Caring for dementia patients in acute hospitals
Not everyone with dementia is a “patient”. The person at home in the community is just a “person with dementia”. In a care home they are a “care home resident with dementia”. Only when in the acute hospital are they “a patient with dementia”. Usually, the reason for being in hospital is not the dementia.
These patients are cardiac patients, or orthopaedic patients, or any kind of patients but they have the added impairments and challenges that come with dementia in addition to whatever brought them to hospital. They will have problems understanding where they are or following instructions. The noise and bustle will cause stress that makes any dementia symptoms worse. Complying with advice such as not trying to stand up without assistance, or using a call buzzer to get a nurse will be difficult. Patients who are living with dementia may forget where the toilet is and will emerge from the toilet and find difficulty in finding the way back to their bedspace. The unfamiliar environment is stressful for anyone, but if you are living with dementia, it is potentially disastrous unless special measures are taken to keep you safe.
It’s very hard for the patient, and also very hard for the health staff who are caring for them, especially if those staff have had little or no education or training in how to care for someone with dementia in the acute setting, and if the hospital environment is not dementia friendly. It has been said that a hospital can be like a meat-grinder for a person with dementia. Important daily things that help to keep them well such as hydration, exercise and sleep become difficult in those settings. Inability to negotiate the unfamiliar environment creates a risk of falling over. Inability to find the toilet in time may be regarded as incontinence, and measures are sometimes put in place, such as continence pads, that mean the person loses the capacity to recognise and respond to the need to go there.
““John’s Campaign” is about the right of people with dementia in hospital to be supported by family carers. Having your dad go into hospital isn’t a holiday for you as a carer. If you don’t stick to his side, he may come back home to you much more disabled than he was when he went in.”
“John’s Campaign” is about the right of people with dementia in hospital to be supported by family carers. Having your dad go into hospital isn’t a holiday for you as a carer. If you don’t stick to his side, he may come back home to you much more disabled than he was when he went in. If you have power of attorney, you are in a better position to influence what happens. It is not uncommon for a person with dementia to go downhill and as a result of the trauma of being in hospital end up being discharged from hospital to a care home, rather than to their own home, where they were surviving (just about) before they became a hospital patient. Getting the patient with dementia discharged home as soon as possible is vital.
During the COVID 19 lockdown in early 2020 I volunteered in my local hospital, and I was astonished at how much better acute hospital care for admissions with dementia has become. Cognitive status was checked on admission and allowances made. Hydration was addressed carefully, and there were spaces on the ward, such as a small room done up like a living room, where the person could escape from the noise and movement of the busy medical ward. Relatives or volunteers could sit with patients there, and keep them company, even joining with them to take their meals and encourage nutrition. The patience and understanding of the nurses was lovely to see. For example, carefully giving messages over and over and not seeming to mind when a patient with dementia, who was agitated and moving about, got in the way or interrupted them in their care for other patients. But this level of care is not universal.
Chapter 12 of my book Dementia (which is now available as an audiobook) gives detailed advice about how families and friends can supplement the care provided by hospital staff and practical ideas of things you can to which will reduce the negative effects of a hospital admission on a patient with dementia. Nurses and hospital staff have also found this useful. We have to do everything we can to maintain wellbeing and independence for as long as possible.
