How to improve dementia care in hospital? A guide for healthcare professionals

Over one-third of people living with dementia will require a hospital stay, and this setting often poses significant challenges, increasing the risk of delirium and falls. Understanding how to improve dementia care in hospital settings is crucial for ensuring patient safety, reducing distress, and optimizing health outcomes.

Quick Summary

Improving hospital care for patients with dementia hinges on implementing person-centered approaches, comprehensive staff training, and environmental modifications. Enhanced communication with both patients and families is key to providing safe, compassionate, and dignified treatment that minimizes anxiety and confusion.

Key Points

• Person-Centered Care: Focus on the individual's unique needs and history to tailor their care plan and reduce anxiety.

• Enhanced Communication: Train staff to use simple language, calm tones, and non-verbal cues to better interact with patients with dementia.

• Environmental Modifications: Adapt the hospital space by reducing noise and clutter, using clear signage, and allowing familiar personal items.

• Family Involvement: Actively include family and caregivers in the patient’s care plan, leveraging their invaluable knowledge and presence.

• Staff Education: Ensure all healthcare staff receive mandatory, in-depth training on dementia awareness and management techniques.

• Proactive Behavior Management: Use non-pharmacological methods to address behavioral symptoms by identifying and treating underlying causes.

• Comprehensive Discharge Planning: Develop a clear, collaborative plan for transitioning patients back home or to other care facilities to prevent readmissions.

Understanding the Challenges of Hospitalization for Patients with Dementia

Hospital environments can be highly disorienting for individuals with dementia. The unfamiliar surroundings, loss of routine, and presence of new people can trigger anxiety, confusion, and behavioral changes. These challenges can complicate medical treatment, increase hospital stays, and lead to poor outcomes, including falls, delirium, and increased reliance on sedatives. Addressing these unique needs requires a shift from standard medical protocol to a holistic, patient-centered approach that focuses on understanding and managing the patient's perspective.

The Foundation of Improved Care: A Person-Centered Approach

Person-centered care is the cornerstone of better dementia care in any setting. It involves understanding the patient as a unique individual with their own history, preferences, and abilities. Care should be tailored to minimize distress and support their sense of identity.

Effective Communication Strategies

Communicating with a person with dementia requires patience and specific techniques. Staff must be trained to recognize non-verbal cues and adapt their style accordingly. Key strategies include:

• Maintain eye contact and address the person directly.
• Use simple, clear language and avoid complex sentences or jargon.
• Speak slowly and calmly, using a reassuring tone.
• Avoid arguing or correcting them if they are disoriented; instead, validate their feelings and gently redirect the conversation.
• Use gestures and visual aids to reinforce your words.

Creating a Dementia-Friendly Hospital Environment

The physical environment of a hospital can significantly impact a person with dementia's experience. Modifications can reduce confusion and promote feelings of safety and calm. Consider these environmental adaptations:

1. Reduce noise and clutter to minimize overstimulation.
2. Use clear, consistent signage with pictures to help with navigation.
3. Provide familiar objects such as family photos or a favorite blanket to create a personal space.
4. Enhance lighting to reduce shadows and improve visibility.
5. Utilize calming colors and avoid busy patterns in decor.
6. Ensure easy access to a safe, quiet space for moments of agitation.

The Critical Role of Family and Caregivers

Family members and informal caregivers are invaluable partners in care. They can provide essential information about the patient’s preferences, routines, and typical behaviors. Involving them in the care plan fosters a sense of security for the patient and ensures continuity of care. Hospitals should consider flexible visiting hours and create comfortable spaces for families to stay, as their presence can significantly reduce patient anxiety.

Comprehensive Staff Training and Education

Effective dementia care requires specialized knowledge. All hospital staff, from nurses and doctors to receptionists and housekeeping, should receive mandatory dementia awareness training. This training should cover:

• Understanding the nature of different types of dementia.
• Recognizing and responding to behavioral and psychological symptoms.
• Learning effective communication techniques.
• Developing empathy and a person-centered mindset.

Addressing and Managing Behavioral Symptoms

Behavioral symptoms like agitation, aggression, or wandering are often a form of communication when the person cannot express their needs. A trained care team can use non-pharmacological interventions first. These include:

• Assessing for underlying causes, such as pain, hunger, or need for the restroom.
• Providing diversional therapy, like music, art, or a simple activity they enjoy.
• Engaging in reminiscence therapy, discussing their life history and past experiences.
• Avoiding confrontational situations and redirecting attention gently.

Seamless Care Transition and Discharge Planning

Discharge is a high-risk period for patients with dementia. A clear, coordinated discharge plan is essential to prevent readmission and ensure a smooth transition. The plan should involve the patient's family, primary care physician, and community support services. It should include written instructions in a simplified format, and a post-discharge follow-up call is a good practice to ensure the patient is settling in well at home or their new residence.

Leveraging Technology for Enhanced Care

Technological advancements can play a supporting role in improving care. Digital care plans can help ensure consistency across shifts, and smart monitoring systems can alert staff to potential falls or wandering incidents. Furthermore, telehealth services can facilitate follow-up appointments with geriatric specialists post-discharge.

Comparison of Standard vs. Dementia-Friendly Hospital Practices

Feature	Standard Hospital Practice	Dementia-Friendly Hospital Practice
Patient Identification	Often not prominently flagged; relies on notes.	Clear flagging in electronic health records; staff alerted immediately.
Communication	Fast-paced, direct, may use jargon.	Slow, clear, simple language; uses non-verbal cues.
Environment	Clinical, noisy, bright lights, unfamiliar.	Calm, quiet, familiar items, personal space.
Behavior Management	Reactive, potentially using medication or restraints.	Proactive, non-pharmacological, focuses on underlying cause.
Family Involvement	Limited to fixed visiting hours.	Encouraged and involved in care planning; flexible hours.
Discharge Planning	Standard instructions, often overwhelming.	Simplified, collaborative with family, includes post-discharge support.

Conclusion

To effectively improve dementia care in hospital settings, a multi-faceted strategy is required. It starts with a person-centered philosophy, supported by comprehensive staff training, environmental adaptations, and robust communication practices. By viewing the patient not just through the lens of their medical condition but as a whole person, healthcare facilities can create a safer, more compassionate, and ultimately more therapeutic environment. This commitment benefits not only the patient but also their families and the entire care team.

For more resources on dementia, visit the Alzheimer's Association website.

Frequently Asked Questions

Why is hospital care particularly challenging for people with dementia?

Hospital environments are often noisy, confusing, and unfamiliar, disrupting the patient's routine and sense of control. This can lead to increased anxiety, confusion, and behavioral symptoms like delirium.

What is person-centered care for dementia patients in a hospital?

Person-centered care involves treating the patient as a unique individual by incorporating their life history, preferences, and habits into their care plan. This helps reduce distress and promote dignity during their hospital stay.

What role do families play in improving dementia care in hospital?

Families are crucial partners who can provide vital information about the patient's life, routines, and triggers. Their involvement helps staff tailor care and their presence can offer significant emotional support to the patient.

What kind of training should hospital staff receive to better care for dementia patients?

Staff should receive training that covers the different types of dementia, effective communication techniques, recognizing behavioral cues, and strategies for managing symptoms with non-pharmacological interventions.

How can the physical hospital environment be improved for patients with dementia?

Improvements can include reducing noise, using clear signage, providing familiar personal items, ensuring proper lighting to minimize shadows, and creating safe, quiet spaces for patients to retreat to.

What are non-pharmacological ways to manage agitation in a patient with dementia?

Strategies include assessing for pain or discomfort, providing calming activities like listening to music or looking at photos, and gently redirecting the patient's focus away from the source of distress.

Why is discharge planning so important for patients with dementia?

Effective discharge planning ensures a smooth transition and reduces the risk of readmission. A good plan involves the family, primary care providers, and community support to maintain continuity of care and support.