Hospital Noise and Older Adult Patients
A recent New York Times article about the perils of noise and clatter in hospitals generated an endless cacophony (albeit noiselessly) of blog entries. Majority of the comments came from patients and nurses who were unanimous in their conclusion that noise in hospitals, particularly the ICU and other high-acuity places is a serious “threat” to the patient’s ultimate recovery.
The hospitalized older adults is particularly vulnerable to the negative effects of noise and other interruptions that leads to poor quality of rest and healing sleep due to higher risk for delirium. Advance age and co-morbidities such as dementia, stroke, sensory impairment and Parkinson’s disease have been implicated in increasing baseline vulnerability to delirium. Although no specific study has looked into the role of noise in causing or aggravating delirium in older adults, the interventions used to treat it might require noise- generating devices such as IV pumps and monitors or admitting the patient to the ICU, an inherently loud place where incessant monitoring takes precedence over quality rest and sleep.
Delirium is the strongest independent predictor of death, ventilation time and ICU stay.1 In older adults, sleep deprivation due to noise can potentially exacerbate delirium. A recent study showed that not all noises are created equal. Electronic sounds (alarms from monitors and infusion devices and the ringing from telephones) caused a greater and more sustained elevation of instantaneous heart rate.2 This undue cardiac stress is of particular concern to the older adults who might already have underlying heart rate and rhythm problems. An increase heart rate would increase oxygen demand and trigger a cascade of hemodynamic effects in an already compromised heart. Therefore, noise does not only impact the quality of sleep, it affects the overall health outcome of hospitalization.
Addressing the horrors of noise in healthcare through patient-centered approach is not new. In 1860, Florence Nightingale’s cutting-edge book Notes on Nursing contained nine pages of instructions on how to counter the ill-effects of noise and how to care for the patient quietly. She wrote: “Unnecessary noise is the most cruel absence of care which can be inflicted either on sick or well” (p. 27.)3 If all health care providers will stop to pause and listen to the clatter, we will be more sensitive to our patient’s comfort, speak more softly and walk noiselessly to the bedside and avoid non-essential treatment during much needed rest and sleep time. In achieving better care outcomes, we can combine both the wisdom of Nightingale and today’s leading-edge technology in implementing a “quiet approach” to keep the bedside conducive to recovery. Nurses can best begin to follow Nightingale’s advice: “never to allow a patient to be waked, intentionally or accidentally, is a sine qua non of all good nursing care” (p. 25). Nightingale understood that uninterrupted, peaceful sleep is essential to healing especially among the vulnerable older adults.
1. Shehabi, Y., Riker, R.R., Bokesch, P.M., Wisemandle, W., Shintani, A., Ely, E.W., & SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group (2010). Delirium duration and mortality in lightly sedated mechanically ventilated intensive care patients. Critical Care Medicine, 38(12), 2311-2318.
2. Buxton, O.M., Ellenbogen, J.M., Wang, W., Carballeira, A., O’Connor , S., Cooper, D., Gordhandas, A.J., McKinney, S.M., & Solet, J.M. (2012). Sleep disruption due to hospital noises: A prospective evaluation. Annals of Internal Medicine, 157(3), 170-279.
3. Nightingale, F. (1860). Notes on Nursing: What it is and what it is not. London: Harrison.