Because of the various ranging side effects of dementia – which can be anything from forgetfulness and confusion to incontinence to mobility issues – people with dementia end up in hospital more often than the rest of the general population.
However, despite the frequency of admissions of people with dementia, these emergency rooms are not equipped to handle and manage people who may have dementia symptoms.
Most hospital emergency rooms are run as if every patient has perfect intellectual function – and yet this is something that many people living with dementia have some degree of impairment. That is why it is important to be able to support someone if they are admitted to hospital.
According to the Australian Institute of Health and Welfare, approximately 41% of all hospital admissions were for people over 65. Many of these people are elderly, frail and may have other medical conditions, as well dementia symptoms.
Many people who have dementia and are still living at home, end up going to hospital and never to return as they are put into respite or aged care. Dementia patients are twice as likely to suffer preventable complications such as pressure ulcers and pneumonia in hospital.
Pain management is also considerably different for people with dementia. Patients with dementia and a fractured hip tend not to be given as much pain relief as other patients with fractured hip.
Uncontrolled pain in dementia gives rise to delirium that is often undiagnosed and untreated in hospitals. As a result, half of these patients who develop delirium die in six months.
Many patients with dementia may get missed by accident at mealtimes and have problems eating and drinking which are made worse in hospital.
One research suggests that if a person has dementia, then they will stay in hospital longer than another person with the same clinical condition. And it has been reported that it wasn’t until after a hospital admission that it was discovered the person was not coping well at home.
However, there may be reason to believe that the reverse might be true. Not that it was discovered that the person was struggling at home before the hospital stay – but that they developed these struggles from staying in the hospital.
A person who struggles to eat and drink in the hospital may have been eating fine at home. And the person who was able to bathe themselves and go to the toilet in the familiarity of their home, may find it difficult in hospital where the facilities are so unfamiliar.
Someone who was able to live comfortably and entertained at home and sleep well, may be kept awake by the noise and light and find themselves isolated and bored during the day. Hospital stays, and the disruptions to their comfortable routine, may trigger mood swings, sleep problems, and behavioural concerns.
And when this happens, the symptoms can often be confused with delirium – a reversible state of confusion caused by stress and infection – and patients may be prescribed anti-psychotic medication to calm and quieten them, starting a never ending cycle of medication.
These is a lot that families can do to support a loved one in hospital – especially if they have dementia.
Being there for them is important; to help them eat, to help them wash, keeping them company and making sure that they swallow their medication.
Families should work together with the hospital to offer their loved ones the best care. This, by no means, is a criticism of hospital care or the work of the staff, but rather a practical response. There is no-one that knows a person living with dementia better than their family, friends and loved ones – so it’s important to speak up and notify the healthcare teams of any changes observed.
Despite best intentions to support people with dementia remain healthy and free from sickness, sometimes a hospital visit cannot be avoided. And when it occurs, if families support the person in hospital, it helps the nurses, reduces delayed discharges and maintains the dignity of the patient.
4.5
I would add that the presence of an A4 laminated sheet of paper is essential.
On that paper, include
Name
Known as
Medications
Do they need help feeding?
Family
Likes
Dislikes
Favourite music
Favourite people
Interesting thing they like to talk about
Things Never to talk about
Environment they grew up in, eg. Farm, Italy, etc.
If they went through a war.. Why? Loud noises might set them off.
You get the idea..
Have a copy for the ambulance
hand a copy to the reception at ER
Have a copy of they are admitted for the ward. Punch holes in that copy so it is included in the folder. Cater for both 2 and 3 hole binders.
Have a red plate for their meals
Have a copy if they are transferred to a facility
Have a copy for the registrar
You get the idea I’m sure..
You’re welcome..
Peter Gooley
Alzheimers and Dementia Coach
5
This article touches on a very important issue: what ensures the best outcomes for patients with dementia when they are in hospital? The answer is very good patient centred care., medical and nursing.
Spend a day in any ED or hospital ward and you will see how unlikely this is. The time and expertise required to meet the needs of patients with cognitive and behavioural deficits just does not exist. No staff:patient ratio factors in dementia as a variable. All patients are deemed to be equally needy and each will have to hope to have their needs individually assessed and met.
A patient with dementia who pulls out an IV, a naso gastric tube, a urinary catheter or removes ECG electrodes is high care. If they climb out of bed they are a danger to themselves and a security risk for the hospital. All of these contingencies can be managed by someone who can sit with the patient, reassure them and monitor the nature and quality of the care delivered. The two common problems at this stage are over treatment (mechanical and chemical sedation) and under treatment (analgesia and hydration).
Sometimes the best person will be a family member and sometimes it will be a professional supporter/advocate. Whoever that person is the must be health literate, assertive and collaborative.
2.5