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Confused about Post-Operative Confusion

Posted in category Discharge Planning, Geriatric Medicine

78 comments


We continue to receive a tremendous response to Nora’s blog about her father’s post-operative confusion and know that many of you have experienced similar situations. We invite you to visit our Resources page, where you will find links to helpful sites, including the Foundation for Health in Aging’s delirium topic page.  You may also want to learn about 10 tips for preventing delirium in older adults from the Hospital Elder Life Program. And subscribe to our Front pAGE e-newsletter for monthly updates on the work of our grantees to tackle issues, like delirium, that cause harm to older adults.

Several months ago my 80-year-old father had triple bypass surgery.  As any family member would be, my father’s wife, my siblings, and I were both worried and hopeful.   We were told that the surgeon was the best and my father was in good hands.  Afterwards, we were told that the surgery went well.  However, one of the night nurses in the coronary care unit reported that my father took a swing at one of the doctors.  My father didn’t remember the incident.  My father also asked his wife a few times when the surgery would take place because he was anxious to get it over with and get home.  These incidents caused a flurry of calls from my father’s wife and my siblings asking me if Dad now had dementia.

I explained that post-operative confusion and delirium are common in older people who have had general anesthesia, and that in time Dad would become more oriented and less confused.  (I couldn’t guarantee, however, that he wouldn’t want to take a swing at someone who awoke him in the middle of the night.)  Unfortunately, my prognosis did not calm their fears.  So my family members asked physicians they knew the same question and reported back to me that a cardiologist, a neurologist, and an internist had said that my father should not be experiencing any confusion after surgery and therefore he must have dementia.   This came as a complete surprise to me, as I just assumed that all health care professionals, especially those who work with older people, would know what I knew.  I didn’t receive medical training, but I am a geriatric social worker.  I have worked in hospitals, where I came to know firsthand that older people are commonly confused for a period of time following major surgery and anesthesia.  How could it be that these physicians were not aware of this?

So I called Jeff Silverstein, a professor of Anesthesiology, Surgery, and Geriatrics & Palliative Care at Mt. Sinai School of Medicine, who is an expert on geriatric anesthesiology.   Jeff told me that it is a complicated issue.  He said that post-operative delirium and confusion are common in older people who have had general anesthesia and that most people will eventually return to their former level of cognitive functioning after a period of time.  However, perhaps 40% of people over 70 who have had a coronary artery bypass graft (CABG), which is what my father had, will experience a decline in cognitive ability following surgery.  He referred me to an interesting essay included in Larry McMurtry’s book Walter Benjamin at the Dairy Queen, in which the author describes a profound loss of cognitive capacity following heart surgery.   Jeff also said that the issue of geriatric anesthesia is not well studied, and we need more information about pre-op and post-op care to minimize delirium and confusion in older patients.

Of course, even if we don’t have all the answers or know all the whys and wherefores, it is important that everyone treating older people who have had major surgery know about post-op delirium and confusion.  It would save families and caregivers a lot of worry and possibly prevent them from making wrong decisions about placement for their loved one following discharge.

As for my father, I was not able to convince anyone that his confusion might be temporary.  His wife insisted on a CT scan, which of course showed nothing.  My dad went home and is now driving himself to nearby physical therapy sessions three times a week.  His confusion is clearing up a bit, but it still remains a concern for his wife and my siblings. I spoke with Jeff about this, and he said that it could take years for the effects of anesthesia and general surgery to completely dissipate.  Sometimes people never fully regain their former level of function.

It seems to me that older patients and their caregivers should be better informed about post-operative confusion and how to deal with it, as well as all the risks involved and possible consequences of certain surgeries.  Having doctors, nurses, and/or social workers hold these discussions with the patient and family prior to major surgery would be a step towards ensuring a proper informed consent and the beginning of an appropriate discharge plan and post-operative care.  And when patients and their caregivers ask questions, health care professionals should have the right answers.  Is this too much to ask?

For more information on delirium please visit the website of the newly formed American Delirium Society, which is having its inaugural meeting in Indianapolis June 5-7, 2011.  They will also be publishing a special edition of the Journal of the American Geriatric Society on delirium, supported by the John A. Hartford Foundation.

78 thoughts on “Confused about Post-Operative Confusion

  1. Thanks for sharing this Nora. I have a similar family story – my uncle who was on dialysis (but otherwise quite functional) became severely delirious several times (one of the side effects of the treatment). (See http://www.jhartfound.org/blog/?p=1358.) Once when he was hospitalized for the delirium but still raving, a physician attempted to discharge him, claiming that my uncle was demented, not delirious despite the sudden on-set and the known risk factor. It may seem pretty basic stuff, and a very common risk for older people, but somehow, ignorance, lack of powerful interventions, and incentives for shorter lengths of stay seem to combine into an almost willful misperception we have to address.

    • thank you for this article. My husband has been in ICU for several days, and under sedation until yesterday. He is exhibiting agitation, frustration, and some confusion as to time, and what is or is not real. The staff indicate this is to be expected….Im hoping it will pass quickly as I try to reassure him of what is/is not real. It is additional stress for the care giver if not expecting to see this in their loved one.

      • This helps so much. My dad is also in icu and had his triple bypass last Wednesday. He has been hallucinating for a few days now. How long does it usually last? We are praying that he is strong enough to move into a general ward soon

        • Hi even my dad has got disorientation after angioplasty , he too is a renal patient. My family and me are very much worried. Can any one suggest how long will it become normal? Your answers can help us

      • I know how you feel. My father had a CABG 2 weeks ago. He is off most of the machine, however he is still confused. I worried so much wondering if he is going to be the same.

      • My father had a CABG done 2 weeks he is still confused.

      • Help. My husband, 55, is also suffering from this. Thank you all for posting your info. I’m terrified.

  2. Nora – Thank you for taking the time to create this. It’s a subject near and dear to us at the America Delirium Society, and so many healthcare providers are unaware of the risk in this population, as you found out.
    You’ve said it perfectly – it’s a call to action.

  3. Thank you for so much for sharing this! As a geriatric care management service, we often see the worry that post-operative confusion causes to the patient and the entire family. I’ll definitely be sharing this with as many people as possible!

  4. Nora,

    Having cared for many patients with postoperative delirium, I know the impact of delirium on patients, families, caregivers, and healthcare professionals.  With an incidence approaching 50% after cardiac surgery in older patients, delirium is among the most common complications after cardiac surgery. Delirium leads to poor outcomes in the hospital and may have lasting functional and cognitive consequences.  With pilot support from the Hartford Foundation, the American Delirium Society formed in 2010. The ADS held our inaugural conference June 5-7, 2011.  We are a group of healthcare professionals who are committed to lessening the burden of delirium on patients through research collaboration, through development and implementation of clinical programs, and through educational outreach.  At our meeting, 20 countries were represented by leading professionals who are passionate about delirium.  Through ADS, our goal is to answer your final question with a resounding “no” – it should not be too much to ask for healthcare professionals to prevent, diagnose, and  manage delirium.   Thank you for sharing

    • My father is currently in the hospital for a basic vein bypass in his leg as his circulation was very poor he is in renal failure and dialysis 3 times a week. Previous to this surgery last week Tuesday he was mentally intact and even drove himself back and forth to town. Now he is having hallucinations, confusion and the doctors can not give us a medical reason for his current mental state and they feel it’s the environment he’s in. My family is in disbelief that this mental state just happened because he’s in the hospital. He’s had other previous surgeries with no complications like this.

      • Make sure they tell you all the medications he is on and when they change medications. Ask if the hospital has a deleirium protocol. Make sure he is not given “benzo” medications such as Ativan. Those drugs and many others cause delirium and make it worse. We went through it with my dad for months and the providers are not all aware of and careful about medicarion reactions and interactions even in the hospital. Make sure he does not have UTI.

        • Hi what is uti as my dad is going through exactly the same thing thnk

          • UTI is a commonly used medical acronym for urinary tract infection. This is one of the most frequent causes for delirium in older adults, particularly in females.

      • Ello my dad is exactly the same thing right now he is seeing things but in the night he is going completely mad aggressive and staff don’t seem to bothered . Had your dad been dignosises with any condition and how long ago did he gave his op how us he now we are all going out of our minds as to what has caused this any help would be if help thnks

      • My husband is going through the same thing. He had vein bypass 8 days ago and has been hallucinating ever since. How long did your dad’s last? This is so scary. They want to send him to rehab but I’m afraid they will just drug him more.

  5. I am so glad I found this post. I have a mentally disabled Aunt (52 years old) that has just had surgery for a bowel obstruction. She seemed fine in the hospital, but upon returning home, she started to rinse her dishes with no water running, folding her dirty clothes and putting them in her drawers, spending an hour rearranging her lotion bottles, and unable to decide what to do with a banana peel. The doctor told me it was a behavior, this is no behavior. I know her inside and out and this is not an act. If anyone has any hints on how to help her regain independence, I would appreciate any information. Thank you

  6. Hi Nora, This is such an important issue and I see this delirium in my patients frequently.Often the delirium is attributed to opioids, but when they are withdrawn the patient still suffers from a waxing and waning of his/her mental status.
    When my father, a geriatric physician, had surgery, my job was to do everything I could to protect his brain…both of us very concerned about the risks entailed, so much so that he not be given general anesthesia.

  7. My 81 yo father had a hip replacement 48 hours ago. The first 12 hours he was nauseated but did well. The second evening he was confused and combative. He has insufficient pain control (only taking Tylenol) for fear of subsequent confusion. This is frustrating to watch. His surgeon barely acknowledged his confusion and discharged him without discussing his situation. Keeping my fingers crossed he’ll be okay.

    • This is exactly where my father is now. 48 hours after hip replacement surgery. Extremely confused. No pain meds (only tylenol) as these seem to make him combative. In addition, his “hospitalist” wants to give him anti-psychotic medication! We are protesting and fighting this but we are absolutely exhausted. They still plan to release him tomorrow for rehab and there is a great chance he will fall as he is constantly trying to get up now.

    • May I ask how your father is doing now? My father just had a hip replacement this morning and in the evening he started showing some confusion. I am worrying as I was not informed about the possibility of confusion as such. would it be a permanent thing?

      • Dear Jade, it is important for your father to be evaluated by a health care professiona who is knowledgable about geriatric care. your father’s confusion could be delirium or it could be something else. My father did have delirium and within days it subsided. However, his memory was affected by the anesthesia, but over time he did return to his normal memory ability prior to surgery. I hope that your father will get the appropriate care he needs.

        • Hi Nora,
          My 84-year-old dad had delirium last year which we think was brought on by a change in medication. He was diagnosed with Lewy Body Dementia and put on Aricept. At his worst, he would be curled up in bed, couldn’t feed himself and was combative. About 10 weeks later he came out of it and regained full mental and physical faculties. He was fine for about seven months until he had a catheterization and two more heart surgeries to put in stents. Now he has delirium again. (The cardiologist also changed a lot of medications). Any idea if he will run the complete 3-month course again and get worse and worse, or could this bout of delirium be shorter/different? It was never a UTI. Thanks,

        • Hello, thank you for your article, could you tell me what type of doctor should evaluate a patient who is having cognitive problems once they are home?
          I have no clue
          Thank you
          D

    • My mom isninnthe same situation. What the heck do I do?????

  8. my sister had broken hip had operation and pin inserted had intense pain killers while waiting a week for the operation to clear system of tablets she had been taking. Since operation has had confusion, flashes of normal and then back to confusion. Will this be a permanent confusion. It is now four weeks since the operation. No one seems to be offer the answer to us.

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  11. Not only heart surgery, but elective hip replacement surgery often does this in older patients. My husband, 79 at the time, had this surgery four years ago. He went into the surgery a top notch tax accountant, the best in his firm even though he was the oldest. A week after surgery he asked ‘What’s tax accounting?’ and had to retire. He’s improved, but will never be as he was before. I went through hell for many, many months … emergency room, neurologist, psychiatrist, CAT scan, brain scan, indescribable weirdness around the house, and much more. Nothing showed as the problem. Recently I was told by an anesthesiologist that this was most certainly what had happened … too much ‘forgetting’ medication added to the anesthesia. We had no warnings beforehand, no heads’up from doctors. Just ‘You’ll be pain-free and doing your four mile walks again!’ It was not at all worth it, and I tell everyone considering this surgery to be prepared. My husband doesn’t remember the months of hell; I can never forget them. As my husband’s primary care physician told me: ‘You could write a book.’ Indeed I could. It changed and diminished our lives and made them so much less than before.

  12. My 86 yr old mother just had hip surgery today. We had a top notch orthopedic surgeon. Everything went fine. Now 5 hrs after surgery, the confusion and hallucinations have started. Mom was sharp as a whip before the surgery and completely independent. She broke her hip, so surgery was the only option, but we were not aware of this possible post-op condition. She had to wait 24 hrs after she broke the hip and her pain was so severe, they finally decided to give her “Dilaudid” to ease her pain. Now that I have researched this drug, I see it is VERY potent and similar to heroin. We are hoping & praying that when there is no Dilaudid residual in her system, the confusion and hallucinations will cease??? I wish we had been advised about the potency of this drug before administering it. Then again, this condition could have been the result of the general anesthesia, based on what I’m reading here.

    • I feel like I’m reading about my own mother – the only difference is that she is 87.. she also had to wait 24 hours for the hip surgery and was in excruciating pain. The morphine wasn’t helping so they gave her Dilaudid and Gravol. After the surgery she developed horrific terrifying hallucinations, and wouldn’t eat, drink or sleep for nearly 72 hours. The good news is the nursing staff has dealt with this condition and told us Mom would likely crash and then sleep. She did, and as of yesterday she is completely lucid again and is eating everything in sight. We only wish someone at the hospital would have educated us before the surgery – the emotional toll on the family was over whelming and much of it could have been avoided with a little bit of information up front. I see a real need for hospitals to include educating family and caregivers as part of their on-going training programs. Thank you to everyone for posting their stories. I wish I had known about this condition before Mom’s surgery. I hope everyone else’s has a positive ending.

  13. My mother, who lives in assisted living, and who suffers from dementia, is strongly pushing for elective hip replacement surgery… Even though her primary care doctor strongly discourages it. He feels that she will develop delirium, and this will cause functional decline. It is hard fo me to see her in pain, but I am afraid to let her have the surgery. I am an RN and she looks to me for advice. I just don’t know what to do!

  14. Thank you for this. My father had his first colostomy in 2008, then a fixing of the prolapse in 2009, then another surgery 2 weeks ago to fix the prolapse. He is now 71. This was the first time he seemed confused. He had another surgery due to sepsis in the same week. He is VERY confused. Plus, he is still recovering from a psychotic break that began 11/11, ending around 11/12. Plus, my mom passed away 3/11. So with all of this psychological stress, and the effects of anesthesia, I am so worried that he will never come back. I’m the last family member to care for him and I’m so scared that this is also a sign that he’s slipping away.

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  16. My 78 year old father is two days post op from heart surgery. He seems to be suffering from bouts of delirium. He also is having trouble walking – when they stand him up he try’s to walk, but the brain isn’t connecting with the legs. When he finally gets moving, he takes a few steps and then is extremely exhausted. Has anyone experienced this.

  17. I’m also glad I found this site. My 75 yr. old mother fell and broke her hip and arm. Other than some forgetfulness, she had not been confused. Now the hospital is letting us know she is very confused. She thinks people are plotting to harm my brothers and others, that she is in a psychiatric hospital and she see things that aren’t there. She was only getting very mild pain meds, which I asked them to stop, thinking this might be contributing. She even made several trips to nursing station with no walker. We have thought about moving her to the hospital where I work, so she can see family more often. It is 7 days post surgery. I only hope and pray this is temporary. Thank you for your input.

    • My 80 year old mom just had a kyphoplasty done (procedure to fill a fractured vertabre on her back with a liquid cement). She was in extreme pain. She had general anesthesia and after the procedure she was totally confused and agitated. She doesn’t even know where she is eventhough I keep on telling her she’s in the hospital and keeps on trying to take all her tubes out. It’s 1:30am and 7 hours after the surgery. Thank God I stayed with her in the hospital because you have to keep a constant eye on her and the nursing staff would not have been able to do that. What kind of specialist should evaluate this?? I’m so upset, could I take legal means against the anesthesialogist. He was deciding whether to give her local or general anesthesia and never mentioned any if this to us. PLEASE PRAY FOR HER & THAT THIS IS TEMPORARY.

      • my dad has had many falls recently but just fell and broke his hip he is 93 and had operation 6 days ago first 2 days he was brilliant we couldnt believe it then suddenly pesonality change acting really strange shouting trying to get out of bed saying he supposed to be dead and keeps on pressing his button and asking where he is it is so upseting and now they want to get him out and send him to somewher else for rehabilitation they dont seem to listen that is not my dad in that bed yes he was a little confused before but just normal for his age he never been diagnosed with dementia sooo worried

    • Thankyou for writing about your Mom. My mom 81, who was bright, all there, driving before surgery, and after 5 wks of chemo, and radiation, is suffering this post op dimentia, and combative behavior with bouts of paranoia. People are out to hurt her family and steal from us.her care in the rehab has not been the greatest with lack of staffing. We never knew this would happen after colon/rectal surgery.

    • My mother, 90, fell and broke her hip. Being in the hospital going on six weeks. She went to the delirium state for two week after surgery. She had mild dementia, but was able to walk, eat, converse, and dress by herself. She was transferred to rehab hospital where she continues to be on IV for antibiotics. She now does not speak and only makes short statements. The entire time we are with here we watch her nod her head “yes” or “no” to answer our questions. She does not carry a conversation. She is being fed by hand. She is on Tylenol for pain, so we took her off of morphine 2 days after surgery, but makes no progress. Not allowed to put weight on her leg until 8 weeks. I am losing hope she will be the same, and end up bed ridden. Any advice?

  18. i am due to go for a hip replacement at the end of this week, after reading about delirium am seriously considering canceling the op.I am 60 years old and not having a general anesthetic.

  19. We are dealing with a similar situation. My mom (75 yrs. old) had bypass surgery with no heart lung machine used. This was 2 days ago. She still hasn’t come out of anesthesia. She hasnt been given any benzo medication. She is combative, restless and unable to keep her eyes open. In 2 days she has slept about 3-5 hurs total! It is terrifying!!! She has mild Alzheimer’s dx and was on the exelonpatch. We are all praying that this gets better. Any insight would be appreciated.

  20. My dad had vain bypass last Thursday op took 10 hrs since coming out of icu he hasn’t been himself very confused seeing thing but most concerne is at night his getting aggressive swearing spitting it like he changes into another person at night Dr’s have also detected he has sufferers a heart attack since Sunday has any1 else had sane experience as we are going out if our minds as to why this has happened my dad will be 70 in nov thnks

  21. My mother in law, 78, had hip replacement surgery on Tues and she was awake and alert tues and wed I did not go today and when we couldn’t reach her by phone for hours this afternoon and evening we finally contacted the nurses station…all we are told is that she is confused….but it is normal and she will be fine….and they seem to be planning to send her to rehab in this state tomorrow…any ideas…

    • Confusion after surgery is can be normal, but I hope you were able to consult with a physician regarding the possibility of your mother-in-law having delirium. even if you didn’t before her transfer to a rehab, please seek out a healthcare professional who can assist in evaluating your mother-in-law and providing the appropriate care for her while she is undergoing rehab.

  22. My husband had a TURP procedure – but had a spinal anaesthetic. I assume they gave him something to put him to sleep as well as he has no memory of the surgery. He was awake and quite fine the evening of the surgery but the next day he was totally out of it. They gave him some atavan to calm him down as he kept trying to get out of bed and remove the IV, He developed a fever and they put him on a potent antibiotic. For six weeks after the procedure he was extremely confused. He did have a bit of perhaps early dementia but it was just his short term memory. He was fine otherwise and could look after himself.
    The doctor just said to give him time but I didn’t believe it could go on that long. He has just recently returned to what the doctor calls “baseline” which is short term memory loss. I couldn’t believe how confused he was and everyone said it was the anaesthetic but as I said he had a spinal. Can that do it? I am so glad to find this site.

  23. Recently my boyfriend had reconstructive bowel surgery. He seemed ok as far as his mental status afterwards, but ran into complicatons a few days later & had to go back into surgery for a blodclot & a stomache bleed. Since then he had been delerious and suffering hallucinations Right now it is difficult to discern if he’s talking about the past or present at times. His sppech also sounds a bit slurred and his voice different. It has only been about 2 wks. since the last surgery. The hospital is talking of releasing him soon along with getting him therapy in the wks. ahead. Again, its difficult to know mnay times if he’s talking in the preent or in the in the very recent past. Any comments on this? Thank you.

  24. My then-75 year old father was hospitalized after a massive heart attack in late 2011. Early in the morning two days after his bypass surgery, he rang me insisting that he had been kidnapped, that the walls were changing shape, that a sinister magician was performing a magic show in his ward, etc. We had received *absolutely* no warning from any hospital staff that this might happen, so I could only assume that something had gone terribly wrong with the surgery and that my dad was now insane.

    Subsequent responses from medical professionals were along the lines of “yes, a period of confusion is normal for patients of his age following major surgery and anesthesia”. OK – first of all, WHY were we kept entirely in the dark about that until it happened, and secondly, this was not a “period of confusion”, it was a terribly upsetting and frightening bout of hallucinatory delirium. And it kept happening for at least a week after the surgery!

    My dad has never been the same after that. It took him the best part of a year to recover as far as he has, and while he can now drive a car, etc. he’s clearly lost cognitive function, spends much of the day sleeping and has regular depressive episodes. His quality of life has dropped so far that the life-saving surgery hardly seems worthwhile.

    My very strong impression is that the hospital system just doesn’t know how to handle post-op delirium – maybe they’re worried about liability? – so it’s brushed under the rug.

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  26. My mom had reconstructive surgery following double mastectomy for breast cancer, including expander to one breast and TRAM flap to the other. Surgery took longer than expected and she ended up being under anesthesia for 10 hrs. I saw her immediately post-op and she seemed fine. But no more than 2 hrs after surgery the hallucinations and confusion began. I was awake for over 36 hrs straight trying to keep her calm and safe. They even had a “sitter” whose only job was to watch my mom 24/7. This confusion finally cleared after 5 days…. she seems ok noe, but her surgery is a process. It will involve repeat procedures and anesthesia. As an RN I am hesitant about what will happen next time. But I know she is in mid-procedure…. I want her to have the best quality of life. I know for her that means feeling whole and completing the process…. but Im more concerned for her mind.

    • I didnt mention my mom is 70 yrs old. No previous mental issues besides some anxiety that she takes ativan for. Just worried next timr she wont come out of the confusion.

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  28. My mom is 79. On Monday she had 2.5‘ of her colon removed. That day she was sedated with Dilaudid and slept like a baby. The next morning when I arrived she had no idea who I was. She was completely delirious and suffering severe hallucinations. Today is the end of day 3. We stopped all pain meds yesterday and today is by far the worst. She is adamant about leaving the hospital and very angry when told she cannot. She attempts to remove all IV lines and her Catheter. It’s absolutely insane. She thinks I am the henchman and everyone is out to get her. Never ever was told this would happen to this extent. Possibly a little memory loss that would be regained but never this crazy psychotic behavior out of the blue. All medical staff act like this happens to EVERYONE!!!

    • Hello all, I am a science journalist working on a story for a science magazine about delirium and mental changes in older people (60 and up) after surgery and anesthesia. It was helpful to read these blog comments by caregivers and spouses of people who experienced postoperative delirium. I am hoping to include patient or caregiver anecdotes in my story. Would you please message me offline at storrsc@gmail.com if you would be willing to speak briefly about your situation (it shouldn’t take more than 15 or 20 minutes of your time)? I can tell you more about the story and the magazine I am writing for then. Thank you, Carina carinastorrs.com

  29. My mother-in-law had heart surgery and bypass and is still in ICU after a little more than 2 weeks. She had the confusion and then went downhill with other complications with her lungs and a kidney. She is recovering very slowly and my husband and I wonder if she ever will fully recover. Other friends that have had the surgery bounced back much more quickly; of course they were younger but still, it seems doctors don’t fully tell you all the implications of this type of surgery. I suppose it’s in one of their pamphlets or papers that one is made to sign in the fine print but I felt and still do feel that this surgery was too much for an 82 year old woman. I hope she recovers fully but it seems doubtful at this point.

  30. My husband needs a stomach hernia repair and has a stoma from rectal cancer that should be pulled out a bit and not flat. He took a long time to come out of it on his last surgery, he’s 76. why cant they give him a spinal block for these repairs

  31. I am 61 yrs old and had a total hip replacement under spinal block march12th.I have no memory of the first week in hospital and have been told that I had a physchotic dementia. Because I was throwing myself against the walls I had a mattress on the floor. My daughter was very distressed and now I am equally distressed by not knowing what caused this.

    • How are you now? My father had to have a kidney stone removed surgically and it is now 7 days after and he is incoherent , speaking to us as if we are his brothers and sisters that have passed. He is 61

  32. My 83 yr old mother had emergency bowel surgery 3 days ago. She came through better than anyone expected, off the ventilator next day, awake and chatting with us. As of yesterday she seems to be losing track of time and forgetting recent events. Completely confused by nurse call button, even though it is the only large red button on the device. Hoping it is the pain med and temporary. What specific questions should I be asking hosp staff?

  33. There are a lot of questions about delirium – how to prevent it, how to identify those who might be at risk for it during/after surgery, and what to do if a loved one is experiencing delirium following a surgery and how to talk to physicians and other health professionals about it. I cannot give advice, but I can direct you to the American Delirium Society website: https://www.americandeliriumsociety.org/. There you will find a section for patients and families that will provide you with good information.

  34. My 83 yr old gmom broke her femur more than a week ago and had surgery to repair it. She was then transferred to a rehab center 3 days after. I think she is experiencing delirium. She see’s things that are not there, she confuses conversations, she wants to get up from bed to go to the bathroom as she is also suffering from constipation which adds to delirium, she says the nurses want to rape her… it is such a despair to deal with this. She barely eats and is very dehydrated, but she pulled her IV and made herself severely bleed. The staff at the rehab center just keep drugging her, and no one sees concerns she might fall and hurt herself, every night my mother stays to keep an eye on her the staff there clearly doesn’t care.

  35. Aa with everyone else we have had some experience with this. The first time our mother was hospitalized because of the confusion she was experiencing. It was quite scary for us because the behavior bordered psychotic. Mom was about 82 at the time. After 8 days in the hospital with little explanation I cornered a doctor (hospitalist) who said as soon as he got her UTI cleared up she would be fine. I practically came unglued saying we brought her in for the confusion and erratic behavior. He finally said that simply the infection was causing it. That simple and no one would tell us what was going on. Over the next few years she and we would immediately know when she was developing all too frequent UTI’S. However as soon as the Cipro began the symptoms disappeared. Fast firward to age 87. Diagnosed with colon cancer she had her complete colon removed, has been on a myriad of pain medication, was discharged into a wonderful Rehab facility. Was actually discharged with pneumonia discovered by the rehab nurse. Started out confused (anesthesia) then after treatment for pneumonia, she began with intense confusion laced with times of total clarity. Over the several week period she has declined in mental state. She knows she is confused, she developed a UTI which the rehab dr gave her ampicillin instead of Cipro. She became increasingly confused and now is off the ampicillin and does not seem to be improving. Is this a combination of all she has been through? If someone could just educate us on her prognosis. The staff at the rehab facility seems very concerned about her change and decline. It seems there is little education on this delirium and even the dr refers to it as dementia. She has days she is almost euphoric and the next she cannot make herself get out of bed. Can depression play into this at all? Thanks for everyone’s information. It is so very helpful

  36. I completely agree that post op confusion, delirium, and memory loss is not addressed to the extent that it should be to patients and families before procedures. Knowing what to expect and how to handle it would make the experience less traumatizing and frustrating for families who have to witness it. With that being said, although post op delirium is not an ideal outcome, it is seen frequently and is not an abnormal outcome. Although there can be interventions to help, such as frequent reorientation, familiar faces, avoiding the use of benzos and opioids when possible, allowing for uninterrupted sleep, ect, it truely is a waiting game, and a tough one at that, for everybody including the patient, the family, and the caregivers. Please know that although caregivers may not ‘appear’ to care or ‘appear’ to be doing anything about, most of the
    time they do care. And most of the time, they are doing everything they can, which always seems like not enough when dealing with the torturous and draining post op delirium.

  37. My husband, 66, is currently recovering from open heart surgery done 2.5 weeks ago. He was unresponsive for 48 hours post-surgery and when he finally came out of the anesthesia he was combative but seemed to know me and other family members. Because of his agitation and combativeness he was put into deep sedation and when sedation was reduced he was hallucinating and delirious. I requested he be taken off sedation completely. At first his delirium seemed to get worse but after the fifth day we started to see improvement. He remained in ICU for seven days and then an additional 7 days in the stepdown unit.
    The ICU team suggest that the delirium and confusion was not uncommon, but it was their opinion that it was an ICU syndrome. I did do some research on my own and found that it was most likely caused by the anesthesia. My husband does have a recollection of some of the scenarios he experienced and understands that they were not real. However, he does not recall much of what actually transpired during those days he was confused. We are home now and he still has some holes in his memory, but for the most part back to normal.

  38. My 83 year old father had nephrectomy 3 weeks ago. He is disoriented, he acts out and he is still in the hospital. He has been given dilloded, adavant, and halodel (sp) along with anesthesia and 3 weeks of ICU. The surgery was a supposed success but his recovery has been a nightmare. The doctors seem so surprised by this and claim he has dementia. However, he was fine before the operation. Reading this blog, I see the doctors know exactly what’s going on. If I knew this was going to happen, I would have made different choices for him. I hope that I will get my father back, but right now he is lost to all of us.

  39. My husband just had back surgery. He is 54, not elderly. He hallucinated for two days, and has since become very depressed. I had no idea this was so common.

  40. My brother had a major back surgery and he has post op psychosis and now thinks hes god he has change in so many ways and its been over a mth when will it get better. It’s ruining his marriage of nine yrs

  41. My brother has post op psychosis he thinks he god and its ruining his marriage after nine yrs he’s only 36 its been over a mth when will it stop

  42. Just another person chiming in to say that I wish doctors would inform family that confusion/delirium is not uncommon with an elderly patient who undergoes a procedure under general anesthetic. We could have planned better, been emotionally much better prepared and probably deal with the situation much better if the doctor gave us proper information. As it stands, I just hope any damage isn’t permanent.

    This issue seems to be something doctors don’t want to discuss for some reason until after the problem arises!! Families really should be prepared as it is not easy to deal with such a situation.

  43. My friend Is still in a coma 48 hrs after a double heart bypass. Why is this, they won’t tell us why they’re keeping him asleep!

  44. Thank you for writing this. My mom just had hip surgery and I have not heard of this. I am so glad to have found this article.

    • Dear Rachel – We are glad that the information was helpful to you. Best wishes for your mother’s speedy recovery. If you have a minute, can you let us know how/where you found this article? As you can see we have continued to get a lot of readers and comments on this post, so clearly it is an important topic, but we are not sure how it is being found on-line. Thanks, Chris

      • I hope Rachel answers, but in the meantime want to mention this page seems to be the #2 google hit if you search “postoperative confusion in the elderly.” You can also use Google Analytics to learn more about how people find the page.

        Equipping family caregivers to anticipate and recognize this common problem is so important!

        Last but not least, the link to the Hospital Elder Life Program up top is broken…looks like they updated their site and renamed many pages.

        Regards, leslie

        • Thanks Leslie! We have fixed the broken Hospital Elder Life Program link and really appreciate the heads up. We noticed the original post’s well-placed Google listing, but were also wondering if people are spreading the word through their specific social networks. If so, we want to help connect them to good resources. Totally agree that helping family caregivers anticipate this common problem is really important.

  45. Chris and Nora,
    The comments above highlight the patient and family suffering associated with delirium. As our healthcare system is undergoing transformation, it is critical for patients and families to understand that delirium is a risk of surgery. More importantly, there are steps that families can take to keep the brain healthy after surgery – like advocating for early ambulation, sleep, cognitive stimulation, and making sure there is sensory input (i.e. hearing aids, glasses, touch). These are not perfect, but well worth the effort. For those interested in learning more or joining a growing movement, the American Delirium Society has been working to enhance understanding of delirium and most importantly, share methods to improve delirium care for patients. Our website can be found at http://www.americandeliriumsociety.org

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