Every time my father went into hospital his mental state deteriorated. The unfamiliarity of the ward, his fear of death, care from people he did not know, all made it difficult to assess what the outcome would be even when physical treatments, mostly drugs, worked well. Luckily his stays were short and the care he received was good. But, as he became more ill we did begin to wonder if his admission was the right decision. We all wanted his life to be prolonged for as long as possible and on reflection, and with 20:20 hindsight, I regret his last one! Death is not a good option, so he and we, felt we had no real choice.
People with dementia do face many risks as a consequence of hospitalization. Hospitals can seem hostile and are often disorientating. People with Alzheimer's and other types of dementia are particularly vulnerable. Their behavior can seem difficult to manage on busy hospital units. Staff and bed changes, infrequent interactions with staff and family can cause agitation in elders who can easily become even more confused. As a consequence staff/patient interactions often take more time and communication even more difficult. Time is often at a premium in hospital. The result can be a failure of staff to recognise and address their patient's needs effectively.
During their hospitalization physical risks to people with dementia can compound an already complex situation. Examples include poor food and drink intakes, constipation, new medications and drug interactions, acquiring hospital infections, to name a few.
So does hospital admission caused more deaths for people with dementia? The evidence is mixed. There is evidence, however, suggesting a higher post-discharge mortality rate. One study found a two-fold increase in death following hospitalization for hip fractures in people with dementia as compared to patients without dementia.
Asserting his independence while he was in hospital was very important to my father. It was often, bizarrely, more important than his health. Even when he was clearly putting himself at risk by going to the bathroom without help, not using a urine bottle, he struggled to keep going by doing as much as he could for himself. This was sometimes misunderstood by staff as his not being able to understand their instructions.
Hospital care, at its best, is so important to patients and to caregivers. The wide complex roles that staff play in recognizing dementia, diagnosis, treatment of reversible diseases and conditions, education and support of relatives, initiating post discharge treatment programmes is an invaluable lifeline when caring for people in the community.
Published On: August 16, 2011