Dementia & Hospitals: Caution!
Hospitals can often be challenging places for older people, but they are particularly problematic for people with dementia.
About ONE FOURTH of older hospital patients have dementia. People with Alzheimer’s or other dementias have TWICE as many hospital stays per year as other older people. Their dementia may never have been formally diagnosed. Even if it has been diagnosed, it may not be noted in their hospital record.
Because of stress caused by acute illness, along with being in an unfamiliar Because of stress caused by acute illness, along with being in an unfamiliar setting, some older patients show symptoms of dementia for the first time in the hospital. The stress of a hospitalization may worsen the cognition of people with Mild Cognitive Impairment (MCI). “Among older persons without dementia, hospitalization for serious illness is associated with subsequent cognitive decline,” according to Elizabeth A. Phelen, MD, MS. Hospitalization of older people, particularly those with dementia, is a significant event.
Older hospital patients with dementia are at much higher risk than other older hospital patients for delirium, dehydration, inadequate nutrition, untreated pain, and medication-related problems. They can also experience incontinence, pressure ulcers, new feeding tubes, and functional decline. There is an increased risk for falls with injuries, especially if they are sedated and disoriented.
People with dementia are more likely to experience functional decline that does not resolve following discharge. Most people living with dementia are not able to comprehend and adapt to the hospital environment and structure, which creates problems for them and the staff who are trying to care for them. Their normal daily routine is totally disrupted and they are in an unfamiliar environment. It is difficult to rest and sleep because there is constant noise and frequent testing and monitoring throughout the night. This can lead to exhaustion and new or worsening confusion.
Under these conditions, when people with dementia are in the hospital, they are more likely to experience and exhibit symptoms of distress, become agitated and aggressive, and/or try to get out of the bed and leave the hospital. Few hospital personnel are trained to assist people with dementia so their lack of person-centered approaches and responses often make the situation much worse.
Physical restraints and antipsychotic medications are commonly used in hospitals with the belief it will keep them safe — but it does not. It is CRITICAL that someone stay with the person with dementia at all times to support them and ensure the best possible care is given.
What can YOU do to help prevent unnecessary hospitalizations for people with dementia?