Hospitalizing a Loved One with Dementia: “Common Pitfalls”

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Be aware of the following common pitfalls during hospitalization, so you can take steps to prevent them:

  1. Delirium. Delirium is a state of acute mental confusion. People with dementia develop delirium at much higher rates than typical hospital patients. It’s often missed by hospital staff, however, because they don’t know what’s normal for that person. There are many possible causes of delirium. In a hospital setting, common triggers are a hospital-acquired infection or complications from surgery. Many hospital techniques meant to manage a confused patient may worsen confusion, including the use of restraints, tranquilizers, and sleep aids.

What you can do: Know the signs of delirium, and make sure the hospital staff is aware of a sudden change in mental status as soon as possible. Make sure that pain is being adequately treated. Pain can trigger delirium. Work to keep your loved one oriented and calm. Gently orient your loved one with reminders: “Here we are, still in the hospital for that operation, Dad.” “You’re in a hospital bed to have your heart checked.” A familiar blanket or favorite picture from home and a cheerful plant can also be calming.

  1. Accidental falls. Someone with dementia may already be unsteady due to coordination problems. Disorientation can also cause the person to forget where he or she is and get out of bed the wrong way or bump into unfamiliar furniture or walls on the way to the bathroom and take a tumble.

What you can do: Have someone by the person’s side as much as possible so that they can be there to assist when he or she moves about. Issue reminders every time the person gets up: “Here, let me help you because you have those stitches on your side.” Bring hospital slippers that fit securely on the feet, rather than easy-on (and, unfortunately, easy-off) scuffs that can contribute to tripping.

  1. Undertreated pain. Although families often worry about their loved ones being overtreated with pain medication in the hospital, the opposite is more likely to be true in older adults with dementia. This is because it can be hard to gauge pain levels in someone who’s confused or can’t communicate well. Many people worry that by asking for relief, their loved one could become addicted to painkillers; this is almost never true for people with no history of substance abuse.

What you can do: Stay close to your loved one during the hospitalization so that you can monitor for symptoms of pain, including moaning during sleep, frowning or other expressions of discomfort, wincing when moving a certain way, favoring certain positions, or complaining of pain (even if it’s later forgotten by the person). Report pain to hospital staff on your loved one’s behalf. You know what’s normal for your loved one better than anyone else, and what looks like discomfort.

  1. Overused urinary catheters. Bladder catheters are often needed at the start of a hospitalization to drain the bladder, but they’re often left in for longer than is necessary. This raises the risk of infection. Because the catheter is attached to a drainage bag, having one reduces the patient’s mobility, which can make hospitalization less comfortable and can slow recovery. Someone with dementia may forget the catheter is in place, adding to confusion and discomfort.

What you can do: Ask the doctor and nursing staff every day if the catheter is still needed. For men who need a urinary catheter, ask if a condom catheter can be used. They also may reduce the chance of bladder infections, provided the patient doesn’t pick at the catheter too much.

  1. Constipation. Constipation can develop in the hospital for several reasons. It’s a side effect of many painkilling medications, which may be given during hospitalization. Also, the person’s normal routines for eating and drinking, moving around, and yes, voiding, are all thrown off during a hospital stay.

What you can do: Let the nurses and doctors know if your loved one isn’t having a bowel movement at least every other day, or if you see any other signs of constipation, such as abdominal pain, nausea, bloating, cramping, or a loss of appetite, along with poor stool production. Know that there is a range of safe laxative options for treating constipation.

Second of an 8-part series by Leslie Kernisan, M.D. and Paula Spencer Scott, Caring.com.

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