title: "Eight Days of Nightmares … " - Octogenarian Patients' Experiences of Postoperative Delirium after Transcatheter or Surgical Aortic Valve Replacement.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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".
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors.forename: Irene
authors.initials: I
authors.lastname: Instenes
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Molde University College, Molde, Norway.
authors.forename: Eva
authors.initials: E
authors.lastname: Gjengedal
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway; Western Norway University of Applied Sciences, Bergen, Norway.
authors.forename: Leslie S P
authors.initials: LSP
authors.lastname: Eide
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors.forename: Karel K J
authors.initials: KKJ
authors.lastname: Kuiper
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway; Kavli Research Center for Geriatrics and Dementia, Haraldsplass Hospital, Bergen, Norway.
authors.forename: Anette H
authors.initials: AH
authors.lastname: Ranhoff
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway. Electronic address: tone.merete.norekval@helse-bergen.no.
authors.forename: Tone M
authors.initials: TM
authors.lastname: Norekvål
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D003071:Cognition / Q000502:physiology*; D003693:Delirium / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D009664:Norway / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Delirium; Older patients; Qualitative method; TAVI