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The Link Between the ICU and Dementia

Medically Reviewed by Christopher Melinosky, MD on December 16, 2020

ICU delirium is severe confusion that can happen to people while they’re in a hospital’s intensive care unit (ICU). There are several possible reasons for it, and it can lead to serious and possibly long-lasting brain problems, including dementia.

The ICU and Your Brain

The ICU is for people who need round-the-clock care. If you’ve had a life-threatening illness or injury and need major surgery, you’re likely to be there for the first part of your recovery.

People in intensive care are often given powerful drugs. They may also have conditions that affect their brain chemistry or how much oxygen reaches their brain. These things can affect how your brain handles information or balances your mood. They can throw off how you think, communicate, and see the world around you. That’s called delirium, or being delirious.

When you’re delirious, you might not know where you are, or you might think you’re somewhere other than the hospital. You might see or hear things that aren’t there, and you may not be able to speak clearly to other people who want to help. It’s been described as being in a bad dream -- one that can be scary for those around you, too.

Other common signs of delirium are:

  • Confusion about what day it is
  • A hard time concentrating
  • Being unable to remember things
  • Sudden changes in mood

If you’re delirious, you also might think you’re in danger and need to leave the hospital, or you may try to remove tubes or catheters.

Long-Term Effects

Delirium is temporary, but it can take days or weeks for it to go away completely. And research shows that it may lead to problems even after you leave the hospital. More than a third of people who recover from a serious illness in the ICU have trouble thinking clearly, remembering or organizing things, or solving problems afterward.

This can get better in time, but that’s not the case for everyone. Some studies show that up to 75% of people who get out of intensive care show some signs of dementia -- a permanent loss of certain mental abilities, like memory and communication.

Scientists aren’t sure why, but your chances of this seem higher the longer you’re given medicine to make you sleep. People with serious conditions like sepsis, kidney failure, or brain disorders or have had heart surgery also seem to have higher odds of dementia afterward.

How to Communicate With Hospital Staff

Your loved one will have a dedicated team to care for them. If one of them uses terms or refers to new procedures that confuse you, don’t be shy about asking them to explain. Poor communication between families and staff members can be one of the most frustrating things about a hospital stay.

To help improve communication:

  • Choose a main contact person for the staff to talk to. This can be you or another family member.
  • Talk to a doctor each day about the plan and timetable for the hospital stay.
  • Find out which nurse and staff person you should contact each day with questions.
  • Remember that most doctors come by in the morning or late afternoon. Have your questions ready. Tell family members who want to talk to the doctor to be there at those times.
  • Decide which questions you want to ask first. Understand that you may not get all of your questions answered at once.
  • Take notes when you speak with a staff member.
  • Ask for brochures or pamphlets about new procedures or treatments if you want to learn more.
  • Get a contact phone number in case you have questions after your loved one gets home.

If You Won’t Be at the Hospital With Them

Use this time to take care of yourself, especially if you’ll be the main care provider after discharge. It’s normal for you to be tired. It takes a lot of time and energy to care for someone with Alzheimer’s. Fatigue from a lack of sleep, anxiety, and stress can leave you burned out and depressed.

Tell those closest to you how you feel. If family or friends offer to help, take them up on it. Let them know exactly what you need. Feeding your pets, fixing a meal, or getting your mail can be a big help to you and make them feel good, too. Friends and family members can also stay with your loved one so you can have some time away.

Discharge

Hospital stays are sometimes shorter than expected. You’ll need a plan in case they come home early, so start thinking about it as soon as they’re admitted. They may still be recovering when they’re released. They could be discharged to their home and need only a little help from you. Or they might get to go home, but need help from a home health aide. But they could leave the hospital for a temporary rehabilitation facility like a nursing home. A nurse, social worker, or case manager employed by the hospital will help you plan this process.

Be honest about any limits or specific desires you have about their care. Some nursing homes have special care units for people with dementia. You can talk to the discharge coordinator about this option while your loved one is still in the hospital.

To make the discharge safe and smooth, make a list of things that could go wrong and figure out ways to address them. For example, ask for a list of any changes to their medications. If there have been changes, make sure you understand the new medications and the side effects they could have. Check that you have the new prescriptions. You’ll also want to know if your loved one’s been diagnosed with any new illnesses. Make a list of the treatments they’ve had and any other treatments they need. Find out if there’s any new care you need to provide. Get a telephone number you can call at any time with questions. Lastly, make a follow-up appointment with their primary doctor.

Prevention and Treatment

Because of the connection between ICU delirium and long-term problems, doctors have come up with checklists to prevent issues or cut them short if they start. These steps include:

  • Looking for signs of pain or discomfort in people who can’t talk
  • Using painkillers that may be less likely to trigger delirium
  • Letting people get better rest without being disturbed often
  • Taking people off of breathing machines sooner
  • Getting people up and moving earlier
  • Involving family members in their care
WebMD Medical Reference

Sources

SOURCES:

Critical Illness, Brain Dysfunction and Survivorship Center: “Overview,” “Cognitive Impairment,” “Management of Delirium in the ICU.”

ICUsteps: “Delirium and Intensive Care.”

Dimensions of Critical Care Nursing: “Delirium and Dementia in the Intensive Care Unit.”

National Institute on Aging: “What is Dementia?”

Critical Care: “Delirium in the intensive care unit,” “Risk factors for dementia after critical illness in elderly Medicare beneficiaries.”

The New England Journal of Medicine: “Cognitive Trajectories after Postoperative Delirium.”

Journal of the American Medical Association: “Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care Unit.”

Critical Care Nurse: “Delirium in the Intensive Care Unit: Medications as Risk Factors.”

Current Opinion in Critical Care: “Sedation, delirium and mechanical ventilation: the 'ABCDE' approach.”

Critical Care Clinics: “Cognitive functioning, mental health, and quality of life in ICU survivors,” “Preventing delirium in the intensive care unit.”

UpToDate: “Patient Information: Delirium (Beyond the Basics).”

RCN Publishing Company, Department of Health U.K.: “Improving Quality of Care for People with Dementia in General Hospitals.”

Alzheimer’s Society: “Hospital Care.”

National Institute on Aging: “Going to the Hospital: Tips for Dementia Caregivers.”

Next Step in Care (2016): “Hospital-to-Home Discharge Guide,” “Short-Term Rehab Services in an Inpatient Setting,” “Working with home Health Aides.”

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