Hospitals fight delirium with volunteer help

[question everything]

(snip)

In the hospital world, it’s no secret that older patients are prone to abrupt changes of behavior. They may seem perfectly normal at home, but once they’re in the hospital, they may forget where they are, try to pull out their tubes, hallucinate. For years, doctors and nurses tended to shrug off the problem, said Dr. Nima Desai, a staff doctor at Methodist. “It was kind of like, ‘Oh, this is what happens in the hospital.’?” Unlike dementia, it often clears up in a matter of days.

But in 1999, a groundbreaking study at Yale University found that delirium was far more widespread — and hazardous — than people realized, especially in intensive care units, where up to 85 percent of patients may be affected. The causes can range from the profound to the mundane: a drug side effect, a change in routine, sleepless nights, a sense of isolation and depression. And it can complicate their treatment and recovery, as well as terrifying their families. The study’s author, Dr. Sharon Inouye, concluded that delirium was, in fact, often preventable; she came up with the Hospital Elder Life Program (HELP).

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Surprisingly, it relies on a small army of volunteers and a little friendly conversation. What they discovered, Duncan says, is that a steady dose of “high touch, low tech” activities — doing crossword puzzles, reminiscing, talking about their grandchildren — can engage the minds of patients when they’re most vulnerable. Mandi Shimek, 34, is one of the purple-shirted volunteers who can be seen pushing HELP carts through the halls of Methodist. The carts are loaded with tools of the trade: puzzle books, stress balls, lens cleaners and special headsets to amplify voices. “If you can’t hear, or you can’t see,” explains Duncan, “confusion can become really profound.”

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In a 2011 study of nearly 1,000 patients 70 and older, Methodist found that only 2.5 percent of those in the HELP program developed delirium, compared to 8 percent in a control group. Another hospital — the Howard Young Medical Center in Woodruff, Wis. — found that the HELP program reduced the average hospital stay for elderly patients by nearly a full day and cut their fall rate to almost zero. One reason, Desai said, is that delirious patients take longer to recover. Delirium makes it harder, for example, to do physical or occupational therapy and “get them stronger to get out of the hospital.”

Delirium isn’t just an inconvenience, says Dr. Fred Rubin, a geriatric specialist at the University of Pittsburgh School of Medicine, who has collaborated on the national HELP program. It not only makes people weaker, he said, but it can take months for people to fully recover — if ever.

http://www.startribune.com/lifestyle/health/207967361.html

[Warpy]

1. I hope more places do this

Delirium is especially bad at night, in fact it's often called "sundowner's syndrome." When the sun goes down, people who have been normal all day suddenly go off the deep end.

ICU psychosis is also a real problem, tied mostly to the lack of solid sleep due to the racket of alarms on all the machinery, blood draws at all hours, and the need for around the clock treatments. Younger people are just as susceptible to it.

It's well known that people clear pretty rapidly once they're home and in familiar surroundings.

The sad part is that nursing care used to be able to connect these people with their surroundings with conversation and kibitzing crossword puzzles and the like. Nurses are stretched so thin they barely have a chance to say hello. Clearly, this is nuts, but MBAs never see it.

[BrotherIvan]

2. That's very interesting

I experienced this with my mother in the hospital who would BEG me to get her out. She never became delirious, but could never sleep and heal because they woke her up every single hour for whatever. Not in ICU, just a regular hospital stay. She could never improve because she couldn't sleep.

This also recognizes that a patient is a PERSON, something that is woefully missing in healthcare today. I've seen doctors come in, look at the chart, ask questions then leave and never look at her or make eye contact. It was downright dehumanizing. And then, as her advocate, I've had more than a few doctors launch into a tirade about how I didn't have their education and didn't know anything. The last doctor, I actually started laughing it was so absurd. I let him blow himself out and then asked the question again which he realized provided crucial information because he was way off track on her diagnosis. I hope I don't get sick and need hospitalization because I don't trust doctors one whit anymore and have no interest in suffering for their egos. There may be some good, caring doctors out there, but I have rarely met any and I have had to deal with a lot in this ordeal. The nurses are usually better informed on the patient's case, more caring, and don't have the gigantic egos that get in the way of providing care. Our health system is so broken.

[question everything]

4. How sad. The most dehumanizing part, I think

is when doctors talk about a patient, in third person, as if he or she is not there. Even if a patient is unconscious, one can never know how much he or she hears.

I think that all hospitals need to have patient advocates, if a family member or a friend cannot fill this role.

[BrotherIvan]

5. That is so very true

In countries with socialized medicine or some form of single payer, I have witnessed more compassion. I believe it is because doctors are not paid enormous salaries, its more of a regular job, like teaching, you get into because you are passionate about it. I may be wrong, but the God complex of doctors is ridiculous.

And having a patient advocate who is willing to ask questions and translate for a patient who is sick or scared or in pain is invaluable. Having caring people on your side is essential to healing in any situation.

[enough]

3. It's great that volunteers are helping with this, but it is a serious situation that should not be

dependent on kindness. The medical establishment should be dealing with this within their protocols. They already know about "pump head," though they don't like to talk about it. And beyond that, the idea that people will experience something they may never fully recover from, simply because they have had to go to the hospital, should certainly suggest a rethinking of the system.

I have experienced within my close family, several different examples of permanent severe negative changes to old people who have been in the hospital in situations where the surgery or procedure or cure was pronounced completely successful. My mother, my mother in law and my father have all experienced "highly successful" outcomes from which they were never anything like themselves afterwords. They lived in a state of diminished health and transformed personality for several years before they finally died. In each case, the medical professionals were very excited at how extremely successful the care had been, and what great patients they had been.

It has come to the point where my husband and I have agreed we will not go to the hospital for any reason after age 75, and we will think very hard before we would go in for any reason starting now (at age 68).