How can I make my mom's hospital stay with dementia easier?

A fellow caregiver asked...

On top of her Alzheimer's disease, my mom faces surgery for colon cancer. She's 84, and her dementia symptoms are still relatively mild. Do you have any suggestions for how to make her hospital stay with dementia easier?

Expert Answer

Geri R. Hall is an advanced practice nurse who works in the department of neurology at the University of Iowa College of Medicine and at the Banner Alzheimer Institute in Phoenix, Arizona. She's also a speaker and author who since 1996 has facilitated the online support group for the Washington University, St. Louis, Alzheimer's Disease Research Center's Alzheimer List.

Hospitals are fairly inhospitable places for people with dementia. Your mom's symptoms may increase because of the strange environment, routines, and people she'll encounter; the anesthesia, which may take weeks or months to completely leave her system; and the postoperative pain. Surgery can also cause "decompensation" -- a sudden, possibly permanent loss of cognitive (thinking) abilities -- especially if those skills have been stable for quite a while.

Because of these concerns, you may want to talk to the surgeon about how long he expects your mom to live without the surgery. If her cancer is growing slowly, you may want to consider whether it's really worth the effort right now.

If your mother does need to have surgery, schedule it for a week when close family members can stay with her. Don't rely on the nurses to know what to do to help someone with dementia. Ideally, you'll want one close family member at your mother's bedside whenever she's awake. At the very least, have someone there in the evening, when she's most likely to become confused and agitated, and during meals, as she'll need more time to eat.

If at all possible, you should insist on a private room. After surgery, keep the TV off at all times to help keep things calm.

Before the hospitalization, put together a discharge plan and arrange for in-home care. Your mom will require round-the-clock supervision for a few weeks after the surgery. You may want to talk with the hospital social worker about finding help.

From the moment of admission, tell every nurse you see that your mom has Alzheimer's and that you intend to stay with her to assist with her care and help her remain calm. If a nurse reassures you that she can manage your mom just fine, the nurse does not understand Alzheimer's.

Prior to surgery, make absolutely certain that you tell the anesthesiologist about your mom's condition and its severity. He can adjust the type and dose of anesthesia to minimize confusion. Do not rely on the surgeon to relay this information.

When speaking with your mother's surgeon, insist that her Alzheimer's medications be continued throughout her hospitalization. And make sure they give her pain medication every four hours instead of waiting for your mom to ask for it.