Delirium in hospitalized elders.
I just saw the following headline & abstract in the NEJM table of contents (to which I subscribe because it's free, unlike the publication, and because they have many interesting free articles). Anyway, here it is:
Delirium in Hospitalized Older Adults
Edward R. Marcantonio, M.D.
N Engl J Med 2017; 377:1456-1466October 12, 2017DOI: 10.1056/NEJMcp1605501
"Delirium, an acute confusional state, is common among hospitalized elders and is associated with poor outcomes. All patients with delirium should be evaluated for reversible causes. Behavioral disturbances should be managed with nonpharmacologic approaches whenever possible."
This makes me mad all over again. Hubs to ER 4x w/dehydration, UTI in 2010. Kept in hospital 4th time. Yes, he probably had MCI by then--he wasn't remembering details of conversations & the like. But was still driving, bike riding, conversing, enjoying friends & family & remembering the important things. Dr wanted him in hosp for safety because he'd fallen (unhurt but confused) & wanted to do MRI. During the 3 days he was there, he wanted to get up and pee and also leave the hospital, so they restrained him with Ativan, then bed alarm, neither of which he understood. A smarmy male nurse tried to muscle him into staying in the bed on the 2nd night and hubs allegedly hit the nurse so they put him in restraints & gave him Haldol, which basically made him a zombie. I was told I couldn't care for him at home (well, I already knew that, but...) so they found him a bed in a memory care. When I met him there the next morning he had no memory of ANY of it and said in astonishment, "How did you find me?" He did improve a lot when I hired private caregivers & then sprung him after a month & brought him home, and he even went back to driving, bike riding, walking, etc. and recovered his speech & his parkinsonism just went away, but after a year in which I was thinking he was going to be the exception to the rule he reached a plateau, FAR below what he'd been when he got sick, and the decline has been steady and inexorable ever since. Of course, I'm not saying that the hospital is to blame for his dementia, but giving him all that Ativan and the Haldol certainly accelerated his decline. Our neurologist at the time said that giving a dementia patient Haldol was medical malpractice! Anyway, I just feel sorry that I didn't protect him better. I was just in too much denial of his decline at the time, and didn't realize...