Six tips for seniors to help limit confusion after surgery

Mar 13 2018

The longer you live the more likely you will develop a medical condition that requires surgery or a procedure. In fact, half of all people 65 and older will have at least one surgical procedure in their lifetime. And along with common potential side effects from anesthesia during surgery such as nausea, chills or muscle aches and itching, older patients are at risk for confusion or short-term memory loss. But rest assured, there are steps seniors can take to minimize these side effects.

"The aging brain is more vulnerable to anesthesia and surgery, but there is research that provides guidance to decrease these risks," said James D. Grant, M.D., M.B.A., FASA, president of the American Society of Anesthesiologists (ASA). "Older patients should talk with their physician anesthesiologist prior to surgery about their entire medical history and any memory problems they've had in the past, so an anesthesia plan can be developed that ensures their safety and reduces the chance of side effects or complications."

Two anesthesia-related surgery risks more common in older people include:

Postoperative delirium – This is a temporary condition that causes the patient to be confused, disoriented, unaware of their surroundings, and have problems with memory and paying attention. It may not start until a few days after surgery, comes and goes, and usually disappears after about a week.

Postoperative cognitive dysfunction (POCD) – This is a less well understood but more serious condition that can lead to long-term memory loss and make it difficult to learn, concentrate and think. Because some of these problems are already common in elderly people and may be the sign of an underlying long-term cognitive decline, the only way to determine if a patient actually has POCD is to conduct a mental test before surgery.

Researchers in anesthesia care continue to study and learn more about these conditions and how to prevent or reduce the effects.

During Patient Safety Awareness Week (March 11 – 17) ASA offers six tips for seniors to help limit confusion after surgery:

1. Ask your physician to conduct a pre-surgery cognitive test -; an assessment of your mental function. The physician can use the results as a baseline for comparison after surgery.
2. Be sure your caregiver, a family member or friend stays or can visit with you as you recover, carefully observes your physical and mental activity after surgery and reports anything troubling to your physician.
3. Check with your physician before taking medications after surgery that can affect your nervous system, such as those for anxiety, seizures, muscle spasms or sleep aids.
4. If you wear hearing aids or glasses, ask that they be made available as soon as possible after the procedure.
5. Request a hospital room for recovery with a window if possible, so you can tell whether it's day or night.
6. If you will be staying overnight in the hospital, pack a family photo, a clock and a calendar, or other familiar objects from home, to help you readjust.

In 2016, ASA launched the Perioperative Brain Health Initiative which has engaged a multidisciplinary group to work with health care providers, payers and the public to create better access to care that minimizes the impact of pre-existing conditions that may impair mental thinking or intellectual abilities, and optimizes patients' cognitive recovery and their experience before, during and after surgery for adults 65 and older.

To learn more about preparing for surgery, visit asahq.org/wscpreparingforsurgery. You also can download and print Preparing for Surgery: An Anesthesia Checklist to take with you to visit your physician anesthesiologist prior to surgery, as well as when you go to the hospital or outpatient clinic for the surgery. A brochure on seniors and anesthesia is also available for download. To learn more about the critical role physician anesthesiologists play before, during and after surgery, visit www.asahq.org/WhenSecondsCount.