How having an operation can send you delirious: Terrifying post-surgery hallucinations strike up to half of the over-65s: “can also leave people in a permanent state of confusion and suffering from dementia”

By Roger Dobson

PUBLISHED:18:46 EST, 10  September 2012| UPDATED:18:46 EST, 10 September 2012

When Gordon Sturmey came around after  surgery, he was convinced people were trying to kill him.

He believed a nurse was trying to poison him,  and he soon started to think his relatives were also involved.

Gordon, 65, of Thatcham, Berkshire, had been  admitted to the Royal Berkshire Hospital in Reading, where he underwent surgery  for a perforation in his large intestine triggered by a severe bout of food  poisoning.

Older patients can suffer from hallucinations, which can be benign, such as flying pigs and alien spaceships, but some report more sinister experiencesOlder patients can suffer from hallucinations, which can  be benign, such as flying pigs and alien spaceships, but some report more  sinister experiences

‘Afterwards, I was convinced the nurses and  my family were trying to kill me — and it was very, very real,’ he  recalls.

‘When my family came to see me, I asked for  them to be taken away from my bedside.

‘I remember one nurse spending 30 minutes  trying to explain what was happening to me, but I didn’t believe  her.’

Gordon, a retired accountant, had suffered  post-surgery delirium — a side-effect that leaves patients confused,  disorientated, aggressive and prone to hallucinations.

The condition is alarmingly common,  especially in older age groups.

Up to half of men and women aged over 65  experience post-surgery delirium.

Experts say a number of factors place this  age group at risk.

One reason they are particularly vulnerable  is because they are more likely to have underlying health conditions (such as  diabetes or high blood pressure) or be taking multiple medications — both of  which raise the risk.

Recently, however, scientists have suggested  another key factor may be that older brains are more susceptible to  inflammation.

Experts believe that inflammatory molecules  are released when we undergo surgery and can leak into brain tissue, triggering  confusion.

In younger people the protective barrier  around our brains prevents this from happening, but the barrier becomes less  effective as we age.

As a result, patients can suffer from  hallucinations.

These can be benign, such as flying pigs and  alien spaceships, but some patients report more sinister experiences — as Gordon  did.

Worryingly, experts warn that not only does  delirium slow recovery, it can also leave people in a permanent state of  confusion and suffering from dementia.

With record numbers of older people  undergoing surgery, there is growing concern that this condition could be  contributing significantly to the numbers of people with  dementia.

Professor John Young, a researcher at the  Academic Unit of Elderly Care and Rehabilitation at Bradford Royal Infirmary,  explains: ‘We have only recently recognised that delirium can persist long after  the time of surgery.

‘In 25 per cent of cases it is permanent, and  can become dementia. It usually appears within the first three days of surgery.

‘In some it can be fleeting, lasting just  hours. But in others it can last for days or weeks, or even become  permanent.

‘It can double the risk of premature death,  although the death is usually linked to an underlying health  problem.’

Wards tend to be very bright, busy and noisy, and are disorientating environments for people who are ill and vulnerableWards tend to be very bright, busy and noisy, and are  disorientating environments for people who are ill and vulnerable

Even when patients recover, many have partial  or full recollection of their terrifying visions, which can continue to haunt  patients for years.

This was certainly true for Gordon.

‘The hallucinations only lasted for about  half a day,’ he says.

‘But the experiences are as real to me now as  they were then. I recently attended a meeting and met the nurse who I thought  was trying to  poison me, and I still felt  very  uncomfortable.’

But why are so many  patients falling  prey to this terrifying condition?

‘Many things are going on in the onset of  delirium,’ says Professor Young.

‘Surgery is the trigger, but people at high  risk of delirium will have a background of fragile health.

‘They are likely to have a chronic illness or  be taking a combination of drugs.

‘We don’t fully understand the processes, but  some brain chemicals are implicated, particularly choline and dopamine.

‘Many medications can have deleterious  effects on these chemicals, including some anti-histamines, steroids and  pain-relieving opioids.

‘It was at first linked with heart surgery,  but it can occur with any procedure.’

Yet Professor Young says  the condition  is very simple  to prevent.

‘We need a cultural change that regards  delirium as a potentially preventable complication,’ he explains.

‘The reduction in delirium can be done with a  relatively simple strategy that identifies the risk factors and does something  about those that can be modified.’

Along with colleagues in Leeds, he is about  to start a major clinical trial at hospitals in Britain, testing a new strategy  for preventing the condition on 500 patients.

Results from pilot studies suggest that  targeting ten risk factors can lead to vast improvement: disorientation,  dehydration, constipation, an existing mental impairment, sleep problems,  infection, immobility, breathing difficulties, pain and multiple drug  use.

‘We decided to do this work because it has  been neglected in research,’ he says.

‘I was astounded by the sheer number of cases  and the distress it caused.’

A small pilot study showed a 50 per cent  reduction in the incidence of dementia.

‘The modern hospital is in many ways the  opposite of a traditional caring environment,’ says Professor Young.

Wards tend to be very bright, busy and noisy,  and are disorientating environments for people who are ill and  vulnerable.

‘We also now realise it is crucial that  patients are adequately hydrated around the clock, and that they are able to  sleep, as both dehydration and lack of sleep contribute to  delirium.

‘It is also important to orientate and  reassure the patient with clocks, a calendar, and frequent staff contact, and to  ensure they have their glasses and hearing aid if they need them.

‘This preventive approach is extremely cost  effective. If a patient develops delirium, they tend to stay longer in  hospital.

‘And at £300 a day per patient, that soon  mounts up.

‘Unfortunately, health services have been  slow to recognise that the modern general hospital should increasingly be  regarded as an older person’s facility.

‘We have largely designed a system to cater  for people who have only one thing wrong with them at once — but this has  changed, and it’s now mainly used by elderly people who have many things  wrong.’

Gordon now assists in running a support group  for patients who have suffered from the condition and believes greater awareness  is vital.

‘Although people have different  hallucinations, they never forget their experience,’ he says.

To  contact the support group, email icusupportnetworkreading

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