Larner Assistant Professor of Medicine George Cao, M.D., M.B.A., a hospitalist at the University of Vermont Medical Center, explains in a Medscape article why it is important for hospitalists to encourage mental stimulation for patients.
In the hospital, Cao says, even small shifts—like becoming less active, eating less, or changes in personality—can become much more obvious. “As hospitalists … we see patients throughout the day, in different situations, and often end up spending more time with them over the course of a week than their primary care provider might in a year. This gives us a real advantage in picking up on subtle changes in mental awareness.”
Declining mental awareness in the inpatient setting is often a sign of an underlying problem—whether that’s a reversible medical condition, unrecognized dementia, or the development of delirium, Cao said. Changes in how patients function day-to-day, shifts in their behavior, or even something as simple as not wanting to get out of bed can be early signs of an aging mind or untreated psychiatric issues, he noted.
Delirium is the most common cause of sudden mental status changes in the hospital, and “it’s easy to miss if you’re not looking for it.”
By combining what he notices bedside and what is learned from the medical record (and from the people who know the patient best), Cao said he’s able to catch these changes early, identify the underlying cause, and work toward the best possible outcome. “One of the main interventions is providing mental stimulation,” he said.
Cao recommends encouraging patients to be more engaged during the day through conversation, activities, or regular reorientation. “This supports the brain networks that help prevent inattention and confusion, which are the hallmarks of delirium. Daytime stimulation also helps build up the natural drive for nighttime sleep, so patients are less likely to nap during the day and be awake and disoriented at night.”
Ensuring patients have their glasses, hearing aids, and familiar routines, along with encouraging mobility and hydration, further protects against delirium and supports patients’ cognitive health during hospitalization. “These same principles are just as important in outpatient subacute rehab settings and at home, so it’s essential to take home these strategies after discharge,” he said.