FYI Daily

Hospitalization: Alzheimer's "Tipping Point"

Last updated: Jun 20, 2012


When dementia family caregivers compare notes about hospitalizations, you often hear stories of loved ones who seemed to go downhill or who never seemed quite the same cognitively afterward. A new study in Annals of Internal Medicine blames the combination of dementia and delirium, which is a state of heightened confusion or unusual mood or behavior, for serious declines in people with Alzheimer's who are hospitalized.

As a result, about one in eight hospitalized Alzheimer's patients faces a major complication within a year of hospitalization, including increased risk of winding up in a nursing home or of dying, reports Reuters.

The Boston-area study tracked almost 800 people with mild Alzheimer's disease at the Massachusetts Alzheimer's Disease Research Center between 1991 and 2006. About half were hospitalized for falls, infections, or other problems. They then used other federal data to see what happened in the year after the hospitalization.

Hospitalization was associated with nearly twice the likelihood of a poor outcome, including mental decline and death, and delirium seems to be the common risk factor, researchers say. The data works out to about one in 16 dying, one is seven being put in a nursing home, and one in five suffering a mental decline within one year of getting out of the hospital. Those who never went to the hospital and those who went to the hospital but didn't have delirium did better.

Delirium is an often-overlooked complication in hospitalized people with dementia.

Doctors say the takeaway messages from this research are:

1) Hospitals should take steps to prevent delirium, such as having eyeglasses or hearing aids available and not giving unnecessary pain medications that can worsen confusion.

2) Family caregivers need to be educated to expect delirium in the first place (since many have never heard of it), including what delirium is and how to spot signs of delirium in someone with dementia who's hospitalized.

3) Families need coaching on what to do if they suspect delirium. When a hospitalized loved one with dementia develops delirium, caregivers can actually do a lot to help minimize the problem.

Image by Flickr user ribena wrath, used under a Creative Commons license.