How to support someone with dementia in hospital?

Navigating a hospital stay with a loved one who has dementia can be overwhelming and confusing for everyone involved. For the person with dementia, the unfamiliar environment and disruption of routine can be profoundly disorienting, often increasing anxiety, fear, and agitation. Understanding how to support someone with dementia in hospital is crucial for ensuring their safety and comfort during this difficult time.

Quick Summary

Helping someone with dementia in the hospital involves strong advocacy, preparing a detailed personal information sheet for staff, and creating a calming environment with familiar routines and objects. Active communication with the medical team, managing overstimulation, and staying patient are key to minimizing confusion and distress.

Key Points

• Pre-Pack a Bag: Prepare a 'grab-and-go' bag with medical info, comfort items, and a personal information sheet for staff to understand the person's routines.

• Be a Strong Advocate: Take an active role in communicating with hospital staff, sharing your unique knowledge of the person's needs and behaviors.

• Reduce Confusion: Minimize overstimulation by keeping the environment calm and maintaining familiar routines. Consider a private room if possible.

• Identify Health Changes: Be vigilant for sudden changes in behavior, which could signal pain, delirium, or dehydration, and inform the medical team immediately.

• Plan for Discharge Early: Start discussing the discharge plan at admission, and be prepared to challenge it if it is not safe for the person to return home.

• Ensure Comfort: Bring familiar comfort items, preferred snacks, and ensure the person's glasses and hearing aids are accessible and worn.

• Practice Calm Communication: Use simple language, a calm voice, and reassuring touch. Avoid arguing or correcting them when they are confused.

Preparing for a Planned Hospital Stay

If a hospital stay is planned, preparation can make a significant difference. Pre-empting common challenges helps create a smoother experience and reduces distress for the person with dementia.

Assemble a Comprehensive Grab-and-Go Bag

Creating a hospital bag in advance can save valuable time and reduce stress during an emergency or planned admission. Include essential documents and items that can provide comfort.

• Medical Documents: Include a complete and updated list of all medications (with dosages and frequency), current medical conditions, and known allergies. Having contact information for all their healthcare providers is also vital.
• Personal Information Sheet: This detailed sheet can be a lifeline for busy hospital staff. It should include the person's preferred name, daily routines (e.g., waking, bathing, eating), and how they communicate their needs.
• Comfort Items: Pack familiar objects that offer comfort, such as a favorite blanket, pillow, or photographs of loved ones. A music player with headphones featuring familiar, soothing music can also help reduce anxiety.
• Clothing: Choose comfortable, loose-fitting clothes and non-slip footwear. Wearing their own clothes can help the person feel more secure and grounded than hospital gowns.
• Essentials: Don't forget hearing aids, dentures, and glasses. Labeling these items clearly can prevent them from getting lost. Snacks and drinks they enjoy can also be comforting, pending staff approval.

Discussing the Stay with Your Loved One

It is best to discuss the hospital stay shortly before admission to prevent prolonged anxiety. Use simple, reassuring language. Let them know what to expect and that a familiar person will be with them. Avoid talking about the stay as if they aren't there, which can be embarrassing and upsetting.

Advocating Effectively for Your Loved One

In a busy hospital environment, you are the person's most important advocate. Your knowledge of their needs and behaviors is invaluable to the clinical team.

Working with Hospital Staff

Establishing a good relationship with the nursing staff and doctors is crucial. You can do this by being proactive and polite.

• Share the Personal Information Sheet: Provide a copy of the personal info sheet to the named nurse and ask for one to be kept with their chart. This ensures consistent care and helps staff understand their specific needs.
• Communicate Consistently: Designate one or two main contact people from your family to speak with the care team to avoid confusion. Take notes during conversations with medical staff to keep track of information and questions.
• Speak Up About Changes: Since you know the person best, you are likely to notice subtle changes in behavior that may indicate pain, dehydration, or the onset of delirium. Inform the medical team immediately if you notice anything unusual.

Navigating the Discharge Process

Discharge planning should begin at admission. It is your right to be involved in this process to ensure a safe transition home.

• Question the Plan: If you believe your loved one is not ready to go home, you can challenge the discharge plan. You have the right to file an expedited appeal with Medicare, which can delay the discharge until reviewed.
• Understand the Instructions: Ensure that discharge instructions, including new medications and follow-up care, are explained clearly to you, as the person with dementia may not remember them.

Communicating and Creating a Calming Environment

Effective communication and a soothing environment are key to reducing confusion and distress.

Communication Strategies

• Speak Calmly and Slowly: Use a reassuring tone of voice and simple, direct sentences. Avoid asking too many questions at once.
• Use Nonverbal Cues: A gentle touch, a calm expression, or a reassuring smile can convey comfort when words fail.
• Validate Feelings: Listen to their concerns, even if they seem illogical. Validating their feelings rather than correcting them helps reduce agitation.

Environmental Adjustments

• Minimize Noise and Stimulation: Busy hospital wards can cause sensory overload. Ask for a private room if possible, and turn off the television and loud intercoms.
• Maintain Routines: Stick to their usual daily routines as much as possible, including mealtimes, waking times, and bedtimes. Consistency provides a sense of security.
• Label Important Areas: Simple signs with pictures or large font can help them find the bathroom or closet.

Table: Pain Management and Delirium

Recognizing and managing pain or delirium is critical, as they can cause significant distress and further cognitive decline in a person with dementia.

Symptom Type	Signs to Look For	Recommended Action
Unexpressed Pain	Grimacing, moaning, fidgeting, restlessness, sudden behavior changes.	Tell staff. Request a pain assessment and potential non-medication interventions like heat pads or massage.
Delirium	Sudden increase in confusion, agitation, disorientation, hallucinations.	Inform the doctor immediately. This could be caused by infection, dehydration, or medication. Avoid sedation.
Dehydration	Dry mouth/eyes, dark yellow urine, reduced urination, fast heart rate, weakness.	Encourage fluid intake with preferred drinks and hydrating snacks. Inform staff immediately.

Looking After Yourself as a Care Partner

Caring for a person with dementia in the hospital can be exhausting. It's essential to schedule breaks for yourself to avoid caregiver burnout. Ask family and friends to help out, and remember that taking time for your own well-being is not selfish but necessary.

For more in-depth guidance on navigating this challenging journey, the National Institute on Aging offers valuable resources on their website [https://www.nia.nih.gov/health/alzheimers-caregiving/taking-person-alzheimers-disease-hospital].

Conclusion

Supporting someone with dementia during a hospital stay requires patience, preparation, and proactive advocacy. By creating a calm, predictable environment and ensuring clear communication with medical staff, you can significantly improve your loved one's experience. Effective preparation, persistent advocacy, and recognizing key indicators of pain or delirium will help ensure the best possible care during this difficult time.

Frequently Asked Questions

What is the most important thing to do when a person with dementia is in the hospital?

The most important thing is to be their advocate. As their care partner, you know them best. Your role is to communicate their needs, routines, and preferences to the hospital staff, who may not be familiar with their specific type of dementia.

How can I calm a person with dementia who is agitated in the hospital?

To calm them, first, ensure their basic needs are met (e.g., pain-free, not dehydrated). Speak in a calm, reassuring tone, use a gentle touch, and provide a familiar comfort item. Minimize noise and distractions in the room.

Should I correct a person with dementia if they are confused about where they are?

No, it is generally not helpful to correct them. Gently remind them in a calm manner, but focusing on logic will likely increase their distress. Instead, validate their feelings and gently redirect their attention.

What should I tell the hospital staff about a patient with dementia?

You should provide staff with a personal information sheet detailing their routines, communication needs, likes and dislikes, and nonverbal signs of pain or distress. This helps staff provide person-centered care and distinguish between dementia symptoms and other medical issues.

How can I prepare for an emergency room visit with someone who has dementia?

Have an emergency bag packed with their medical history, medication list, and comfort items. Have a family member or friend accompany you if possible. Be prepared to explain the situation to staff calmly, and ask them to avoid restraints or sedatives unless absolutely necessary.

What is delirium and how does it affect a person with dementia in the hospital?

Delirium is a sudden state of confusion, different from dementia, often triggered by illness, infection, or medication side effects. In the hospital, it can cause agitation and hallucinations. It's crucial to inform staff immediately if you suspect delirium, as treating the underlying cause is key.

Can a person with dementia challenge a hospital discharge plan?

Yes, patients and their families have rights regarding discharge. If you believe the plan is unsafe, you can appeal the decision with Medicare. Hospitals are required to provide information about this process.

How can I ensure my loved one eats and drinks enough in the hospital?

Mealtimes can be challenging due to unfamiliarity and noise. Offer preferred foods and drinks regularly. Provide soft, easy-to-eat options and remind them to drink fluids, as dehydration is a common risk.