Octogenarian patients’ sleep and delirium experiences in hospital and four years after aortic valve replacement: a qualitative interview study

Abstract

ObjectivesSleep disturbances and delirium are frequently observed complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve implantation (TAVI), especially in octogenarian patients. However, a knowledge gap exists on patient experiences of sleep and delirium. In particular, patients’ long-term sleep and delirium experiences are unknown. This article explores and describes how octogenarian patients suffering from delirium after aortic valve replacement experience their sleep and delirium situation.DesignAn explorative and descriptive design with a longitudinal qualitative approach was applied. Qualitative content analysis following the recommended steps of Graneheim and Lundman was performed.SettingPatients were included at a tertiary university hospital with 1400 beds. Delirium and insomnia screening was performed at baseline and five postoperative days after aortic valve treatment. For qualitative data, 10 patients were interviewed 6–12 months after treatment with focus on delirium. Five of these patients were reinterviewed 4 years after treatment, with focus on their sleep situation.ParticipantsInclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium after treatment.ResultsFor the initial interview, we included five men and five women, four following TAVI and six following SAVR, mean age 83. One overarching theme revealed from the content analyses; Hours in bed represented emotional chaos. Whereas three subthemes described the patients’ experiences with sleep and delirium, a cascade of distressful experiences disturbing sleep, the struggle between sleep and activity and elements influencing sleep. Four years after the treatment, sleep disturbances persisted, and patients still remembered strongly the delirium incidences.ConclusionsFor octogenarian patients, sleep disturbances and delirium are long-term burdens and need a greater attention in order to improve patient care.

Exploring the Documentation of Delirium in Patients After Cardiac Surgery

“…The patients themselves would also benefit from the information because they may be left with strong long-term memories of the delirium period. 30 In this study, the possibly delirious patients needed more nursing actions, such as help in daily activities and in the care of cannulas and treatment devices, which is consistent with the literature. 31,32 Multiprofessional interventions and educational programs can improve the identification of delirium, patient care, and delirium documentation, and national and organizational guidelines and monitoring of care processes are needed.…”

“…Therefore, the information about the patient's delirium is not necessarily transferred to follow-up care. The patients themselves would also benefit from the information because they may be left with strong long-term memories of the delirium period 30 …”

Needs of older persons undergoing cardiac surgery: Exploring the perceptions of nurses, patients waiting for and patients having had surgery

“…Views and opinions of nurses appear to influence their attitudes, performance and work environment; therefore, it impacts patients' outcomes (Gallagher et al, 2018;Martorella et al, 2018). Furthermore, patients' perception of their needs may help healthcare professionals identify areas of intervention that may be improved and tailored to their specific needs (Amofah et al, 2021;El-gafour et al, 2021). Nurses' and patients' perception of pre-operative cardiac surgery needs allows to explore areas of disagreement and enables nurses to clarify, improve or negotiate with patients (Ding et al, 2017) ing had elective open-heart surgery and experienced cardiothoracic staff nurses were chosen as a method because it encourages participants to express their perspectives about the topic (Morgan, 1996).…”

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

“…Qualitative studies have concentrated on the immediate psychological implications of delirium, [13][14][15][16][17][18][19] with a focus on delirium that occurs exclusively in the intensive care unit (ICU). 18,20 These studies emphasize the heterogeneous and multifaceted presentation of delirium with patient accounts reflecting feelings of anger, fear, and loneliness during POD, as well as a perceived inability to communicate with health care workers. 19 Studies have also shown increased rates of self-reported anxiety and depression among patients who experience POD in the short term.…”