Older adults have borne the brunt of the COVID-19 pandemic. Whereas Canadians aged 60 years and older make up solely 20 p.c of the inhabitants, they account for 69.5 percent of all COVID-19 hospitalizations, and most — 91.7 percent — of all COVID-19 deaths.
One facet of well being care throughout the pandemic that has acquired significantly much less consideration is the failure of efficient delirium care.
Delirium is a sudden and distressing state of confusion that occurs in up to half of hospitalized older people. It’s normally triggered by a change in well being, comparable to an an infection or surgical procedure, and is usually short-lived however can typically trigger long-term cognitive impairment resulting in an elevated danger of dementia.
Thankfully, delirium might be prevented or minimized utilizing easy methods. Within our own health practices, we have seen the effectiveness of promoting family caregiver presence, encouraging mobility and minimizing disruptions to eating, drinking and sleeping.
In Might 2020, an opinion piece written by geriatrician Dr. Sharon Inouye within the New York Instances warned of an epidemic inside the pandemic that was leaving many hospitalized older sufferers extra susceptible to delirium by abandoning many easy care approaches. Sadly, she was proper.
Our examine just lately revealed in JAMA Network Open confirmed that the concern of a delirium epidemic was realized. We discovered that throughout the first two years of the COVID-19 pandemic, older adults admitted to Ontario hospitals skilled extra delirium and have been discharged dwelling with extra sedating drugs in comparison with earlier than the pandemic.
Disruptions to delirium prevention care brought on by the pandemic are partly responsible. A scarcity of workers and volunteers, customer restrictions, and an infection management guidelines created the right storm of much less interplay with sufferers and fewer alternatives to make use of non-drug approaches for stopping and managing delirium.
Our examine outcomes are notably alarming as a result of now we have made a lot progress in delirium care during the last 30 years. Initiatives comparable to Senior Friendly hospitals, acute care of the elderly units, and hospital elder life programs have flourished throughout Canada. Within the three years previous the pandemic, our examine exhibits a transparent development of declining prescriptions of dangerous and addictive sleep medicines given to older folks after they left the hospital.
COVID-19 disrupted this hard-fought progress. Even two years after the onset of the pandemic, the variety of new sedative prescriptions being prescribed out in hospitals has not returned to pre-pandemic ranges.
So how will we reverse these harmful traits?
It’s possible that the autumn and winter will deliver a seasonal wave of viral illness comparable to influenza, RSV — and COVID-19, amongst others. Hospital and well being care programs will quickly be confronted with choices about customer and volunteer insurance policies within the face of viral outbreaks.
We are able to reduce charges of delirium by:
1. Implementing insurance policies centered on delivering dignified care, particularly to older individuals with cognitive impairment who can’t all the time advocate for themselves.
2. Renewing nationwide hospital efforts to mandate versatile hospital visitation and implement the straightforward and evidence-based care methods wanted to forestall and handle delirium.
3. Addressing nationwide staffing shortages plaguing well being care amenities throughout the nation and redoubling our efforts to construct and maintain senior-friendly well being care environments.
By no means once more ought to sick sufferers with delirium be remoted from their household caregivers.
We should return to offering the usual of take care of older people who reduces delirium and minimizes sedating medication. We owe it to our getting old inhabitants to supply the sort of humanistic care that helps older adults go away hospitals with their independence and cognition intact.
Christina Reppas-Rindlisbacher, Nathan Stall, and Paula Rochon are geriatricians.