Outpatient Surgery Magazine

the risk of the patient experiencing severe delirium after surgery. Using the tests in combination is not a perfect predictor of how severe post-op delirium will be, but it's an improvement over current screening methods, which focus on older adults with dementia-level cognitive impairment. Those patients are indeed at the highest risk of suffering severe post-op delirium, but focusing on those individuals ignores countless others who are at moderate risk, and who need the same compassionate care during their recoveries. Proactive approach You can take steps to lessen the severity of delirium. During pre-op assessments, clinic visits or during consent for surgery, educate at-risk patients (and their family members) about what delirium is and inform them that they might feel dis- oriented and confused, and might have trouble focusing or concentrating after surgery. If they do feel this way (or if family members notice these changes) after surgery, they should tell their care providers right away. Patients should focus on bolstering their health before the day of surgery, including getting physical exercise, eating right and maintaining a normal sleep cycle. They should get up and out of bed as soon as possible after waking and engage the mind through constant conversation, game playing and reading. Family members can remind elderly patients about the date and time, and reminisce with them about past life events. On the day of surgery, let patients keep their eyeglasses, hearing aids and dentures until just before anesthesia induction and return the items as soon as possible in the PACU. Those personal items keep patients orientated to their surround- ings by letting them see, hear and communicate clearly. Ask patients for a list of their favorite songs before surgery and play the familiar tunes in recov- ery to reorient them to their surroundings. A proac- tive approach to recovery includes getting out of bed as soon as possible and taking frequent walks, remaining active and mobile. Keeping the mind active through frequent conversation and engage- ment is an important piece of delirium prevention. All of these interventions prevent delirium and also help reduce delirium severity. After discharge, patients should maintain a normal sleep cycle and healthy diet, and return to physical activity as soon as possible. A greater understanding The exact mechanisms that cause post-op delirium are still unknown, but patients with preexisting cog- nitive dysfunction (both mild and severe), function- al disability and several comorbidities are more likely to experience severe forms of the condition. Importantly, benzodiazepines, sometimes used to calm patients before surgery, are shown to increase the risk of post-op delirium. In many ways, post-op delirium is a public health crisis as it has a larger mortality and morbidity bur- den than we once thought. Tools are available to aid in risk assessment and prevention. We now need to use those tools and partner with our clinical care team, patients and their families to reduce the debili- tating symptoms of delirium and optimize surgical recoveries. OSM Dr. Lindroth (hlindrot@iu.edu) is a postdoctoral fellow at Indiana School of Medicine and the Center for Health Innovation and Implementation Science in Indianapolis specializing in delirium prevention in the perioperative setting. A U G U S T 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 7 7 • REORIENT Encourage patients to bring their glasses, hearing aids and dentures on the day of surgery so they can reorient themselves following surgery.

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