Last week's column described delirium, a temporary problem common in hospital patients that can result in long-term - and even permanent - damage, often meaning that people who lived independently before they went into the hospital never do so again after they get out.
What action steps can you take to help prevent or stop delirium in people you care about?
1. Remember that they are medically fragile; ensure that you and anything you bring into their room (such as your hands or their eyeglasses) has been appropriately cleaned.
2. Ensure that they have their eyeglasses and/or hearing aids to help make it possible for them to engage as they normally do, if medically feasible for them to have these devices. Also, provide cases for these, labeled with their name and contents, to increase the odds that the devices won't get lost when not being worn. If they normally use a cane or walker, make sure it is available even if you aren't sure when they will be able to get out of bed.
3. Talk to them to remind them who they are, who you are, where they are, why they are there, what is happening to them, why it is happening, what will happen next, and so forth. Not knowing what is going on can be very disorienting. Even if you don't believe that they are alert enough to absorb the information, do it anyway. And do it repeatedly. You may be surprised later to find out how much they took in.
4. Create as many ties as possible to their normal life. Bring in family photos. Talk about people they know. Listen to their favorite music with them if possible. Put up a calendar where they can see it and cross off each day when it is over so that they have some hope of keeping track of the date and day of the week. (The days simply merge together when one is in the hospital). Share common memories and stories (pleasant ones!) Update them with the latest news on topics they follow. If contact is permitted and possible, hold their hands, and so forth.
5. Document events they experience in the ICU such as interactions with doctors and nurses, treatments, improvements in their condition, setbacks, visitors they see, etc. Note reasons for events and circumstances and explain these in real time as well as documenting them. For example, if they are restrained, you might explain that this is being done so that they don't accidentally pull out an IV line delivering needed medicine. These explanations and the written record can later help them sort out misinterpretations and memories based on delirium from facts, and help them recover mentally. (I remember being in the ICU a number of years ago after having surgery. A nurse repeatedly pounded me on the back, making me cough. I could not understand why this person who was supposed to be taking care of me kept hitting me when I wasn't even in a position to defend myself. It would have helped if someone had explained, "We want you to cough to help open and clear your lungs so that you do not get pneumonia, a common complication after surgery").
6. Ensure that they can get the rest they need. Are there lights on and alarms going off 24 hours a day? Ask if the lights can be dimmed and the alarms quieted. Failing those improvements, provide eye masks and lots of earplugs. (One study found that just giving ICU patients earplugs to make it possible for them to sleep through all the alarms at night cut delirium in half). Don't allow visitors to tire them out by providing non-stop action all day.
In short, treat them the way you would want to be treated if you were in their shoes. It is easy to believe that the gravely ill or injured aren't like us, and to lose sight of simple facts that we would never lose track of for ourselves, such as that experiencing bright lights and loud noises 24/7 would make us exhausted, cranky, and more fragile, and that we'd start hallucinating after living like that for a few days, too.