Discharged with delirium
November 4, 2015 8:26 PM Subscribe
Were you, or someone you know, discharged from the hospital with delirium? What can I expect? Does delirium clear up faster outside the hospital?
My father has been in the hospital for 8 days, in the ICU for 6 of them, and has had delirium for 5 days. They are talking about discharging him since he is doing well physically and he will be discharged to home. This does not seem like a good idea to me. Has anyone experienced a situation like this?
My father has been in the hospital for 8 days, in the ICU for 6 of them, and has had delirium for 5 days. They are talking about discharging him since he is doing well physically and he will be discharged to home. This does not seem like a good idea to me. Has anyone experienced a situation like this?
Response by poster: To be more clear, this is after heart valve replacement surgery. He was sharp as a tack going in, now delirious for almost a week. He's not on any pain medication. He understands the general situation and knows who we are, but he sees things that aren't there and rambles incoherently for long periods.
posted by PSB at 9:11 PM on November 4, 2015
posted by PSB at 9:11 PM on November 4, 2015
Ugh. I sympathize, but you really want to get him out of the hospital before he gets an infection, and so he can sleep well and deeply through the night. That alone may be enough to make a huge improvement in just a couple of days.
This is not a great situation post-surgery, and I hope someone is being practical and forthcoming about what this may mean. If he does not fully recover in any short-term sense and becomes prone to wandering or strong enough plus unstable enough to hurt himself or someone else, you may have to take additional steps for his care.
But hospitals aren't for cognitive dysfunction. If you won't take him home, you'll need to look for a place in a nursing home.
posted by Lyn Never at 9:18 PM on November 4, 2015 [6 favorites]
This is not a great situation post-surgery, and I hope someone is being practical and forthcoming about what this may mean. If he does not fully recover in any short-term sense and becomes prone to wandering or strong enough plus unstable enough to hurt himself or someone else, you may have to take additional steps for his care.
But hospitals aren't for cognitive dysfunction. If you won't take him home, you'll need to look for a place in a nursing home.
posted by Lyn Never at 9:18 PM on November 4, 2015 [6 favorites]
This can be a sign of a bacterial or viral infection - even a urinary tract infection can cause this in elderly people.
posted by Year of meteors at 9:19 PM on November 4, 2015 [10 favorites]
posted by Year of meteors at 9:19 PM on November 4, 2015 [10 favorites]
Hospital delirium is a thing. If you google it, you'll find a lot of scary stuff linking it to worse outcomes, but my dad experienced delirium after knee replacement surgery and recovered well enough (and he's certainly still alive several years later). It was really frightening for me at the time, since I was the only family member taking care of him, but his delirium vanished once he got into the physical rehab place and then home.
That said, DEFINITELY politely ask the doctors, the social worker, and the nurses about what to expect in terms of timeline for recovery from the delirium, what to watch for/what symptoms mean you should call the doctor or the ER, etc. Write everything down, as you may be given contradictory/confusing information or things that only become relevant later.
I hope someone with more medical knowledge than I have will comment, but there's my anecdotal experience. I hope your father recovers well (and remember to take care of yourself!).
posted by wintersweet at 9:20 PM on November 4, 2015 [6 favorites]
That said, DEFINITELY politely ask the doctors, the social worker, and the nurses about what to expect in terms of timeline for recovery from the delirium, what to watch for/what symptoms mean you should call the doctor or the ER, etc. Write everything down, as you may be given contradictory/confusing information or things that only become relevant later.
I hope someone with more medical knowledge than I have will comment, but there's my anecdotal experience. I hope your father recovers well (and remember to take care of yourself!).
posted by wintersweet at 9:20 PM on November 4, 2015 [6 favorites]
My father underwent a similar procedure a couple of years ago and had a similar outcome - he was incoherent and not himself for at least a week, possibly more. He spent at least 4 weeks in the hospital but that was mostly due to another, unrelated issue that surfaced after he had the valve replaced. Having spend more time than I ever wished in ICU during that week amongst other patients who had undergone the same treatment, confusion and delirium were common. One lady next to my father was convinced that someone had wheeled her hospital bed out into the snow and she was going to die of cold (it was Summer, and we're in Australia).
I cannot think that a patient who has recently undergone heart surgery and who is still non compos mentis would be in any condition to be released unless the family had some sort of nursing plan in place at home.
That said, my father started making sense and stopped shouting foul names at the nurses, trying to eat his comb, and generally being a mean old man after about a week. He was much more normal after two, but it took a month at least for him to shake off the effects of surgery to the point where he felt "normal".
I hope this helps. Please feel free to MeMail me if you have any questions.
posted by ninazer0 at 9:21 PM on November 4, 2015
I cannot think that a patient who has recently undergone heart surgery and who is still non compos mentis would be in any condition to be released unless the family had some sort of nursing plan in place at home.
That said, my father started making sense and stopped shouting foul names at the nurses, trying to eat his comb, and generally being a mean old man after about a week. He was much more normal after two, but it took a month at least for him to shake off the effects of surgery to the point where he felt "normal".
I hope this helps. Please feel free to MeMail me if you have any questions.
posted by ninazer0 at 9:21 PM on November 4, 2015
Sent you a MeMail.
posted by honeybee413 at 9:26 PM on November 4, 2015
posted by honeybee413 at 9:26 PM on November 4, 2015
My dad had hip surgery recently, and his doctor warned us in advance of post-operative delirium. He said it was caused by the anesthesia, and could linger up to several weeks. His doctor should certainly be able to provide you with more information. Fwiw, my dad was sent home while experiencing hospital delirium as well, and did better once he was home.
posted by I_love_the_rain at 1:49 AM on November 5, 2015 [1 favorite]
posted by I_love_the_rain at 1:49 AM on November 5, 2015 [1 favorite]
IANYD. And you can ask if you can speak to the case manager or social worker about at-home help for the first little while and what they've done in the past. It may be that your dad would do well right now at a step-down facility, like a skilled nursing facility. But--if your dad is discharged home and still confused, some things that could help (often done for patients w/ delirium/confusion on the hospital).
Keep a big clock in the room he's sleeping in and have the day's date written somewhere in the room. Change it daily. Open blinds when sun is up and let light in; try to avoid him being in a dark room during the day. This could worsen confusion.
And yeah--check about UTI, but I'm sure they have already done this in the hospital. But really--I agree with Lyn Never. Hospitals make you sick, sometimes really sick, and it's very hard for patients to get the good rest they need when there are beeping machines everywhere and someone waking you up for blood draws and vitals in the middle of the night.
posted by namemeansgazelle at 7:48 AM on November 5, 2015
Keep a big clock in the room he's sleeping in and have the day's date written somewhere in the room. Change it daily. Open blinds when sun is up and let light in; try to avoid him being in a dark room during the day. This could worsen confusion.
And yeah--check about UTI, but I'm sure they have already done this in the hospital. But really--I agree with Lyn Never. Hospitals make you sick, sometimes really sick, and it's very hard for patients to get the good rest they need when there are beeping machines everywhere and someone waking you up for blood draws and vitals in the middle of the night.
posted by namemeansgazelle at 7:48 AM on November 5, 2015
You don't mention how old your dad is, but I can share what happens with my dad in the hospital - he's 85. When he was 83, he started experiencing hospital psychosis every time he was in the hospital for more than a few hours. Short ER trips don't seem to do it, but anything a day or longer and he loses touch with reality.
Every time this happens it terrifies me - but every time it happens, going home helps immensely. He is usually fine within a day of getting back into his normal environment. I think for my dad it's the lack of familiar surroundings, people, and routines that does it, and his doctors and nurses agree.
Having all his normal touchstones -- some might say "crutches" -- taken away leaves him adrift. At home, the difference between his real life and his dreams/daydreams is stark; at the hospital, the difference between his completely unfamiliar surroundings and experiences and his dreams/daydreams is much harder for him to pinpoint -- especially when he wasn't feeling well to start with! I do think it's a sign that he's experiencing cognitive decline we don't necessarily notice day to day, but for my dad at least, it only impacts him when he's taken abruptly away from home for a long period.
Definitely ask your father's doctors about it. But if they don't seem alarmed and think going home might help, don't discount it. It very well might.
posted by kythuen at 7:49 AM on November 5, 2015 [1 favorite]
Every time this happens it terrifies me - but every time it happens, going home helps immensely. He is usually fine within a day of getting back into his normal environment. I think for my dad it's the lack of familiar surroundings, people, and routines that does it, and his doctors and nurses agree.
Having all his normal touchstones -- some might say "crutches" -- taken away leaves him adrift. At home, the difference between his real life and his dreams/daydreams is stark; at the hospital, the difference between his completely unfamiliar surroundings and experiences and his dreams/daydreams is much harder for him to pinpoint -- especially when he wasn't feeling well to start with! I do think it's a sign that he's experiencing cognitive decline we don't necessarily notice day to day, but for my dad at least, it only impacts him when he's taken abruptly away from home for a long period.
Definitely ask your father's doctors about it. But if they don't seem alarmed and think going home might help, don't discount it. It very well might.
posted by kythuen at 7:49 AM on November 5, 2015 [1 favorite]
Response by poster: Thank you so much for all the information. My Dad is 80 and was put on a balloon pump after the mitral valve replacement and he also had a prior heart surgery just 4 months ago (aortic valve replacement and mitral valve repair) The repair did not work 4 months ago, hence the need to have this surgery. I did have them test for a UTI and it came back negative. He was much better today. He was never confused about where he was or why or who we were. He still believes the hallucinations he had were real or were revelations from God (he is a religious man) but he didn't have any revelations/hallucinations today. Physically he is doing very well and has a great appetite and is sleeping well at night plus 1 nap per day. I am feeling much better about him being discharged home and he will also have a visiting nurse come in. I am still worried about the implications of this on his long term cognitive ability and concerned about how long it will take for the delirium to completely clear but am feeling better overall.
posted by PSB at 4:10 PM on November 5, 2015
posted by PSB at 4:10 PM on November 5, 2015
I'm a student nurse (but not your student nurse!) and have recently taken care of folks in your dad's age group with post-operative delirium.
Some of the factors that contribute to hospital delirium are the hospital environment (light and noise at all hours, strange people coming in and out of the room, etc.), starting three or more new medications around the same time, sleep disruptions, poor pain management, and invasive medical devices (eg. IV, catheter)--all things that are pretty common in the post-operative period. The fact that your dad has been oriented to person, place, and time throughout is a real strength--some people with hospital delirium don't know where they are or who is with them. His good sleep is another big plus. Heading home could certainly help a lot, as could some of the suggestions above: making sure he's getting light during the day and dark at night, using a clock and daily calendar to keep him oriented to time, things like that.
Hospital delirium does not normally have long term cognitive impact; the medical term changes when the diagnosis is long term (dementia, not delirium), so if your dad's medical team is saying "delirium" they think it's not going to last. However, keeping a close eye on your dad's cognitive status would still be a great idea. If you can follow up yourself, great, or if not, connect with the visiting nurse and ask them to check in with him about hallucinations on a regular basis. Responses above are right that delirium can also be a sign of infection (especially UTI) in older adults, so if this doesn't improve it would be important to get him checked out.
Hope he'll be back to normal soon!
posted by snorkmaiden at 5:45 PM on November 5, 2015
Some of the factors that contribute to hospital delirium are the hospital environment (light and noise at all hours, strange people coming in and out of the room, etc.), starting three or more new medications around the same time, sleep disruptions, poor pain management, and invasive medical devices (eg. IV, catheter)--all things that are pretty common in the post-operative period. The fact that your dad has been oriented to person, place, and time throughout is a real strength--some people with hospital delirium don't know where they are or who is with them. His good sleep is another big plus. Heading home could certainly help a lot, as could some of the suggestions above: making sure he's getting light during the day and dark at night, using a clock and daily calendar to keep him oriented to time, things like that.
Hospital delirium does not normally have long term cognitive impact; the medical term changes when the diagnosis is long term (dementia, not delirium), so if your dad's medical team is saying "delirium" they think it's not going to last. However, keeping a close eye on your dad's cognitive status would still be a great idea. If you can follow up yourself, great, or if not, connect with the visiting nurse and ask them to check in with him about hallucinations on a regular basis. Responses above are right that delirium can also be a sign of infection (especially UTI) in older adults, so if this doesn't improve it would be important to get him checked out.
Hope he'll be back to normal soon!
posted by snorkmaiden at 5:45 PM on November 5, 2015
This thread is closed to new comments.
However, having experienced my grandfather being discharged while very confused a couple of years ago, if you can't get a clear diagnosis, I'd be very clear about requesting that all the possibilities are made clear to you (and your father) before discharge. My grandfather's confusion was misidentifed as resulting from depression (which was a preexisting long-term condition), but was actually the result of a brain tumour. While the failure to identify this condition had little or no impact on the progress of his illness, given his age and limited treatment options, a lack of understanding of the causes of and best approaches to his symptoms caused considerable extra distress to him and to us at the time. So, yes, I would advise you to be proactive in asking for information, and ask as many people as many questions as is necessary to get clear answers.
I wish your father a speedy recovery. I hope you and your family get all the support you need, given how distressing a situation this can be.
posted by howfar at 8:52 PM on November 4, 2015