Since people with dementia often have weaker immune systems and compromised mobility, they are susceptible to infection and falls. Consequently, multiple hospital stays are likely over the course of the disease. A person with Alzheimer’s is likely to experience worsened dementia symptoms due to the oddness of the hospital environment, with its noise levels, unfamiliar odors and lighting, strangers who come in and out of an “unfamiliar bedroom” and do painful things, such as insert intravenous needles.
Caregiving for your loved one with dementia is especially important during a hospital stay. A person with middle stage dementia, and beyond, cannot give reliable answers to questions from medical personnel; cannot be taught how to use a call button; and may not be able to communicate the presence of pain or advocate for himself in anyway. Additionally, the doctors and nurses treating him are not likely to have much training in dementia care, or even be aware of the presence of dementia.
The most important step families can take is to establish a rotation of caregivers to stay with the patient 24 hours a day, while in the hospital, and to have the primary caregiver present at the most difficult times of day for that patient. If necessary, have the doctor write an order for this constant caregiver attendance. Families who haven’t used professional caregivers often call them in to share caregiving during hospital stays. The caregiver’s job will be to communicate with doctors and nurses; keep track of doctor’s orders, including tests and procedures; support the patient with eating, using the restroom, and bathing; and provide a soothing presence.
Since hospital personnel will change constantly, a one page information sheet on your loved one will be a vital communication piece. (You will have already provided a medication list and medical history.) It should include:
- Your loved one’s preferred name
- That they have dementia
- Things that cause increased agitation
- How the person takes medication
- Typical behavior when in pain, thirsty, and hungry
- Preferred foods
- Whether s/he is incontinent
Ask that this information be included in the patient file and give a copy to each new nurse and doctor.
In addition to watching for pain, caregivers should also be alert to sudden extreme agitation or increased confusion. Hospital delirium (HD) is a condition of sudden and severe confusion, which is common in people 65 and older and can be brought on by fever, infection, or certain medications. Patients with dementia are highly susceptible to HD. Caregivers will be most familiar with the patient’s typical behavior and should watch for heightened combativeness, more volatile emotions, hallucinations, and more disturbed sleep. If these dementia symptoms worsen suddenly, hospital staff should be notified.
The calming presence of professional caregivers who understand dementia and the unique condition of your loved one can make a tremendous difference in the level of anxiety and confusion he or she experiences in the hospital. Making the hospital room as personal as possible, with favorite pictures, a familiar blanket, and a preferred drink (if hospital staff permit), can also help soothe your loved one.
Lee Nyberg seeks to help families and those living with Alzheimer’s through education and her company, Home Care Assistance.