Dementia & Hospitalization: 6 Pitfalls to Watch For

How to guard against common complications and mistakes in the hospital
Portrait of a happy nurse and patient
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Hospitals are all about healing. But complications, accidents, mistakes, and unnecessary procedures happen. And these can worsen the hospital experience for any patient -- especially someone with dementia.

Be aware of the following common pitfalls, so you can take steps to either prevent them or recognize them when they're happening:

1. Delirium

Delirium is a state of acute mental confusion in which a person's state of mind suddenly becomes worse than usual. Anyone can develop it during a hospitalization as a result of an infection or other stressor, but people with dementia develop delirium at much higher rates. It's often missed by hospital staff, however, because they don't know a patient's baseline -- that is, what's normal for that person. And when someone has dementia, a certain level of confusion, apathy, and other signs of delirium are already normal.

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.

  • Make sure the hospital staff is aware of a sudden change in mental status as soon as possible. Emphasize that even though the person has dementia, what you are seeing is a change in the level of confusion.

  • Make sure that pain is being adequately treated. (See below.) Pain can trigger delirium.

  • Work to keep your loved one oriented and calm. Not all delirium can be prevented, but a reassuring environment helps minimize confusion. 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.

Find out more about identifying, managing, and preventing delirium in the hospital.

More pitfalls to watch out for when someone with dementia is hospitalized

2. Accidental falls

Someone with dementia may already be unsteady due to coordination problems. Or he or she may forget existing limitations from, say, a recent fracture, and move in dangerous ways. 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:

  • Stay at the person's side as much as possible so that you can be there to assist when he or she moves about. Or hire an elder companion or personal aide to take your place.

  • Issue reminders every time the person gets up: "Remember to watch your arm, Dad." "Here, let me help you because you have those stitches on your side." For some people with mild dementia, a large printed sign can help provide simple reminders when you're not present.

  • Bring hospital slippers that fit securely on the feet, rather than easy-on (and, unfortunately, easy-off) scuffs that can contribute to tripping. Soles should have good traction and not be too smooth and slippery.

3. Undertreated pain

Although families often worry about their loved ones being "doped up" and overtreated with pain medication in the hospital, the opposite is more likely to be true in older adults with dementia: Pain tends to be _under_treated. This is, in part, because it can be hard to gauge pain levels in someone who's confused or can't communicate well.

There's no need for your loved one to be unduly uncomfortable in the hospital. 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.

  • If you can't be there at all times, make sure a "deputy" is. Rotate bedside duties with other family members or consider hiring someone to do this from a home health agency.

Find out more about managing pain in the hospital for someone with dementia.

More pitfalls to watch out for when someone with dementia is hospitalized

4. Overused urinary catheters

Bladder catheters (also known as Foley catheters) are often needed at the start of a hospitalization to drain the bladder. The problem is that they're often left in for much 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, because the person is less able to move around.

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. These cover the penis, rather than going directly into the bladder, and may be less uncomfortable -- although dementia patients tend to still find them bothersome and restrictive. They also may reduce the chance of bladder infections, provided the patient doesn't pick at the catheter too much.

5. Constipation

Constipation can develop in the hospital for several reasons. Older adults are more prone in general. It's also a side effect of many opiate (painkilling) medications, which may be given during hospitalization. Finally, the person's normal routines for eating and drinking, moving around, and yes, voiding, are all thrown off during a hospital stay.

Untreated constipation can worsen confusion, which is why it's especially important to try avoiding the condition in someone with dementia.

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. Not all are equally effective. In general, senna and polyethylene glycol (Miralax) are pretty effective; docusate (Colace) isn't.

6. Vital signs taken unnecessarily

Hospitals never sleep. Unfortunately, patients need to. Hospital routines tend to call for the checking of blood pressure and pulse around the clock. Although this may seem important, it's not always necessary.

Night checks, in particular, interrupt a patient's rest. This can interfere with healing in anyone, but for someone with dementia, it can also worsen confusion.

What you can do:

  • Ask the doctor if nighttime checks can be canceled. Because taking vitals is a pro forma procedure, they often just happen unless somebody says, "Hey, we don't really need to do this."