A recent study published in JAMA Network Open reveals a consistent and ongoing rise in delirium cases among the elderly population. Delirium, defined as “a mental state in which you are confused, disoriented, and not able to think or remember clearly,” has long-term implications, including increased vulnerability to dementia.
Research suggests that the significant rise can be attributed to the COVID-19 pandemic – in part due to visitor limitations, infection control protocols, a nationwide shortage of staff and reduced patient-doctor engagement. As a result, older adults were leaving hospitals more confused and overmedicated. And the crisis continues, even as we return to the new normal.
The paper’s lead author, Dr. Christina Reppas-Rindlisbacher, geriatrician at Sinai Health and University Health Network and PhD student at Women’s Age Lab at Women’s College Hospital, tells us about this study and the importance of dignified care for the aging population.
Why is this research important?
While working in hospitals, it always struck me how patients would enter with a singular health problem and leave with a myriad of new challenges.
This research is important because older adults have already borne the brunt of the COVID-19 pandemic, and this is just one more example of how we failed to provide dignified care. We must learn from these lessons so that we can recover from the pandemic with better policies and ensure that we don’t repeat the same mistakes in the future. Delirium, although serious, distressing, and common (occurs in up to 50 per cent of hospitalized older people), receives little attention compared to other conditions.
How do you think your findings could inform healthcare policies to mitigate the impact of future disruption on patient care?
These study results are particularly alarming because we have made so much progress in delirium care over the last thirty years. In the three years leading up to the pandemic, our study revealed a noticeable decline in the prescription of potentially harmful and addictive sleep medications for older adults upon hospital discharge. What is now evident is a complete reversal of this declining trend since the onset of the pandemic.
As we approach fall and winter, we will face a surge of seasonal viral illnesses, presenting hospitals and healthcare systems with important decisions regarding visitor guidelines during outbreaks. These policies must prioritize compassionate care, particularly for older individuals dealing with cognitive challenges who may not be able to advocate for their needs. We need to allow flexible hospital visitation, tackle the urgent issue of hospital staffing shortages across the country, and think of creative solutions like diversifying hiring and volunteer programs.
Delirium can be devastating to patients and families, but prevention care is quite simple – we need to advocate for the presence of family caregivers, promoting mobility and minimizing disruptions to eating, drinking and sleep patterns.
In the study, you discuss the importance of considering delirium care in future decision-making about isolation practices. In what ways can healthcare policymakers and institutions ensure this is considered?
Sick patients with delirium or dementia should never be isolated from their family caregivers who should be considered “essential care providers.” The risks of viral spread must be weighed against the risks of delirium, which can cause longstanding or permanent cognitive damage and loss of independence. Institutions could mitigate viral spread by allowing family caregivers flexible visiting hours with appropriate training and personal protective equipment. This is especially important from an equity standpoint for older adults who are already cognitively impaired or for those who do not speak English as their preferred language.
What next steps do you recommend taking to achieve this?
Firstly, we need to raise awareness about this issue – we need to get the message out about what happened to delirium care during the pandemic to the public. We are doing this through messaging on social media, writing op-eds, and reaching out to advocacy groups like the Senior Friendly Care Network, the Alzheimer’s Society, and the Regional Geriatric Program of Toronto. We will also be presenting the results within our local hospitals and to hospital administrators.
What are your hopes for addressing delirium care moving forward?
We need to bring humanity back into patient care – this includes ensuring families are present and involved in the care team, that older patients move, sleep, and eat well, and that they aren’t overmedicated. Future hospital infrastructure is also important – there should be single rooms with large windows, wide entranceways that promote movement with walkers and wheelchairs, and limited noise and light overnight. Finally, the human elements of care – social connection, orientation, and engagement – cannot be underestimated.
I will be dedicating my career to delirium research, aiming to prevent its onset and mitigate its impact. If we implement effective delirium preventative care across the board, it will better serve patients, their families and healthcare systems nationwide.