!
Hmmm…could it be that the exercise sessions have benefited her brain? Perhaps these exercise sessions have contributed to her full recovery from the postoperative cognitive issues that lingered for more than three months post-surgery.
Final Thoughts on Postoperative Delirium in the Elderly
Severity of cognitive problems right after surgery or the lingering effect may not be predictive of permanent cognitive impairment.
My mother really was in bad shape cognitively, but seeing her today, it’s nearly impossible to believe she was in such sorry shape last year.
One of the most crucial things you can do for an elderly parent is to get them on a structured exercise program, as exercise has been shown by loads of research to increase the size of an elderly person’s brain.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.