Older patients are at higher risk for certain side effects from sedation and anesthesia that affect thinking ability. Two of these are Postoperative Delirium and Postoperative Cognitive Dysfunction (POCD). Postoperative Delirium occurs when a patient is confused or has trouble remembering things. It can resolve within a few hours but could take multiple days to subside. The incidence of Postoperative Delirium can be as high as 50% in certain high-risk groups like those who need surgery for hip fracture. POCD is long-term memory loss and decreased thinking ability that occurs after anesthesia. It can be permanent, or it can improve over days, weeks, or months.
While these possible side effects are very serious issues, there are other important issues to consider when an older person needs surgery. Almost always, when an older person is recommended to have surgery, the risks of not having the surgery outweigh the risks of having the surgery and the necessary anesthesia. One example of this is a hip fracture that requires surgery. If the patient chooses not to have surgery, he or she will likely be confined to bed and have pain with every body movement. Also, the fracture is not likely to heal without surgery and the patient will probably have another life-threatening complication in the next few weeks like major blood clot, bed sores that become infected, ongoing pain, and significant problems from taking narcotic pain medications for a prolonged period of time.
The following are issues that can increase the risk of postoperative thinking problems. Please discuss with your anesthesia provider if you have any of these:
- memory loss
- Alzheimer’s disease
- Parkinson’s disease
- heart disease (especially congestive heart failure)
- lung disease
Researchers at major universities are actively studying the phenomena of Postoperative Delirium and Cognitive Dysfunction. While our team is very experienced in caring for older adults, there is no proven way that can guarantee Postoperative Delirium and POCD won’t happen. However, if delirium or POCD do occur after surgery, there are certain practices that can help minimize their impact. These include:
- Minimizing narcotic pain medications. Nerve blocks are techniques that can be done in some cases. Nerve blocks help control pain and eliminate or reduce the amount of narcotic pain medication that is needed.
- Having a family member or close friend stay with you after surgery.
- Bringing your glasses and hearing aids – wear them as soon as possible after surgery.
- Asking for a room with a window – looking outside can help you orient to day and night time.