This Just In: The Elderly Hallucinate in Hospitals, Says New York Times

Opened my New York Times this morning and was treated to the breaking news - in a below-the-fold front-page story, no less - that the elderly hallucinate in hospitals.

Uh, right.  Stop press.  This changes everything.

Actually, to be fair, the Times isn't just reporting about hospital hallucinations - it's also reporting that the medical profession is finally taking them seriously.  Which if true, is in fact news, and good news, too.

As to the remarkable fact of the hallucinations themselves - sorry, Times, but every Alzheimer's caregiver has known about them for years. 

In fact, my father had major hallucinations every time he was admitted to the hospital. 

In the fall of 2003, on the first major hospitalization of his Alzheimer's - also his first major hospitalization since his childhood - he spent a full afternoon time-traveling.  First he was in the Coast Guard (he'd respond to everything I said with "Aye aye, Sir!")  Then he was a reporter (he looked at me and asked, "Are you guys also working press?")  There was a New York Giants game on television and he managed to conflate it with something else he'd been thinking and turned it into an enormous litigation in which the Giants were suing Columbia University or Columbia was suing the Giants or they were suing each other.  Then he noticed the 74 year-old man in the next bed and started giving him advice about how to start a dental career.  We found out later that the 74 year-old man was in fact planning a dental career, so that, at least, was a shared hallucination.

By 2006 things had gotten darker.  My father was in the hospital during the Christmas-New Year's week.  One morning my wife and I walked into his room and found him flat-out raving - during the night, he said, he'd been kidnapped multiple times, men had stormed into his room and he'd fought them and they'd fought each other and there was a riot, an absolute riot in his room, and then they took him across the street and held him there, and there was a shadowy figure called The Menace that was after him...

This went on for hours, at a high, energetic pitch.  There were also grandiose fantasies about how my business controlled the world and was going to make everything right.  My wife and I looked at each other, then went straight to the nursing station and tried to report to anyone who'd listen that he'd sailed off the deep end and we'd never seen him that way before.

The reaction was an ongoing stream of condescending smiles - oh, yes, of course, never been like that, sure, we know, the families always say that.  We pressed the point because he was supposed to be discharged that afternoon, and we had no idea if it was safe to take him home.  But all we got was the patronizing stonewall - until about 4 p.m., when a couple of the more arrogant house staff physicians, suddenly looking sheepish, took us aside and the first one said, "Uh, about those hallucinations... we just had a look at his chart..."

It seems that when he'd gotten agitated overnight, somebody on the nursing staff had dosed him up with Ativan.  As I could have told them if anybody had asked, my father tended to have what are called paradoxical reactions to anti-anxiety and antipsychotic meds - meaning that they'd make him anxious and psychotic.  That's what happened here.  The hospital did its usual thing ("stuff him with meds, put him down!")  We got him home that afternoon but it took another three days for the hallucinations to clear.  We finally had to tell him that he'd hallucinated the kidnapping - it was so vivid that he refused to believe it wasn't real.  But once we gave him the background, he got bemused in a mostly happy way - "Really?  I imagined all that?  But I remember it all so clearly..."

What I remember, mainly, other than the sense of alarm, is being patronized by the doctors.  "Oh, yes, silly mortal, the elderly often do this.  We'll humor you when you tell us his behavior is unusual, but we know better because we, by definition, know better.  That's what makes us doctors."  Many times, on many hospital visits, we were treated to the technical term for his hallucinations - "sundowning," so called because the hallucinations happen mostly in the evening.  "Oh, yes," Dr. R would tell us, "he's been sundowning."  He said it with an air of, "we have a word for that, therefore we know all about it."  He might as easily have said, in his expert voice, "Oh, yes, he's got a serious case of Romaine lettuce." Syndrome identified, case closed.  No one ever did anything about the sundowning - followed up on it or asked if it happened at home, too (it usually didn't) or thought critically about the hospital environment to see if it could be minimized.  No, we have a word for it, and now that we've registered our expertise, we'll move on.

So it's a Very Good Thing if, as the Times suggests, the medical profession (or at least some parts of it) now recognizes that hospital hallucinations are common, they're harmful, and it might be a nice idea to change the routines in order to mitigate them a bit.  I'm all for it.  In fact, if anybody's interested, I'll be happy to share my notes.

If you're taking an elderly person to the hospital, you might want to clip the article and carry it with you to show the medical professionals who Know Everything and Will Tell You So Themselves.  Couldn't hurt.  Could help.  Could free you and your loved one from the burden of thousands of tiny creatures, some on horseback, when they attack.

 

Comments

[Amy]

I'm really glad you are back blogging. I'm definitely going to have to read that article now. I dismissed it because of the headline.

[Karen]

Happy you are back! I experienced this firsthand with my Mother. Glad to see someone finally recognize it as an issue.

[Cathy]

Ditto to both comments above!