Oct 2, 2013

Hospitalization, the Emergency Room, and Alzheimer's Patients

A new environment filled with strange sights, odors and sounds, a change in the daily routine, medications and tests, and the disease process itself can all be factors that increase confusion, anxiety and agitation in a hospitalized person living with dementia.

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Hospitalization, the Emergency Room, and Alzheimer's Patients

If you find your loved one in the Hospital or the emergency room for an extended stay, you will want to review the information presented below.

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The following information is presented in a way that would allow you to share the information with Hospital and Emergency room personnel.

You should review the information below and use it as a checklist to insure good care while in the hospital.

However, you might find that some hospital personnel are not trained to deal effectively with Alzheimer's and dementia patients.

You might also find that some personnel are less than - empathetic - to persons living with dementia.

As a result, you might want to print the information below and have it with you should a stay in the hospital or emergency room become necessary.

When hospitalization occurs, the best option for the person living with Alzheimer's disease is the constant presence of a family member or a trusted friend.

Remember, family members are the most valuable resource for information about the individual, and for the caregiving techniques that work best.

Communications Tips for Use in the Hosptial and for Hospital Personnel
  • Always begin by identifying yourself and calling the patient's name.
  • Always approach from the front.
  • Maintain good eye contact.
  • Use short, simple sentences.
  • Speak slowly.
  • Be specific. Use the name of the person or object instead of "this" or "they."
  • Keep tone of voice low and pleasant.
  • Keep facial expression warm and friendly.
  • Use non-verbal cues: a reassuring touch, a smile, a demonstration stating the emotion.
  • Give the person plenty of time to respond to your question (20 seconds).
  • Always repeat your question exactly the same way.
  • Use concrete language.
  • State in positive terms. Constant use of "no" or commands increases resistance.
  • Don't test the patient's memory. Erase the words, "Don't you remember?" from your vocabulary
  • Give directions simply and one at a time.
  • When helping with personal care, tell the patient what you are doing each step of the way. Add occasional social or reassuring comments to avoid "task-focused talk" only.
  • Do not appear rushed or tense. The patient will become tense and agitated.
  • Listen to the patient. Try to find the key thought and take note of the feeling or emotion being expressed along with the spoken word.
  • Reassure through words. Remind the patient who you are and that you will take care of him.
  • Sometimes asking a "Why" question can get to the reason behind a repetitive question and decrease its occurrence. (i.e. "Why are you concerned about what time it is?")
For Emergency Room Personnel
  • Do not leave the patient alone. A family member, trusted caregiver or friend should be present at all times.
  • Continuous cueing to the environment (place) and activity may be necessary. A family member can assist with this and offer reassurance as well.
  • Obtain patient's history from a close relative or caregiver; not from the person who is deeply forgetful.
  • Pay close attention to the caregiver's description of the patient's usual level of consciousness. Increased dementia or the onset of delirium can be a sign of acute physical illness or metabolic distress.
  • Perform a complete head to toe assessment. The patient may not be able to automatically identify painful or affected areas to you.
  • Before every communication with the patient, make sure you have his/her attention by saying his name and making direct eye contact with him. Your eyes should be level with the patient's eyes.
  • Ask simple "yes" and "no" questions. Allow ample response time (at least 20 seconds).
  • Watch for non-verbal communication of pain or discomfort such as grimacing, guarding or anger.
  • Apologize each time you cause pain and avoid repeating painful exams.
  • In short, simple statements, tell the patient what you are doing, why and that you will be finished soon. Repeat this throughout the examination.
  • Never talk about the patient to others as if he is not in the room.

Related Articles

My Patient Has Alzheimer's: General Guidelines

For an Alzheimer's patient, the trauma or ailment that preceded hospitalization, the strange new environment, the disrupted daily routine,  and the influence of medications can all be factors for increased confusion and decreased ability.

There are a number of things hosptial personnel can do to reassure a patient.

They should:
  • Provide a consistent, predictable routine. Ask the primary caregiver for the patient's usual routine and follow it as closely as possible.
  • Encourage the use of security objects from home (i.e., favorite pillow or quilt, baby doll, etc).
  • Provide care by the same nurses and nursing assistants as much as possible.
  • Avoid surrounding the patient with several doctors and medical students at one time.
  • Evaluate the patient for sources of potential pain and discomfort. Even though s/he may be experiencing pain, the patient will probably not verbally complain.
  • When possible, schedule tests at a time of day when the patient is at his best and not fatigued.
  • Discontinue asking orientation questions once the patient's level of comprehension is established.
  • Use good communication techniques. 
  • Schedule at least two rest periods: A half hour after morning care and an hour in early afternoon. Rest is important!
  • Post rest period times on the patient's door. Use a big "Resting" or "Do Not Disturb" sign during the actual rest period.
  • Limit visitors to one or two at a time.
  • Cue the patient for sleep by darkening and quieting the room.
  • Avoid using physical restraints. They do not prevent falls. Injuries from falls while the patient is restrained are often more serious.
  • Always communicate a sense of security, caring and respect.
  • Each staff/patient interaction should include: touch, eye contact, orienting information and an activity the patient can successfully perform.
  • Eyeglasses, dentures and hearing aids can enhance the patient's communication. Offer to assist the patient with placement of these devices. Be aware in some instances the patient is more comfortable without them.
  • If the patient has a comfort item, something that makes him feel secure, make sure it is within reach.
  • Do not ask the patient to fill out a menu. Ask the family about food preferences.
  • Smaller, more frequent meals may work better for the patient than the standard three large meals.
  • Cueing the patient to eat by using verbal reminders along with a light touch to the forearm increases food intake.
  • Finger foods, cups with lids and broad-handled utensils may make mealtime easier for the patient.
  • Late stage patients may chew, but need frequent reminders to swallow.
  • Plate guards and bibs with pockets catch spills and protect the patient's clothing.
  • Offer the patient fluids frequently throughout the day. Ask the caregiver what the patient prefers to drink and the type of drinking container used at home.
General Guidelines
  • Think of behaviors (no matter how unusual) as communication signals from the patient that there is a problem or unmet need. Try to figure out that signal.
  • Remain calm.
  • Protect the patient from embarrassment.
  • Offer reassurance and appropriate assistance.
Adapted from:
Acute Hospitalization &Alzheimer’s Disease: A Special Kind of Care
North Carolina Department of Health and Human Services Division of Aging

You are reading original content +Bob DeMarco , the Alzheimer's Reading Room