"Eight Days of Nightmares … " - Octogenarian Patients' Experiences of Postoperative Delirium after Transcatheter or Surgical Aortic Valve Replacement.
Irene Instenes, Eva Gjengedal, Leslie S P Eide, Karel K J Kuiper, Anette H Ranhoff, Tone M Norekvål
Heart, lung & circulation February 2018 DOI: 10.1016/j.hlc.2017.02.012 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Qualitative study (phenomenological) Peer reviewed |
|---|---|
| Sample size | 10 |
| Population | Octogenarian patients (five women, five men, aged 81-88 years) with severe aortic stenosis who underwent surgical aortic valve replacement or transcatheter aortic valve implantation and experienced postoperative delirium |
| Duration | Delirium assessed for five days postoperatively; cognitive function assessed preoperatively and at 6-month follow-up; interviews conducted 6-12 months post-discharge |
| Measures | Confusion Assessment Method, Mini-Mental State Examination |
| Topics | Dreaming |
| Keywords | Delirium Older patients Qualitative method Tavi |
| Key findings | Octogenarian patients who underwent SAVR or TAVI reported strong and distressing memories of their postoperative delirium that could persist for up to 12 months. Their experiences were grouped into six themes, including "Like dreaming while awake," "Trapped in medical tubes," and "Meeting with death and the deceased." The authors propose these findings can improve health service delivery and empathic professional care. |
Abstract
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.
Comparable studies
Other qualitative studies on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| The Other as a Nightmare: The Israeli-Arab Encounter as Reflected in Children's Dreams in Israel and the West Bank Jewish and Arab fifth to seventh graders living in various settings in Israel and the... | 1989 | Qualitative content analysis | n = 212 |
| Nonwaking Responses to Waking Stressors: Dreams and Nightmares1 Men from the cohort eligible for military duty during the Vietnam Conflict, varying in... | 1990 | Survey interview study | n = 442 |
| Communing with the Gods: The Dreaming Brain in Cross-cultural Perspective | 2011 | Phenomenological study | |
| Partial memory reinstatement while (lucid) dreaming to change the dream environment. Lucid dreamers | 2020 | Qualitative study | |
| Strange themes in pandemic dreams: Insomnia was associated with more negative, anxious and death‐related dreams during the COVID‐19 pandemic Global survey participants | 2022 | Longitudinal mixed-methods study | n = 2,240 |