Pre-op and post-op screenings
In many cases, older surgical patients don't realize they've suf-
fered from postoperative brain fog until weeks after surgery. Friends
and family may actually be the first to notice the signs, which could
be a grandmother who keeps repeating the same facts to her grand-
child or a group of bridge players who notice their friend's game has
slipped.
If the delirium status of the patient is unknown, use a delirium
screening process to identify patients who might be at risk for compli-
cations from anesthesia. Ask your older patients to do a preoperative
memory test or to draw a time on a clock face. Go through this
process again after surgery, and you'll get a sense of how your
patients' mental state has changed and if they're going through a post-
op cognitive slide.
Before your patients head into surgery, ask them these key ques-
tions taken from the ASA/AARP Brain Health Initiative:
• Have you ever had a problem with your memory or thinking ability
after hospitalization or surgery?
• Have you ever had an episode of confusion, or imagining things
that were not real?
• Are you taking drugs to help your thinking or memory, such as
Namenda (memantine) or Aricept (donepezil)?
These questions help you prepare for patients who might be suscep-
tible to postoperative cognitive decline and delirium. Remember,
there's no one-size-fits-all approach to caring for older patients. You
need to have a different set of expectations for the patient who is
already on memory drugs and the one who is still solving Sudoku puz-
zles every morning.
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