Nowadays when we’re all consumed with COVID-19 news, it’s easy to forget our kupuna, hospitalized for any number of health issues.
As Dr. Sharon Inouye, a Hawaii- born, Boston-based geriatrics physician pointed out in a recent New York Times commentary, delirium among older patients has become a new epidemic. Despite the no-visitor rules, Inouye suggests that it is time to let caregivers attend to hospital-bound elders who are even more vulnerable under the current COVID-19 environment.
According to a recent commentary in the New England Journal of Medicine by an international group of physicians (www.nejm.org/doi/full/10.1056/NEJMc2008597), restrictions on visitation have caused a rise of up to 70% in delirium among their older patients.
A hospital can be an intimidating, sterile place with unfamiliar bland food, arrays of alien-looking instruments and strangers cloaked in masks that conceal their faces. It’s akin to being on another planet.
Consequently, sometimes older patients may not know where they are and may not even recognize family members. Dementia may play a role, but often, lack of sleep and side effects of medication (particularly prescription opiates) are the culprits. With strong sedatives, it is not unusual to see patients hallucinate.
In short, delirium can lengthen hospital stays, impede healing, and even increase the probability of death.
Geriatricians have battled this condition for years, but the answer is not more high-tech machines or state-of-the-art drugs.
First and foremost is to reduce the feeling of isolation.
One of the most effective measures to prevent isolation, said Inouye, is the “presence of a family member or volunteer who provides comfort and orientation.”
Family members or trained volunteers can aid patients with a host of activities that most health professionals simply don’t have the time to do. This includes reading the newspaper, playing games, helping with meals, massage and exercise, primarily walking.
Clinical trials have proven that all these actions have a beneficial effect. Kupuna have reduced stress and physicians do not feel as pressured to treat delirium with a pill.
It’s a common sense, preventative solution that works for the patient, the family and the medical staff.
To their credit, most Hawaii hospitals allowed for these kinds of visits prior to COVID-19.
Unfortunately, the landscape has changed.
No visitors mean that medical staff has often had to revert to powerful tranquilizers and even physical restraints, such as wrist cuffs or bed alarms to combat delirium.
So, what can we do to change this equation?
First off, as Dr. Inouye suggests, family caregivers, especially for patients at risk for delirium, shouldn’t be classified as “visitors.” They are, in effect, essential care providers.
With the proper PPE (personal protective equipment) and guidance, family and friends can and should be allowed to be in hospital rooms with their loved ones. Hospitals can and should provide training and protective gear, given adequate supplies for medical staff. This would lead to better outcomes by reducing convalescence and ultimately, freeing up hospital beds.
It’s a win-win for the patients and the institutions, not to mention the families.
We have the power to stem the epidemic of delirium among our kupuna. We need to begin right now.
Bradley Willcox is a professor and director of research in the Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii; Becky Gardner is a law lecturer at the William S. Richardson School of Law and founding board member of Envision Kaimuki.