Short-term changes in mental function are commonly seen after surgery and anesthesia. The most common short-term change in the elderly is delayed emergence from anesthesia, which means that the patient is slow to wake up from anesthesia. In the elderly patient, delayed emergence may result from a decreased ability to metabolize or eliminate anesthetic drugs or increased sensitivity to drugs due to age-related changes in organ function. This results in a longer-than-normal duration of anesthetic effects.
Postoperative delirium is another common short-term mental status change seen postoperatively in the elderly. Delirium, by definition, is a transient disorder with a sudden onset of mental-status changes characterized by confusion, disorientation, hallucinations, delusions, and overactivity of psychomotor autonomic nervous system function. Patients with delirium have disorganized and incoherent thinking. Short-term memory is impaired. Patients are often disoriented to time, but not infrequently they are also disoriented to place and person. Attention disturbance is always present, with the patient easily distracted. The patient often has no idea where they are, why they are there, and at times do not even recognize family members. This is usually seen on the first or second postoperative day, and symptoms are worse at night. The literature reports between 10 percent and 60 percent of elderly patients may experience postoperative delirium depending on the magnitude of surgery and the age of the patient.
Cognitive impairment is also commonly seen in the elderly patient after surgery and anesthesia and may occur with or without other overt mental status changes. Cognitive impairment includes problems with memory, learning, understanding, and reasoning. These changes may be quite subtle in the absence of other overt mental status changes, sometimes only picked up with sensitive testing.
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