Certain Leisure Activities Can Decrease the Risk of Post-Surgical Delirium among Older Adults

Post-surgical delirium is a common complication in the older people. The term refers to sudden changes in the mental function induced by drugs, infection, electrolyte imbalance, immobilization etc. after surgery.  Elderly people are more likely to develop delirium, dementia and even death following major surgeries. This research has demonstrated that engaging in pleasurable activities lessens the chances of developing this preventable condition. 

Study Design

The research was carried out by a team of experts from Albert Einstein College of Medicine in the Bronx, NY. The purpose of the research was to find out whether indulging in the activities that reduce the chances of memory loss also help in decreasing the odds of post-surgical delirium. The results of this study were subsequently published in the Journal of the American Geriatrics Society.
During the course of this prospective cohort study, the researchers examined 142 elderly patients who were due to undergo major surgical procedures for hip, knee and spinal injuries at the Montefiore Medical Center Orthopedics outpatient clinics. These patients were inquired whether or not they indulged in relaxing activities such as gardening, book reading, cross word puzzle solving etc.

 
Results 

The results showed that forty five participants (about 32% of the subjects) who partook in the research developed post-surgical delirium following the operative interventions. These figures were adjusted for age, sex, co-morbid conditions and baseline cognition. All of these 32% patients participated in lesser leisure activities as compared to those patients who actively engaged in leisure activities. 
It was demonstrated that playing computer games, book reading and emailing were the activities that reduced the chances of post-surgical delirium to the greatest extent. Singing and playing computer games were the activities that lessened the severity of post-surgical delirium. It was shown that every day which is spent being involved in leisure activities decreases the odds of developing post-surgical delirium by almost 8%. 
It was postulated that participating in such pleasurable activities increase the “cognitive reserve” in the elderly population since if the brain is used more, it results in improvement of brain functions. Thus, taking part in enjoyable activities is beneficial for the older people, making them less prone to develop dementia and other forms of cognitive deficit, specifically, post-surgical delirium. 

Recommendations

The researchers recommended taking an active part in pleasurable activities such as knitting, reading newspapers and books, playing cards and other such games or socializing since they can have a positive impact on the brain functions and can help prevent post-surgical delirium, thereby preserving the brain functions. 
It was proposed that engaging in leisure activities can be taken up as a prophylactic measure in patients who are about to undergo a surgical intervention. Mass level education can help the older people avoid the common complication of postsurgical delirium. 
These activities can, therefore, improve the life expectancy linked with major operations in the elderly population in order to age in a healthy way and to avoid the morbidities associated with old age. 

Post-Operative Delirium Delays Functional Recovery after Elective Surgery

Post—operative delirium is a common complication associated with the surgical procedures. Although it often goes undiagnosed, almost 11-50% of the elderly people are plagued with this problem following surgeries. Latest research shows that post-operative delirium interferes with the recovery process after surgical interventions, especially in the older population. 

The research was conducted by experts from the Harvard Medical School-affiliated Hebrew Senior Life Institute for Aging Research (IFAR) along with researchers from Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Brown University, and Northeastern University. The results of this study were subsequently published in Annals of Surgery.

Study Design

The basic aim of this prospective study was to evaluate the effects of post-operative delirium on functional recovery after an elective surgery. The participants of this research were selected from the Successful Aging after Elective Surgery (SAGES) study and all of them were aged at or above 70 with a mean age of 77. 58% of the participants were females. 

All of the study subjects were to undergo elective surgery followed by a minimum hospitalization period of 3 days. The study subjects were evaluated for the presence and severity of post-op delirium during their stay at the hospital after elective surgical procedures using a technique called Confusion Assessment Method. The patients were followed up for a period of 18 months after surgery. 

Results

It was found out that 24% of the study subjects developed delirium after surgery. In the patients who went into post-operative delirium, the functional recovery was delayed and incomplete as compared to the patients who did not develop post-operative delirium. 
The results demonstrated a clear impact of post-operative delirium on the functional recovery during the 18 months post-operative period. The functional status of the patients in both the groups decreased to a considerable extent almost 1 month following the surgeries but this decline was more pronounced in the group of patients who went into post-operative delirium. 

After the 1 month period was up, the patients who did not develop post-operative delirium started recovering but the functions of patients with post-operative delirium deteriorated even further. By the end of the 18 months period, the patients with post-operative delirium displayed a significant functional decline as compared to the patients without this complication.  

Future Prospects

This study has helped highlight a key post-operative complication that often goes unnoticed. It has paved for implementation of preventive strategies and customized care plans for preventing post-operative delirium in patients who are at high risk of this complication and are about to undergo an elective surgical procedure. This study is also expected to change the common notion among the elderly people that their functions will improve after surgery, discouraging the need to go under the knife unnecessarily. 
In this way, the likelihood of post-operative delirium in the elderly population following elective surgical procedures is expected to be reduced to a significant extent with a considerable decline in the rate of morbidity and mortality associated with the elective surgeries. These preventive measures are bound to ensure full functional recovery for a better quality of life.