This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.
As Henry Ford Health System
(HFHS) neuropsychologists Dr. Adrianna Zec and Dr. Brad Merker watched the COVID-19 pandemic unfold in Metro Detroit, they began to wonder how the throngs of COVID-19 patients emerging from intensive care units (ICUs) were going to cope. They were highly aware of how an ICU stay can have lingering, negative effects on patients after discharge – and they were inspired by an innovative care model offering a variety of interdisciplinary services for those patients, pioneered by The ICU Recovery Center at Vanderbilt University
“We thought that model of care might be great for COVID and other patients here,” says Merker, who serves as division head of neuropsychology for HFHS Behavioral Health Services. “This clinic aims to minimize post intensive care syndrome (PICS) symptoms and maximize a patient’s recovery from serious illness.”
So Zec and Merker 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 conditions, assessment, and treatment of older adults and caregivers, the clinics provide specialized care for adults 55 and older who have survived intensive care.
Dr. Adrianna Zec and Dr. Brad Merker.
As medicine has advanced, the number of people surviving critical illness, and subsequent time in an ICU, continues to increase. In 2016, experts estimated that 1.4 million adults in the U.S. survived critical illnesses. COVID-19 has greatly increased these numbers. On just one day in September, 2,437 Michiganders were in ICUs due to COVID-19. First labeled in 2010, PICS was identified as a serious threat to recovery for those who had lived through a hospitalization that included time in the ICU. Up to 80% of these individuals experience a wide range of physical, cognitive, and psychiatric impairments when they get home.
“Part of what we do is assess the thinking changes that may happen because of being in the ICU and having some things that can come about because of the stay,” says Zec, a senior staff member with the HFHS Division of Neuropsychology. “If older adults had mild cognitive issues beforehand, those can mask cognitive declines that happened because of their ICU stay. Particularly if patients are on a ventilator, there are some concerns about changes in cognitive functioning.”
Older people may mistakenly blame PICS cognitive issues, like difficulties with memory and concentration, slowed mental processing, and trouble carrying out tasks, on their age. Physical symptoms of PICS often include
breathing difficulties, weakness and balance problems, neuromuscular impairments, and pain or numbness. Psychologically, past ICU patients may experience anxiety and depression, insomnia, or post-traumatic stress disorder. Zec says these psychological impacts arise because of the sheer trauma of living though a near-death experience.
“There are all the alarms, the whistles, the traumas of the near-death experience that they are facing. And in some cases, they are being exposed to the near-death or death experiences of others within close proximity,” Merker says. “In the beginning of the COVID hospitalizations, there was huge social deprivation — not to have family visit, all the staff in full protective gear, masks, face shields. You can’t see anyone, can’t call friends or family. Definitely compared to the traditional ICU stay, 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 experiencing PICS symptoms after being hospitalized in ICUs throughout the state. An ever-increasing number of Michiganders who have been — or will be — hospitalized for COVID-19 will need help getting back to normal, physically, mentally, and emotionally. People specifically hospitalized for COVID-19 are at even higher risk for the psychological impacts of PICS.
“Our goal is to identify these people and get them treatment,” Zec says. “Unmasking cognitive deficits post-ICU is crucial. They have a lot of visits to go to, places to go, rehab, changes to their routine. If we are not catching these cognitive impairments, they are not able to follow up on their care. We are kind of a safety net.”
Dr. Adrianna Zec.
When patients sign up with the clinic, they and their family caregivers complete a comprehensive, two-part neuropsychological examination to understand their difficulties. After they complete the first half virtually from home, they come to the clinic to complete the second half.
Depending on the symptoms a patient reports, the evaluation may test lung function and walking or screen for anxiety and depression. Patients will be asked if they are having difficulties with daily tasks — and if their quality of life has decreased since they got home from their hospitalization. Treatment plans may include physical therapy and exercise, psychotherapy, or medication.
“Based on our evaluation, we offer recommendations,” Merker says. “For any potential causes of cognitive or psychological [issues], we refer to other specialists – for example, pulmonary, sleep medicine, or neurology. Then, if needed, we may refer them to a psychiatrist or to psychotherapy. In addition, we make use of in-house cognitive remediation or, if they need more specific cognitive relearning or retraining, refer them to speech therapists.”
ICU patients’ family members have been assigned a syndrome of their own. Post-intensive care syndrome-family (PICS-F) describes the anxiety, stress, depression, and complicated grief that can prevent family members from being able to take good care of patients who need support after they get home from 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 keep themselves healthy as well.
“We are here for the patients themselves and also trying to help their caregivers to connect them to things that can help the patient, but also provide them with resources for themselves to help them adjust to the caregiving role,” Zec says.
“We do an evaluation of the caregiver’s stress burden and also provide some treatment to those caregivers,” adds Merker.
Anyone in Michigan aged 55 and older who has been hospitalized in an ICU in the past year and continues to experience cognitive, behavioral, or psychiatric symptoms can seek help at the Henry Ford Post ICU Brain Clinic. A portion of a $500,000 Healthy Aging Grant from the Michigan Health Endowment Fund to the clinic is being allocated to help uninsured patients access these much-needed services. Referrals for patients and their caregivers can be made by calling (313) 874-4846.