Harvard Health Blog
By Beverly Merz
My mother was lucid and alert when she was hospitalized for pneumonia. But by the middle of the first night, she was wondering how she had ended up at a “hotel” that allowed strangers to enter her room at all hours. The second night, she wandered into the corridor, slipped, and fractured a hip. She didn’t leave the hospital alive.
Her story, though extreme, is sadly typical. According to several major studies, about half of people over 65 have episodes of delirium — a sudden change in mental status — during hospital stays, and those who do are at increased risk for falling, requiring nursing home care, and developing cognitive impairment and dementia.
It’s easy to understand why hospitalization can be disorienting. Your daily routine is overturned, you are introduced to a stream of new caregivers, and it’s hard to sleep through the night. Anesthetics or sedative medications can also affect your mental state. But decades ago, Sharon Inouye, M.D., M.P.H., professor of medicine at Harvard Medical School, recognized that delirium in older patients isn’t an inevitable consequence of hospitalization.
HELP during hospitalization
Inouye and colleagues developed the Hospital Elder Life Program (HELP). Available at 200 hospitals in the United States, HELP involves identifying patients at risk for delirium when they enter the hospital and assigning them to receive special care to minimize six major risk factors associated with delirium — cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration. Studies have found that HELP is associated with significant reductions in the percentage of patients who develop delirium. It is also linked to fewer falls while in the hospital, shorter hospital stays, fewer nursing home admissions, and a lower rate of cognitive and physical decline.
What you can do to avoid delirium
If you or a loved one is scheduled for a hospital stay, ask whether your hospital has HELP or another program for preventing delirium. If not, there are several things you can do as a patient or caregiver.
If you’re going into the hospital:
1. Gather your records. Prepare a “medical information sheet” listing all your allergies, the names and phone numbers of your physicians and your usual pharmacy, all your medical conditions, and all the medications — both prescription and nonprescription — you’re currently taking. Have your medical records forwarded to the doctors who will be caring for you.
2. Bring the essentials. You’ll need your glasses, hearing aids and fresh batteries, and dentures. Ask if you can bring a few familiar things like family photos, a good book, or an MP3 player with your favorite music or relaxation exercises.
3. Set up a support team. Let family and friends know you’re being hospitalized and ask them to visit.
If you’re a caregiver:
1. Arrange companionship. Schedule family and friends to visit in shifts — and stay overnight, if possible.
2. Work with the nurses. See if they’d like your help in encouraging the person to eat, stay hydrated, and to participate in rehabilitation therapy.
3. Be vigilant. If you notice signs of confusion, memory problems, or personality changes, let the nurses or physicians know immediately.
(Beverly Merz is the executive editor of Harvard Women’s Health Watch.)