Although no one chooses to go to the hospital as a destination, it can be the best place to go when you are injured or ill. People living with dementia are at risk of certain complications during a hospital stay. Research is now focusing on ways to make the most of your time in hospital.
What are the risks of a hospital stay for a person living with dementia?
First, we should start by saying that not going to a hospital when you are injured or unwell carries very high risks.
Researchers have looked at how to reduce the harms caused in the hospital and have therefore identified risks and steps to reduce these risks. The risks identified for people living with dementia include:
– Development of delirium (an acute and temporary state of increased confusion)
– Falls, pressure injuries or infections
– Higher chance of repeat hospitalizations.
It is important to note that there is a large international body of research focusing on ways to improve these effects following hospitalization at home.
The patients. This body of research has shown the importance of the role of:
● Hospital workers (from all fields) – and how they do their work
● Patients (how to prepare and behave during hospitalization)
● Family and friends (how to help someone who is in the hospital).
What’s really interesting about most of these strategies is that they simply mean good care! Many of the steps to take that help reduce risks and harms are not expensive, technical, or difficult to implement. Note that all of these will depend on your health and the reason for your hospitalization, so work with your healthcare team to see what might be right for you.
Some of the steps that have been identified as preventing and properly managing delirium are:
1. Knowing that someone is at higher risk.
For this reason, it is important to let staff know if a person has a diagnosis of dementia. They can then monitor them more closely and ensure they have adequate support during their stay.
2. Track any changes.
If you notice any changes in their memory and thinking during your stay, let the care team know. Care partners and visits from family and friends will also play an important role in noticing if anything has changed. The staff will regularly ask some questions to help the family and friends check if anything has changed in their health or mental state.
3. Personal items and reminders can help.
The environment around a person who is hospitalized can help with orientation (knowing where you are, what time it is, and who you and others are). It is important to have essential equipment (glasses, hearing aids, mobility devices), to communicate and stay active. Other things like clocks, personal photos, and music can be helpful in setting up your environment to suit you.
Bringing these to the hospital can be a useful step in reducing risks.
4. Preparing space and time as support facilitators.
Preparing your room and establishing a routine during your hospital stay can help prevent or manage delirium—and make your stay more pleasant. This includes things like:
– Curtains open to let in daylight during the day
– Staying out of bed and without pajamas during the day if appropriate for the condition and treatment
-Enable access to things like news and music
-Enable easy and safe ways to get around and get things done
This may mean a suitable chair and desk, additional areas in the ward for transition, and a clear path and support for walking to the bathroom and other activities.
5. Work with your healthcare team to eat and drink, and stay active and engaged
One important aspect of preventing delirium and helping with recovery is making sure the person eats and drinks enough (considering their condition).
This can be supported by meal reminders, help with getting to the meal tray and opening containers, and having someone around during meals. Family and friends can help here. Keeping active (moving around in bed, sitting up out of bed, walking) and engaged (talking, puzzles, reading, etc.) is also an important part of reducing the risks. One program being tested in Australia is called the Eat Walk Engage program and is working to establish classes
and treatment to prevent delirium.
6. Pain management.
Pain in the hospital can present in many ways. Pain can worsen delirium and slow recovery. Some pain medications can worsen confusion or impair mobility. Taking a team approach to identifying and managing pain is essential in these cases – so make sure you let people know if you see the person feeling uncomfortable or in pain. If they
If you regularly need pain medication (such as for arthritis), it is important to inform the staff, even if this problem is not related to the reason for hospitalization.
Studies have shown that delirium prevention programs that involve the entire staff, the patient, family and friends, and take into account the environment can be very effective in reducing potential harms. Many hospitals and health services state that delirium prevention and optimal management are part of the essential services that the hospital offers (quality standards).
Preparing for a planned hospital stay can involve preparing ahead of time, such as bringing things that will help.
Maintaining orientation and employment during the stay, as well as personal information and information about the regular routine and written treatment preferences. If the person has signed advance directives, and there is a written copy of the medical history and medications, these can also be useful.
Written by Prof. Jackie Liddell
