Caring Currents

Why Hospitals and Alzheimer's Are a Tough Mix

Last updated: Jun 30, 2009

Image by boliston used under the creative commons attribution license.

The hospital is a stressful place for everyone "“- and when the sick also have Alzheimer's or another form of dementia, both patient and loved ones face some extra hurdles, like these:

  • Hospitalized people with dementia forget where they are.

"Where's my wallet? When can I check out already?" My dad is ready to leave the "hotel" "“ a.k.a. the medical center where he''s just spent the past five days following a small stroke. (He's weak but, miraculously, seems okay.) He wants to pay the "hotel bill" and split. Only my Dad has dementia, so he keeps forgetting that he's in a hospital, not a hotel, much less that he's had any sort of medical crisis.

Yesterday it was (in a hopeful tone), "So is there a bowling alley here?"

I couldn't tell if he were making a joke or really expected he was in some kind of resort. Probably a little of both, knowing both my old dad and the newer one who has cognitive trouble. He got gentle reminders that he was in the hospital because the doctor thought he'd had an infection, which turned out to be a small stroke. That explanation was as satisfying to him as it was surprising, at least for short periods at a time.

While it's often okay to go along with a delusion (mistaken belief), sometimes low-key "reorientation," reminding "“- without losing patience --- comes as a relief amid the extra confusion of being transported, evaluated, and admitted. Try pursuing whichever course is least agitating.

  • Hospitalized people with dementia forget about limitations.

They forget they have an IV and want to hop out of bed in the middle of the night and use the bathroom. They forget they've had surgery and must move carefully or slowly. They can't remember the nurse's instructions

That's why they need a constant advocate at their side, day and night, during the hospitalization. Otherwise they're at higher risk of falls or dangerous complications. Or a mild-mannered person who nevertheless keeps "ignoring advice" and pulling out an IV might be given restraints for the night.

  • Hospital staff tends to focus on the immediate concern.

It's not usually dementia that requires hospitalization. It's cancer, a heart condition, a broken bone, or something else, like my Dad's stroke. That's the problem that the doctors and nurses are primarily focused on. Great staff that's made aware of dementia will be considerate of that problem and work with it, of course. But you'll be seeing a lot of different people -- and every one needs to be made freshly aware of the situation.

  • Hospitalized people with dementia gravitate to familiarity.

The constant familiar presence of the primary caregiver and/or spouse or adult child is the number-one soother. If you leave the room, someone prone to wandering might leave, too, in search of something or someone who feels like "home."

Security objects from home such as a favorite pillow or blanket can be very calming. If flowers or cards seem distracting, however thoughtful and lovely, remove them.

Often overlooked sources of comfort and security: Glasses, dentures, and hearing aids (all of which are often removed for tests and procedures and forgotten by everyone).

  • Hospitalized people with dementia can be agitated by all the unfamiliar sights and sounds.

Even safe in the hospital room, minimize attention-sappers. Don't leave the TV on in the background unless it's actively being watched. Space out visitors. Don't be shy about asking visitors in a shared room to use quiet voices if it gets boisterous.

  • Caregivers of hospitalized people with dementia have to be especially (respectfully) assertive.

It doesn't come naturally for some people to ask doctors pointed questions or insert themselves into conversations. But if you see medical staff (including nurses and orderlies) addressing only the patient with dementia and receiving misinformation in reply, don't hesitate to set them straight.

Because they tend to be "just fine" when asked directly, for example, undermedication, is a common problem for people with dementia in the hospital that can have [scary consequences] ( Be diplomatic and respectful, so you're not talking about the patient as if he weren't in the room. But do be firm: "Actually, Dad did complain about pain just five minutes ago, and five minutes before that, even though I realize he says he's okay right now. What do you think, Dad?"

  • On top of the rest of their stress and worry, caregivers of hospitalized people with dementia need to think ahead.

Hospitals tend to put us in reactionary mode. But to make things easier on the patient, consider:

  • Seeing if you can get the right kind of room. Best: In a quiet corner with minimal traffic passing by (as opposed to, say, the rooms opposite the central nurse's bullpen). (I know, not always possible, but worth trying. Ideally you don't want to have the person moved every day or two "“ more confusion.)
  • Asking the staff's permission to remove artwork from the walls if it's upsetting or distracting. Pictures of animals or people can be perceived as real by someone with later-stage Alzheimer's. Ditto ill-placed mirrors that can make reflections look like strangers.
  • Filling out meal request forms for the person. Decision-making can vex someone with dementia. Best: Don't even bother asking choices ("Do you want orange juice or tomato juice?") Rather than being considerate, offering even narrowed choices inadvertently raises the stress level a notch.
  • Making sure the dementia is part of the considerations during discharge planning.

All these things aren't necessarily top-of-mind in a medical crisis, but even keeping them in the back of your mind can lower everybody's stress level a notch or two.