Caregiver Challenges of General Hospital Care for Dementia Patients

Simple procedures by first responders and hospital personnel, like having their blood pressure taken or getting a shot in the arm, can be confusing or scary for anyone with dementia.  Many first responders and hospital healthcare providers have little experience with people with dementia.  Yet over 40% of people over the age of 85 have some type of dementia.1

Dementia caregivers take their loved ones to the hospital to restore health and to ensure their safety and the safety of others.  Their expectations are that the hospital physicians know how to treat all types of dementia patients.  Unfortunately, not all hospital physicians know about the dangers of overmedicating dementia patients that may be extremely sensitive to medications.2 A dementia knowledgeable physician will prescribe medications only as a last resort and begin with the lowest dose.  The prescribing physician will also instruct the hospital staff to closely watch for changes in the symptoms and the side-effects of all medications.

Problems can occur for either emergency or scheduled medical treatments of dementia patients.  When problems do arise, dementia patients may need to stay in the hospital many days after treatment to recover from receiving anti-psychotics and anesthetics.   Some never fully recover.  Statistics show that more than 80% of dementia patients require 24-hour skilled nursing care or die within a year after being released from a hospital.3  Avoiding a hospital can sometimes be the healthy choice.

Stories are common about dementia patients who are unknowingly treated like most people in a hospital.  In a typical scenario, the dementia patient becomes anxious or delirious in the strange and chaotic surroundings of the hospital ER.  The emergency room physician may prescribe an anti-psychotic to calm the patient.  Next the patient becomes agitated – not calmer.  Then the dementia patient may be transferred to a psychiatric unit where another physician orders a stronger anti-psychotic drug.  Predictably, the situation grows worse.  Then the patient must stay in the hospital for days of observation.   Unfortunately, anti-psychotic drugs can cause permanent neurological damage, lingering side-effects and possible death.2

Different situations can occur in the hospital operating room.  The anesthesiologist unknowingly orders a general anesthetic that may be inappropriate for a person living with dementia.  The dementia patient may battle recovery with postoperative delirium, hallucinations and other frightening symptoms.4

It is not the fault of the EMS technician, or the ER physician, or the hospital psychologist, or the anesthesiologist for overmedicating your loved one.  Perhaps the caregiver did not remind them that they were treating a dementia patient.  The family dementia caregiver needs to be the advocate for their loved ones.

Every dementia caregiver needs to protect their loved one from unintended medical mistreatment. All dementia caregivers can be advocates for their loved ones by:

  • Giving dementia Medical Alert cards to every healthcare provider;
  • Using Medical Alert bracelets – now you can include on some bracelets the patient’s name, date of birth, the name of the specific dementia and a list of medications;
  • Using a Vial of Life with a health history, a list of medications and legal documents to give to first responders;
  • Speaking out and being an advocate for your loved one with every healthcare provider in and out of the hospital;
  • Reminding everyone treating your loved one that their patient may react adversely to medications;
  • Being sure that the hospital physicians avoid prescribing anti-psychotics;
  • Not signing the release form for surgery until you are satisfied that the anesthesiologist will use the safest alternative to a general anesthetic for a dementia patient; and
  • Asking for a hospital dementia care wristband.

 

Written by Tom Clark – 830-220-9155 , Group facilitator for the Austin and Highland Lakes Area Lewy Body Dementia Caregiver Support Groups

 

References on general hospital care of dementia patients

 

1 http://www.webmd.com/healthy-aging/news/20110509/4-in-10-over-age-85-have-cognitive-impairment

2 https://www.lbda.org/content/10-things-you-should-know-about-lbd

3 https://healthcare.utah.edu/healthlibrary/related/doc.php?type=6&id=715649

4 https://www.lbda.org/node/211

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