dementia patients have an especially difficult time in the hospital

One of the hardest challenges I experienced in caring for my father was helping take care of him when he was hospitalized. His memory got worse and his confusion was heightened being in a new setting. He suddenly became aggressive and agitated and had to be temporarily restrained which increased his agitation even more. I felt helpless and heartbroken.

It is not unusual for seniors to find themselves facing some type of medical problem due to a medical condition or accident that requires hospitalization. When you add that condition to someone who already has memory loss or confusion the need for specialty care becomes elevated. The first thing to do is understand why a hospitalization can trigger these types of reactions:

 

  • They may be in pain or uncomfortable because of the medical problem and not understanding why they are in the hospital. They may have to undergo medical treatment like x-rays, injections, IV’s, catheters, that can be very frightening and painful.
  • Their regular routine has changed and they may be unable to sleep in a hospital setting causing more confusion and fear.
  • They are in a new place with hospital staff that are strangers coming in their room all hours day and night which can be very frightening and confusing.
  • Delirium, or sudden mental confusion, can occur with a hospitalization. It can be triggered by an infection or extreme stress. Even people with no memory issues can suddenly have an altered memory status.

 

Now you have an understanding of what the potential reasons for enhanced memory or

behavior problems are. It is important to note there are concrete steps you can take to help

manage these problems or at least try to reduce the severity and longevity:

 

 

Work With Hospital Staff at time of Admission

The hospital staff needs to understand what your loved one’s baseline memory and functionality is so they can act quickly if changes are noted.

 

Have a Familiar Family Member Spend as much time as possible with the patient

Having someone your loved one knows be close by to help advise staff and calm the patient is very important. Just seeing a familiar face can reduce agitation and anxiety.

 

Discuss Hospital Policy on Management of Patient with Aggressive Behaviors

 

Talk to a doctor and hospital staff about what they recommend when these instances occur and patient and staff safety become problematical. They may suggest restraints or medication that can calm the patient.  Make sure you are OK with the plan. Do you want to be contacted if this occurs? Are you against the use of restraints? Ask about other options like a sitter or an alarm.

 

Consistency of Staff and Routine

Request that your loved one has the same nurse, nurses aide, or other staff when they are working. Having people a patient is familiar with can reduce the incidence of behavior problems or enhanced memory issues. Also having the same routine every day can be helpful. For example meals and physical/occupational/ speech therapy sessions at the same time can help orient a patient.

 

Placement of Patient

If your loved one is disruptive have him/her in a room closer to the nursing station and without a roommate. This helps ensure staff will be more attentive as issues arise. Not having a roommate disrupts the frequency of unfamiliar people coming in and out possibly causing regressive tendencies.

 

Visual and Verbal Reminders

Try to have a clock and calendar visible to help orient your loved one. Have photos of family members with names on them. When visiting, speak softly in short sentences identifying who you are. Be in front of the your loved one by their face so you can be seen and they are aware you are there. Hospital staff should be advised to also use these techniques. Remind patient’s why they are in the hospital. Refer to your loved one by name or relationship, i.e.. “Dad this is Iris, your daughter.”

 

Use Calming Techniques

Using a smile or gentle touch can go a long way to calming an agitated person.

Don’t dispute or argue about what they are saying. Instead try to understand why they are saying it. My father told me he saw a cow outside his hospital room. Rather than discounting it I looked out his window. I noticed a piece of construction equipment that was oddly shaped and looked like it might have horns. I asked him if that was the cow? It was. Use reassuring words. If they seem worried about something ask why. 

Don’t try to rush them into doing something. Allow time for them to prepare and explain what is going to happen in understandable steps. Offer reassurance that you will be there as things that might cause anxiety will be happening.

 

Bring Familiar Items from Home

If your loved one has a special pillow, blanket, clock or photograph, bring it to the hospital. If they like specific music, use that as something to do together during your visit. If they wear glasses, dentures, hearing aids make sure they are there because that can help with communication and orientation. Things can easily get misplaced or disappear from a hospital room so keep track of where they are placed as much as possible. 

Good communication is a key component in making the hospital stay go as well as possible. Make sure that information about your loved one’s deficits is placed in their chart, their care plan, and if there is a board in the hospital room for special care instructions place it there. Also you can write this information on a piece of paper and hang it on the wall near their bed. If you see new staff working with your loved one, make sure they are aware of any special concerns or care needs. These steps can bring peace of mind and lessen anxiety for all concerned parties.

Written by Iris Waichler
Iris Waichler, MSW, LCSW is the author of Role Reversal How to Take Care of Yourself and Your Aging Parents. Role Reversal is the winner of 5 major book awards. Ms. Waichler has been a medical social worker and patient advocate for 40 years. She has done freelance writing, counseling, and workshops on patient advocacy and healthcare related issues for 17 years. Find out more at her website http://iriswaichler.wpengine.com

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6 Comments

  1. Spot on. I just lived this with my mother who is almost 97. I’d stay with her in the hospital for 12, 14 hours, but she was in a private room and there was no place for me to sleep (not even a recliner), so I’d leave to sleep and return to a wildly fearful, agitated mother. Staff would practically run into the room, talking quickly, not facing her; two would appear to move her into or out of the bed and they would act so quickly that she didn’t have time to process what was happening … more fear. Although there was a clock, the windows were tall and narrow, not windows that she could look out, so she didn’t know if it was 6 am or 6 pm. At the nursing home that she went to for rehab, her roommate was in bad shape and in the bed near the window, so they kept the shades pulled down, which made telling night from day worse. And I had to buy a dry-erase marker to write the day and date on both of their white boards because the staff never did!

    Reply
  2. Have no expertise in geriatrics. Don’t have the slightest idea how to care for a patient with dementia.

    Reply
  3. I’ve always slept with mom when in hospital. My husband usually would come late afternoon so I could shower and rest.

    Reply
  4. They don’t know how to help. They usually make it worse

    Reply
  5. This is go true. Living it.

    Reply
  6. You literally have to stay there.
    Last time Mom was in there I actually slept there right next to her. If it wasn’t for two friends coming to relieve me every other day to go home and shower and last down in my bed for two hours I would have gone nuts.

    Reply

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