How having an operation can send you delirious: Terrifying post-surgery hallucinations strike up to half of the over-65s
23:46 GMT, 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 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 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 @royalberkshire.nhs.uk