Don't go there – It's not a nice place: Older adults’ experiences of delirium

Weir, Elizabeth; O’Brien, Anthony

doi:10.1111/inm.12563

Cited by 7 publications

(6 citation statements)

References 26 publications

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“…This was most clearly expressed by patients as a perceived inability to engage with their environment or communicate with health care providers, a finding reported elsewhere. 34 Patients’ perceived communication barriers with health care staff and relatives resulted in patients feeling dismissed or misunderstood. Health care staff may alleviate this distress by ensuring that patients’ immediate environment remains familiar and predictable, a recommendation endorsed by many practice guidelines.…”

Section: Discussionmentioning

confidence: 99%

Examining Subjective Psychological Experiences of Postoperative Delirium in Older Cardiac Surgery Patients

Cohen

Atkins

Evered

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Postoperative delirium (POD) is an acute syndrome including inattention and impaired cognition that affects approximately 42% of older cardiac surgical patients. POD is linked to adverse outcomes including morbidity, mortality, and further cognitive decline. Less is known about the subjective psychological experience of POD and its ongoing impact on well-being. METHODS: We performed a qualitative analysis of the long-term psychological sequelae of older adults who experience POD after cardiac surgery. We sampled 30 patients aged 60 years and older who experienced at least 2 episodes of POD during a prior hospital admission. We administered semistructured interviews with participants via telephone 3 to 5 years postoperatively. Interviews were transcribed and thematically analyzed. Data were interpreted in accordance with the naturalist paradigm. RESULTS: Three overarching themes emerged in our qualitative analysis. The first reflected the multifaceted presentation of POD, including distortion of time and reality; feelings of isolation; and a loss of self, identity, and control. The second theme reflected the psychological challenges associated with functional decline after surgery. Common examples of functional decline included cognitive difficulties, excessive fatigue, and a perceived loss of independence. The final theme captured the emotional sequelae of acute illness, which included low mood, reduced motivation, and social comparisons. CONCLUSIONS: Our findings emphasize the multidimensional experience of POD and long-term effects on psychological wellbeing. Our research highlights the beneficial role multidisciplinary clinicians play in managing POD including strategies that may be embedded into clinical practice and helps anesthesiologists understand why patients who have experienced POD in the past may present with specific concerns should they require subsequent surgery. (Anesth Analg 2023;136:1174-81) KEY POINTS• Question: What is the long-term perceived psychological impact of delirium on older adults after elective cardiac surgery? • Findings: The experience of postoperative delirium was associated with feelings of isolation, poor mental health trajectories, and disillusion with the health care system. • Meaning: Understanding patients' subjective experiences of delirium as they manifest during and following the episode is pivotal to the continued development of appropriate care pathways.

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Section: Discussionmentioning

confidence: 99%

Examining Subjective Psychological Experiences of Postoperative Delirium in Older Cardiac Surgery Patients

Cohen

Atkins

Evered

et al. 2022

Anesthesia &Amp; Analgesia

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“…8 POD is also associated with long-term psychosocial impairment, including distress, isolation, and psychological trauma. 12 Reducing the incidence of POD has the potential to improve postoperative outcomes for older individuals, improve recovery, improve independence, and reduce the community burden of dementia.…”

Section: Postoperative Deliriummentioning

confidence: 99%

Reducing Perioperative Neurocognitive Disorders (PND) Through Depth of Anesthesia Monitoring: A Critical Review

Evered¹,

Goldstein²

2021

IJGM

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General anesthesia has been administered for over 150 years, and in that time, has become progressively safer. Improvements in outcomes have been driven by multiple advances, including the use of non-invasive monitors to assess cardiovascular and respiratory status. More recent advances have included the development and use of monitors to measure neurologic status by means of "processed" electroencephalography (pEEG), wherein the frontal EEG signal is analyzed by proprietary algorithms to produce a dimensionless number (scaled from 0 to 100), wherein low values are associated with deepening levels of sedation that progresses to loss of consciousness. Such monitors have been shown to enable anesthetic titration so as to expedite emergence and early recovery, and their use is advocated for the prevention of intraoperative awareness in the setting of administration of total intravenous anesthesia and neuromuscular blockade. Whether their use can minimize, or prevent, longer term adverse events is a matter of debate. In this narrative review of the most recent literature, we provide an assessment on the use of pEEG monitors in the prevention of a notable, and important, postoperative adverse outcome -delirium -in elderly patients. As we will discuss, the existing data do not support its routine use for the prevention of postoperative delirium in this, or any other, patient population.

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“…It is also present in about 40% of nursing home residents [10]. Experiencing delirium and having flashbacks of delirious episodes is frightening for patients and affects their psychological and emotional well-being [11][12][13]. Providing appropriate care to delirious patients imposes a great burden on healthcare professionals, for example, because of difficult behaviors of patients and overlapping symptoms with dementia [14,15].…”

Section: Deliriummentioning

confidence: 99%

The influence of a serious game’s narrative on students’ attitudes and learning experiences regarding delirium: an interview study

et al. 2020

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Background: Delirium is a neuropsychiatric syndrome that affects patients' attention and awareness as a result of a physical condition. In recent years, persistent gaps in delirium education have led to suboptimal delirium care. Still, little is known about what are the most important aspects of effective delirium education. Serious games are both entertainment and an interactive, safe learning environment where players can experiment and create new knowledge. They have the potential to contribute to improved delirium education. We used a video-based serious games' narrative to explore aspects essential to enhance students' attitudes and learning experiences regarding delirium. Methods: We created a semi-structured interview guide and interviewed seven nursing and nine medical students about their attitudes and learning experiences, after they had played the game. A qualitative descriptive design and inductive content analysis with constant comparison were used. Results: The patient's and nurse's perspective, interactivity to experiment, realistic views on care options, and feedback on care actions were important for enhancing students' attitudes and learning experiences regarding delirium. Students felt these aspects encouraged them to get actively involved in and experiment with the study material, which in turn led to enhanced reflection on delirium care and education. Our findings highlight the importance of a more patient-oriented focus to delirium education to drive attitudinal change. Students' learning experiences were further enhanced through their affective responses provoked by the perspectives, interactivity, realism, and feedback.

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Don't go there – It's not a nice place: Older adults’ experiences of delirium

Cited by 7 publications

References 26 publications

Examining Subjective Psychological Experiences of Postoperative Delirium in Older Cardiac Surgery Patients

Examining Subjective Psychological Experiences of Postoperative Delirium in Older Cardiac Surgery Patients

Reducing Perioperative Neurocognitive Disorders (PND) Through Depth of Anesthesia Monitoring: A Critical Review

The influence of a serious game’s narrative on students’ attitudes and learning experiences regarding delirium: an interview study

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