Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are increasingly performed in octogenarian patients with severe aortic stenosis (AS), including those with high surgical risk. Postoperative delirium (PD) is a common and serious complication in older patients, characterised by reduced awareness, change in consciousness, disturbance in logical thinking and hallucinations.
To explore how octogenarian patients experienced PD, a qualitative study was conducted including five women and five men between 81 and 88 years. The incidence of PD was assessed for five days using the Confusion Assessment Method. Cognitive function was assessed preoperatively and at a 6-month follow-up using the Mini-Mental State Examination. In-depth interviews were conducted 6–12 months post-discharge, transcribed, and analysed using Giorgi’s phenomenological method.
Postoperative delirium experiences were grouped into six themes: “Like dreaming while awake”, “Disturbed experiences of time”, “Existing in a twilight zone”, “Trapped in medical tubes”, “Moving between different surroundings” and “Meeting with death and the deceased”.
For the first time, we show that octogenarian patients who undergo SAVR or TAVI have strong and distressing memories of their delirious state that can persist for up to 12 months later. These findings provide valuable new information that will likely improve delivery of health services and enhance professional and empathic care of octogenarians after SAVR and TAVI.
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- 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial.Lancet. 2015; 385: 2477-2484
- American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults.J Am Geriatr Soc. 2015; 63: 142-150
- Cognitive Outcomes of Cardiovascular Surgical Procedures in the Old: An Important but Neglected Area.Heart Lung Circ. 2016; 25: 1148-1153
- Delirium in the intensive care unit.Crit Care. 2008; 12: S3
- Delirium in older people.BMJ. 2007; 334: 842-846
- Postoperative delirium and short-term cognitive dysfunction occur more frequently in patients undergoing valve surgery with or without coronary artery bypass graft surgery compared with coronary artery bypass graft surgery alone: results of a pilot study.J Cardiothorac Vasc Anesth. 2011; 25: 811-816
- Diagnostic and statistical manual of mental disorders: DSM-5.5th ed. American Psychiatric Association, Arlington2013: 596-605
- Delirium in elderly people.Lancet. 2014; 383: 911-922
- Nurse perceptions of the Nursing Delirium Screening Scale in two palliative care inpatient units: a focus group study.J Clin Nurs. 2015; 24: 3276-3285
- Experiences of undergoing cardiac surgery among older people diagnosed with postoperative delirium: one year follow-up.BMC Nurs. 2015; 14: 17
- A journey in quest of meaning: a hermeneutic-phenomenological study on living with memories from intensive care.Nurs Crit Care. 2008; 13: 86-96
- Patients’ and nurses’ experiences of delirium: a review of qualitative studies.Nurs Crit Care. 2011; 16: 303-315
- Interviews: learning the craft of qualitative research interviewing.2nd ed. Sage, Los Angeles, Calif2009
- Comparison of frequency, risk factors, and time course of postoperative delirium in octogenarians after transcatheter aortic valve implantation versus surgical aortic valve replacement.Am J Cardiol. 2015; 115: 802-809
- Delirium as a Predictor of Physical and Cognitive Function in Individuals Aged 80 and Older After Transcatheter Aortic Valve Implantation or Surgical Aortic Valve Replacement.J Am Geriatr Soc. 2016; 64: 1178-1186
- Guidelines on the management of valvular heart disease (version 2012).Eur Heart J. 2012; 19: 2451-2496
- Transcatheter aortic valve replacement in elderly patients.J Geriatr Cardiol. 2012; 9: 78-82
- Clarifying confusion: the confusion assessment method. A new method for detection of delirium.Ann Intern Med. 1990; 113: 941-948
- “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- Concerning the application of phenomenology to caring research.Scand J Caring Sci. 2000; 14: 11-15
- Severely ill ICU patients recall of factual events and unreal experiences of hospital admission and ICU stay–3 and 12 months after discharge.Intensive Crit Care Nurs. 2006; 22: 154-166
- Delirium superimposed on dementia: A quantitative and qualitative evaluation of informal caregivers and health care staff experience.J Psychosom Res. 2015; 79: 272-280
- Delirium superimposed on dementia: A quantitative and qualitative evaluation of patient experience.J Psychosom Res. 2015; 79: 281-287
- Review articles: postoperative delirium: acute change with long-term implications.Anesth Analg. 2011; 112: 1202-1211
- Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients: A Systematic Overview. The SENATOR project ONTOP Series.PLoS One. 2015; 10: e0123090
- Cognitive Dysfunction, Delirium, and Stroke in Cardiac Surgery Patients.Semin Cardiothorac Vasc Anesth. 2015; 19: 309-317
- Delirium recall – an integrative review.J Clin Nurs. 2016; 25: 1515-1527
- Acute confusion and unreal experiences in intensive care patients in relation to the ICU syndrome. Part II.Intensive Crit Care Nurs. 1999; 15: 19-33
- “Sundowning” as a biological phenomenon: current understandings and future directions: an update.Aging Clin Exp Res. 2016; 28: 383-392
- Temporary confusion: a fearful experience.J Psychiatr Ment Health Nurs. 2002; 9: 339-346
- Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement.Eur J Cardiovasc Nurs. 2016; 15: 168-177
Published online: March 21, 2017
Accepted: February 5, 2017
Received: December 23, 2016
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.