Home > Caregivers, Delirium, Hospitalization, Safety > Going To the Hospital

Going To the Hospital

I recently read an interesting news article, describing a recent study which concluded that individuals with dementia who are hospitalized are at greater risk of moving into a nursing home, or even dying, within a year.  The study was carried out by researchers with two hospitals in Boston, affiliated with Harvard University.

There wasn’t a great deal of detail given in the story, but the opinion seemed to be that this statistic is due, in part, to the development of an overlapping condition called delirium.  Another possibility is the presence of other health problems that are aggravated, or at least not helped, by the co-existence of Alzheimer’s disease or one of the other dementias.

Delirium is a temporary condition, actually a set of symptoms, which produces alterations in mental status to a varying degree.  It is almost always reversible, with the proper treatment of the underlying disease process.  Some common causative factors are infection, pain, dehydration, reactions to drugs, lack of sleep, and many others.  In the nursing home setting, one of the most common causes of mental status change in residents is a urinary tract infection.

Here are some of my observations on these findings:

  1.  Often people with dementia, especially the latter stages of the disease, lack the ability to recognize the first signs of impending illness, or to report it to their doctors or caregivers.  Sometimes the body actually loses sensation, or the brain loses the ability to attach meaning to the sensation.  This is why it is vital for caregivers to watch their charges carefully, for any little sign or symptom that is not typical.  Is the urine darker than usual, or is the person going to the bathroom more often than normal, or has he suddenly become incontinent?  He may have a urinary tract infection.
  2. One of the most common diagnoses reported by hospitals for these individuals, upon admission, is dehydration.  And one of the symptoms produced by dehydration is increased confusion.  Often their brains lack the ability to recognize signals of thirst, or the person may forget how to go and get a drink, or he may get distracted on his way to the kitchen.  This is why it is important to frequently offer the person liquids, and to monitor her urinary output.
  3. These persons are often beset by other maladies associated with age including hypertension, heart disease, diabetes, arthritis, and so on.  As indicated above, they may not be aware of symptoms suggesting a worsening of these conditions, or may be unable to report them. That only makes it more important that we be especially observant.
  4. Safety is a big concern here.  Falls (and other accidents) are a huge culprit when it comes to hospital trips for these folks.  They usually lack the awareness that they are not strong enough to go to the bathroom by themselves, or the ability to recognize hazards such as hot stoves, to cite a couple.  Again, vigilance on the part of caregivers is the key.

For the sake of brevity, I’ll stop here and continue this in a future post.  I do want to add one thing, however.  I think those people who care for someone with dementia, or any other serious illness, are to be highly commended.  It’s one of the hardest jobs I can imagine, and it’s one that you can’t leave at the end of the day.  You have to stay there, day in and day out.  And as much as you love the person you’re caring for, it can get so difficult to watch them decline, to see the incontinence and the behavior problems, and so on.  And yet, they do it without a second thought.  My hat truly goes off to them.  So often, no one is at “fault” when their charges end up in the hospital.  Sometimes all the vigilance just isn’t enough, and sometimes there’s just no predicting when something will happen.

That’s why it’s so important for the rest of us to support these caregivers, in any way we can.  Give them a respite for a few hours to go shopping or just soak in a hot tub.  Call them up with an encouraging word.  Offer to mow the lawn, or take the dog for a walk. Or any number of other things.

And, that’s all for now.  More will come later, definitely.

(Original article that inspired this is at http://www.timesleader.com/stories/With-Alzheimers-hospital-stays-can-be-risky,165136)

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