As Henry Ford Health System (HFHS) neuropsychologists Dr Adrianna Zec and Dr Brad Merker watched the COVID-19 pandemic unfold in the Detroit metro area, they began to wonder how the crowds of patients COVID-19 coming out of intensive care units (ICU) were going to cope. They were keenly aware of how an intensive care stay can have lingering negative effects on patients after discharge – and they were inspired by an innovative model of care offering a variety of interdisciplinary services for these patients, pioneered by Vanderbilt University ICU Recovery Center in 2012.
“We thought this model of care might be ideal for COVID and other patients here,” says Merker, who is division head of neuropsychology for HFHS Behavioral Health Services. “This clinic aims to minimize the symptoms of post-intensive syndrome (SPIC) and to maximize a patient’s recovery after serious illness.”
Zec and Merker therefore launched the HFHS Post ICU Brain Health Clinic, with locations in Detroit and West Bloomfield. Staffed by board-certified neuropsychologists with expertise in aging, neuropsychiatric disorders, assessment and treatment of the elderly and caregivers, the clinics provide specialized care to adults aged 55 and over who have survived in intensive care.
Dr Adrianna Zec and Dr Brad Merker.
As medicine progresses, the number of people surviving serious illness and the time spent in the intensive care unit afterwards continues to increase. In 2016, experts estimated that 1.4 million adults in the United States had survived serious illnesses. COVID-19 has dramatically increased those numbers. In a single day in September, 2,437 Michiganders were in intensive care due to COVID-19. First tagged in 2010, PICS was identified as a serious threat to recovery for those who had experienced hospitalization that included time in intensive care. Up to 80% of these people suffer from a wide range of physical, cognitive and psychiatric impairments when they return home.
“Part of what we do is to assess the changes in thinking that may occur due to being in intensive care and having certain things that may arise due to the stay,” says Zec, senior staff member. from the HFHS Neuropsychology Division. “If older people previously had mild cognitive problems, these may mask the cognitive declines that have occurred as a result of their stay in intensive care. Particularly if patients are on a ventilator, there are concerns about changes in cognitive functioning. “
Seniors may mistakenly attribute cognitive problems to PICS to their age, such as difficulty with memory and concentration, slower mental processing, and difficulty performing tasks. The physical symptoms of PICS often include difficulty breathing, problems with weakness and balance, neuromuscular impairment, and pain or numbness. Psychologically, former intensive care patients may suffer from anxiety and depression, insomnia, or post-traumatic stress disorder. Zec says these psychological impacts are due to the sheer trauma of going through a near-death experience.
“There are all the alarms, the whistles, the trauma of the near-death experience that they face. And in some cases, they are exposed to the near-death or death experiences of other people nearby, ”Merker explains. “When the COVID hospitalizations started, there was enormous social deprivation – not having a family visit, all staff in full protective gear, masks, face shields. You can’t see anyone, can’t call your friends or family. Certainly compared to the traditional stay in intensive care, with COVID stays, there is an increase in social deprivation. “
HFHS founded the Post ICU Brain Clinic to treat COVID-19 survivors and other patients with symptoms of PICS after being hospitalized in intensive care units statewide. An ever-increasing number of Michiganders who have been – or will be – hospitalized with COVID-19 will need help getting back to normal, physically, mentally and emotionally. People specifically hospitalized for COVID-19 are at even higher risk of experiencing the psychological impacts of PICS.
“Our goal is to identify these people and get them treated,” Zec explains. “Unmasking post-ICU cognitive deficits is crucial. They have a lot of sightseeing, places to go, drug rehabs, routine changes. If we don’t detect these cognitive impairments, they are not able to follow their care. We are a kind of safety net.
Dr Adrianna Zec.
When patients register at the clinic, they and their caregivers undergo a comprehensive two-part neuropsychological examination to understand their difficulties. After completing the first half practically from home, they come to the clinic to complete the second half.
Depending on a patient’s reported symptoms, the assessment may test lung function and gait or screen for anxiety and depression. Patients will be asked if they have difficulty with daily tasks and if their quality of life has declined since returning home from hospitalization. Treatment plans may include physical therapy and exercise, psychotherapy, or medication.
“Based on our assessment, we come up with recommendations,” Merker says. “For all potential causes of cognitive or psychological disorders [issues], we refer to other specialists – for example, pulmonology, sleep medicine or neurology. Then, if necessary, we can refer them to a psychiatrist or psychotherapy. In addition, we use cognitive remediation internally or, if they need more specific cognitive relearning or retraining, refer them to speech therapists.
Family members of intensive care patients have been assigned a syndrome of their own. Post-Intensive Family Syndrome (PICS-F) describes anxiety, stress, depression, and complicated grief that can prevent family members from properly caring for patients who need support after they return home. the hospital. The Henry Ford Post ICU Brain Clinic recognizes that caregivers often need help, support, and sometimes referrals to professional help in order to stay healthy.
“We are there for the patients themselves and also try to help their caregivers connect them to things that can help the patient, but also provide them with resources for themselves to help them adjust to the situation. caregiver role, ”Zec explains.
“We do a caregiver stress load assessment and also provide treatment for those caregivers,” Merker adds.
Anyone in Michigan aged 55 and over who has been hospitalized in an intensive care unit in the past year and continues to have cognitive, behavioral, or psychiatric symptoms can seek help from the Henry Ford Post ICU Brain. Clinic. A portion of a $ 500,000 Michigan Health Endowment Fund Healthy Aging Grant to the clinic is allocated to help uninsured patients access these much-needed services. Referrals of patients and their caregivers can be made by calling (313) 874-4846.