Ira Pastor, ideaXme life sciences ambassador and founder of Bioquark, interviews Dr. Sharon K. Inouye, Professor of Medicine, Harvard Medical School and Director of the Aging Brain Center at the Hinda and Arthur Marcus Institute for Aging Research at Hebrew Senior Life.
Ira Pastor comments:
Today we are going to touch on a topic that we have not yet discussed on previous episodes, and that’s the topic of delirium, a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment, which in contrast to dementia, which is a very chronic and progressive condition, delirium is a very acute, emergent condition, and it can be very shocking for loved ones and medical practitioners alike.
Recent studies indicate that delirium is common for older persons in the hospital setting, with occurrence rates ranging from 29-64%.
Delirium is associated with: increased morbidity and mortality, functional and cognitive decline, increased rates of dementia, institutionalization, caregiver burden, and extreme costs in the hundreds of billions (not just hospital costs, but post-hospital costs, re-hospitalization, emergency department visits, institutionalization, rehabilitation, and formal home care services).
Most shockingly, delirium is often unrecognized. Studies have shown that in affected persons, that delirium is only recognized by about 1/3 of physicians and nurses.
Dr. Sharon K. Inouye: Delirium
Today on the show, we are joined by Dr. Sharon K. Inouye, Director of the Aging Brain Center at the Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, in Boston, Massachusetts.
Dr. Inouye has an M.D., from University of California San Francisco, and an M.P.H. from Yale, currently holds the Milton and Shirley F. Levy Family Chair and is a Professor of Medicine at Harvard Medical School (Beth Israel Deaconess Medical Center).
Delirium: An Under Diagnosed Area of Brain Aging
Her research focuses on delirium and functional decline in hospitalized older patients, resulting in more than 300 peer-reviewed original articles to date.
Dr. Inouye’s Work: Brain Aging and Degeneration
Currently, Dr. Inouye is the principal investigator of the Successful Aging after Elective Surgery (SAGES) study, an $11 million project on delirium funded by the National Institute on Aging, whose purpose is to examine the interface of delirium and dementia, whether delirium alters the course of dementia, and whether delirium leads to long standing cognitive impairment and pathologic changes in the brain.
Dr. Inouye developed and validated the Confusion Assessment Method (CAM), the most widely used instrument for the identification of delirium. She conceptualized the multi-factorial model for delirium, which focuses on identification of predisposing and precipitating factors for delirium, and her work involves translating theories of clinical investigation into practical applications that directly improve the quality of life for older adults.
She has also developed the Hospital Elder Life Program (HELP), a multi-component intervention strategy designed to prevent delirium by targeting six delirium risk factors. HELP was successful in reducing delirium by 40 percent and was published in a landmark study in the New England Journal of Medicine. This study was the first to show that a substantial proportion of delirium is preventable. Additionally, HELP has been shown to reduce falls, functional decline, and hospital costs, and to improve patient, family, and nursing satisfaction. The HELP program has been adopted by hundreds of hospitals worldwide.
Dr. Inouye has been awarded many of the highest accolades in her field, including being elected to the Institute of Medicine of the National Academies.
On this show we will hear from Dr. Inouye about:
Her Background, how she became interested in medicine, public health and this widely un-diagnosed area of brain aging. Her recent paper Joining Forces against Delirium — From Organ-System Care to Whole-Human Care in the New England Journal of Medicine (NEJM) where she describes her own personal findings with her father in a hospital with delirium following a collapse and emergency surgery, where specialty teams overseeing his care did not work with a unified approach. An overview of the HELP protocol in the New England Journal of Medicine (NEJM) – A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients. A discussion of the delirium – Alzheimer’s connection. An overview of the state of pharmacological intervention for delirium. A discussion of the “end-of-life” states of terminal lucidity and terminal agitation/delirium.
Credits: Ira Pastor interview video, text, and audio.
Follow Ira Pastor on Twitter: @IraSamuelPastor
If you liked this interview, be sure to check out our interviews with Dr. Michael B. Fossel and Ms. Laura Trejo!
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