Older adults at higher risk of confusion, memory problems after surgery: anesthesiologists and patients should partner to protect brain health

(BPT) - The "silver tsunami" of people 65 and older combined with the uptick in surgeries during the winter months is creating the perfect storm for a sometimes-overlooked issue — postoperative delirium. More common in older people, postoperative delirium can cause symptoms such as confusion, memory problems or agitation that are usually temporary, but can lead to longer hospital stays and is associated with postoperative cognitive decline. However, if you or a loved one are 65 or older and having surgery, there are ways to reduce the risk, starting with talking to your anesthesiologist before the procedure.

Various factors can increase the risk of postoperative delirium, including the body's response to surgery, frailty and underlying medical conditions. This condition is a growing problem, considering the aging population and older adults account for more than 40% of surgeries. It affects anywhere from 5% to 52% of older adults, depending on the type of surgery and the patient's age, and the rate increases steadily with age, nearly doubling every 15 years.

"Anesthesiologists play a key role in bringing awareness to postoperative delirium and discovering ways to reduce it," said Donald E. Arnold, M.D., FACHE, FASA, president of the American Society of Anesthesiologists (ASA). "Partnering with your anesthesiologist to let them know if you have health issues or other concerns is an important first step to reducing your risk."

ASA is dedicated to safeguarding patients from delirium after procedures requiring anesthesia, through its Perioperative Brain Health Initiative and by providing evidence-based strategies for health professionals and recommendations for patients.

Anesthesiologists Lead the Way in the Prevention of Postoperative Delirium

As the physician leaders in your care before, during and after surgery, anesthesiologists play a crucial role in preventing postoperative delirium. Launched by ASA in 2015, the Perioperative Brain Health Initiative focuses on improving care for older adults with memory or thinking problems by supporting better brain recovery after surgery. It offers best practices, guidelines, a frailty toolkit for care teams, and patient education on postoperative delirium, including suggestions for talking to your anesthesiologist and advice for preparing for surgery.

Additionally, ASA's journal, Anesthesiology, recently published new evidence-based recommendations for strategies that health care professionals may consider, including:

• Expanding preoperative evaluation. Older adults scheduled for inpatient surgery may benefit from preoperative evaluation to assess for frailty or cognitive impairment. At-risk patients can receive care in advance of the surgery from a multidisciplinary care team, visits from a geriatric doctor or nurse and education on postoperative delirium.
• Choosing the type of anesthesia. Anesthesiologists and patients should work together to determine the most appropriate type of anesthesia for that patient based on the surgery they're having.
• Prescribing medication to reduce risk. Anesthesiologists may consider prescribing the sedative dexmedetomidine to older patients having inpatient procedures, because it's less likely to cause postoperative delirium than other commonly used sedatives.
• Minimizing the use of other medications. Anesthesiologists should evaluate the risks and benefits of medications for anxiety, mental health issues and pain that may cause central nervous system effects in older adults, since they may increase the likelihood of postoperative delirium.

Patients Can Help Reduce Their Risk Too

While anesthesiologists are factoring in those strategies, you can reduce the risk that you (or your loved one) will have postoperative delirium by:

• Partnering with your anesthesiologist. When meeting with your anesthesiologist before surgery, be sure to discuss the following, which will help them create the best care plan for you:
  • Any health problems or pre-existing conditions should be communicated to the anesthesia care team.
  • The medications you are taking, including vitamins, herbal supplements or those for anxiety, seizures, muscle spasms or sleep, which can affect your nervous system.
  • If you have cognitive issues such as memory or thinking problems, including if you have ever experienced these issues after anesthesia.
• Undergoing a pre-surgery cognitive test. Ask the doctor to conduct a pre-surgery cognitive test, which can be used to determine your risks for developing ongoing cognitive problems after surgery.
• Having a recovery pal. A family member or friend should stay with you during recovery to help orient you and report any signs of postoperative delirium to your doctor right away.
• Making the recovery environment as familiar as possible. Ask that your hearing aids or glasses be given to you as soon as you are in recovery. If you are staying overnight in the hospital, bring a family photo or favorite item to help you feel more connected as you recover.

Learn more about how age can affect surgery and anesthesia, and how you can reduce your risk.