Download survival guide to hospitalization - Alzheimer`s Foundation of America

SURVIVAL
GUIDE TO
HOSPITALIZATION
WRITTEN BY MARTINE EHRENCLOU
Reprinted from care ADvantage magazine, a publication of the Alzheimer’s Foundation of America
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A
hospital stay can be frightening,
confusing and risky for anyone. But for
people with Alzheimer’s disease or a
related dementia it can be downright
dangerous—and even deadly.
The other reality is that hospitalization is a
likely scenario for people with the brain disorder.
Individuals with Alzheimer’s disease use a
disproportionate amount of healthcare resources;
for instance, they are hospitalized two to three times
as often as people the same age who do not have
the disease. Medicare beneficiaries with multiple
chronic illnesses, including Alzheimer’s disease, see
an average of 13 different physicians; fill 50 different
prescriptions a year; and are 100 times more likely
to have a preventable hospitalization than
someone with no chronic conditions.
A recent Harvard Medical School
study published in the Annals of
Internal Medicine showed that
a hospital stay greatly increases
the chances that a person with
Alzheimer’s disease will enter a nursing
home or die within the next year. It
also found that about half of the hospitalized patients
with dementia developed delirium during their stay,
a serious medical condition that causes a sudden
and rapid change in symptoms. This predictable but
treatable complication of dementia is linked to longer
hospital stays, increased nursing home placements, a
faster rate of mental decline for up to five years after
hospitalization, and death.
Obviously, hospitalization is a necessity at times. But
given these grim statistics, it is critical to try to take
steps to prevent conditions that can land a person
with Alzheimer’s disease in the hospital or, should an
admission be unavoidable, to do whatever is possible to
keep someone safe while there.
RX 1: PREVENTING HOSPITALIZATION
Since individuals with Alzheimer’s disease may not
be able to communicate discomfort, pain or other
symptoms, it is important to be on the alert for signs
or behaviors that could indicate an illness. It might
be easy to write off a cough or congestion to a simple
cold, but these symptoms could be the first signs of
influenza or pneumonia for someone with Alzheimer’s
disease. Better to be safe than sorry by checking these
symptoms out immediately either with a phone call or
visit to the person’s primary care physician.
Another critical component of avoiding emergency
room visits and hospitalizations is to establish a
good relationship with the individual’s primary care
physician. This includes regular visits. Ideally, the
primary care physician knows the person’s history,
and with routine visits will be more likely to pick up
symptoms early on before they have progressed to an
urgent stage that could require hospitalization.
It is important for caregivers to feel comfortable
discussing the person’s condition. Coming prepared to
the medical appointment with a list of symptoms and
other observations, current medications and dosages,
and questions can help enable a productive discussion
with the medical provider.
Coordinated long-term care services can also help
reduce incidences of hospitalizations that result
from a person’s failure to take prescribed
medications, injuries from unsafe
environments or other avoidable
circumstances.
According to a recent research study,
the three most common causes of
hospitalization for people with Alzheimer’s
disease are bacterial pneumonia, urinary tract infection
(UTI), and congestive heart failure, a condition in
which the heart cannot pump blood efficiently to meet
the body’s needs. An earlier study points to fainting
and falling, heart disease and gastrointestinal disease
as major contributors to hospitalization. And among
other reasons, up to 50 percent of individuals with
Alzheimer’s disease who wander will become seriously
injured or die if they are not found within 24 hours.
PNEUMONIA
Tips to prevent pneumonia:
• Have the person get pneumonia and influenza
vaccines. Why both? Pneumonia combined with
influenza is the seventh leading cause of death
among people aged 65 and over, according to the
Centers for Disease Control and Prevention.
• Practice good hand hygiene, including washing your
hands in warm, soapy water before touching the
person.
• Ensure that the individual has good dental hygiene,
including regular dental check-ups, since infections
that occur around teeth can lead to pneumonia.
Symptoms to watch for:
• Altered mental status, increased confusion or
decreased alertness
• Discomfort or not feeling well
• Cough
• Chest pain
• Fever, chills (Note: older people may or may not
have a fever.)
• Shortness of breath
• Difficulty swallowing
URINARY TRACT INFECTION (UTI)
Tips to Prevent UTI:
• Encourage the person to drink six to eight
eight-ounce glasses of water or other preferred
non-caffeinated fluid a day.
• Monitor the amount of fluid intake.
• Maintain good hygiene, including regular bathing
and staying dry.
• Ensure a clear, clutter-free path to the bathroom.
CONGESTIVE HEART FAILURE
Tips to prevent congestive heart failure from
worsening:
• Since people diagnosed with this condition are
typically on prescription medication, be mindful of
the dosage schedule and make sure the medication
is actually taken.
• Discuss lifestyle choices with the person’s physician,
such as exercising, reducing salt intake, managing
stress, treating depression and losing weight.
• Control contributing risk factors, such as high blood
pressure, high cholesterol, diabetes or obesity. Talk
with the person’s physician about a treatment plan.
Symptoms to watch for:
• Shortness of breath
• Fatigue, weakness
• Rapid or irregular heartbeat
• Swelling in legs, ankles, feet or abdomen
• Persistent cough or wheezing
• Lack of appetite, nausea
• Decreased alertness
• Chest pain
FALLS
Tips to prevent falls:
• Monitor the effects of
medications. For instance,
psychoactive medications
may result in increased
confusion, falls and mortality.
• Have the person do physical activity—with the
doctor’s approval, such as walking and gentle
exercise.
• Make sure the person wears shoes that fit well,
are sturdy and have nonskid soles.
• Ensure that staircases and hallways are free of
clutter.
• Fix or remove dangerous items around a person’s
home, such as movable furniture that someone
may wrongly rely on for support, chairs that
blend in with the walls behind them, scatter
rugs, loose or broken steps or handrails, and
dangling extension cords and telephone
wires.
• Maintain uniform lighting levels. A person with
dementia may have difficulty adjusting to stark
changes in lighting, which can lead to temporary
loss of vision and promote confusion.
• Install solid color carpets or other floor coverings
since patterned designs can interfere with depth
perception and balance.
If the person has experienced increased falls,
make an appointment with a primary care physician.
Prepare for the appointment with the following:
• Write down the details of the falls, including
how and when they occurred, and, if applicable,
increased frequency.
• Bring a list of prescription medications and
dosages, over-the-counter medications,
supplements and allergies to medications.
Review this with the doctor, with an eye toward
eliminating or adjusting dosages of those that
may be causing drowsiness, dizziness or low
blood pressure.
• Ask that the person’s blood pressure be checked
on a regular basis.
• Discuss whether other factors may be contributing
to falls, such as dehydration, pneumonia,
a UTI, joint pain, numbness, balance or
walking style.
As Alzheimer’s disease progresses,
the responsibility to help prevent these
conditions increasingly shifts away from
the person with the disorder to others.
A watchful eye, care coordination and
best efforts among family caregivers,
professional caregivers and healthcare
providers can be just the prescription to
help sidestep hospitalization.
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• Promote the regular use of the bathroom or planned
trips at specific times, especially since people with
Alzheimer’s disease may not recognize urges or
think about using the restroom.
• Learn the proper cleaning procedures, if applicable,
for a Foley catheter, a tube inserted into the bladder
to drain urine if a person is incontinent.
Symptoms to watch for:
• Fatigue
• Incontinence
• Fever
• Painful, burning urination
• Foul-smelling urine
• Cloudy or milky urine
• Back pain
• Facial expressions, pulling at clothing
• Distress, especially during urination
• Changes in behavior, increased confusion
RX 2: TOLERATING HOSPITALIZATION
The last thing anyone wants if a person with
Alzheimer’s disease needs to hospitalized is for the
stay to be longer, more involved, more aggravating
to symptoms of the brain disorder, or more lifethreatening than anticipated.
What are some of the potential triggers for these
complications? Someone with Alzheimer’s disease
might have multiple medical issues, requiring the
involvement of several specialists and causing a
situation that is confusing and difficult to coordinate.
In addition, new medications introduced during
a hospital stay can lead to adverse side effects. A
person with Alzheimer’s disease is vulnerable to the
onset of stress and delirium in an emergency room
or hospital room setting. Older adults, especially
if they are disoriented or sedated, are at risk for
falls—a leading cause of death. Lastly, malnutrition,
dehydration, infections, bed sores (decubitus ulcers)
or depression can slow recovery.
While some problems cannot be avoided, there are
steps you can take to help safeguard a hospitalized
person with dementia and better manage the
patient’s stay:
1. Strive to ensure a smooth transition between
care settings, such as moving from the home or
skilled nursing facility to a hospital. Recognize
the stressfulness of this situation and the person’s
special needs, due to poor communication,
confusion or behavior issues; and try to provide
emotional comfort and reassurance.
2. Supply hospital personnel with the person’s
relevant medical records, medical and family
history, and legal documents that convey end-oflife wishes.
3. Bring a list of the individual’s current medications
and dosages, over-the-counter medications,
supplements and allergies—and make sure this is
included in the patient’s chart.
4. Stay informed. Ask questions about
the person’s care plan, including
treatments, procedures and
expected outcomes.
5. Get to know attending nurses
and doctors. Try to be
present during doctors’
rounds to have face-toface interactions with
the patient’s medical
professionals.
6. “Humanize” the
person to the medical
professionals, so the
person is not seen
as the “shoulder
surgery in room number 209.”
7. Stay with the patient, especially if the person has
impaired communication skills, lack of judgment
and confusion. The best scenario, although it can be
challenging, is to continually have a middle person
there as a go-between the patient and healthcare
providers. Consider hiring a private aide.
8. Keep a pad and pen handy. Create a list of questions
for the doctors and nurses, and write down the
answers about the person’s diagnosis, treatment
plan, tests, health status, etc. so you or other family
members can refer to this information later.
9. Watch for, document and bring to a medical
professional’s attention any sudden changes in
Alzheimer’s disease symptoms. A sudden onset
or rapid worsening of confusion, severe behavior
changes or loss of daily functions such as bladder or
eating could be delirium. Among precautions, pay
attention to new drug therapies, keep track of bodily
functions, provide adequate hydration, and increase
or decrease environmental stimuli as needed.
10. Prevent falls. If the patient is at risk for falling, try
to have someone at the person’s bedside at all times.
One strategy is to create a team of family members,
friends and professional caregivers who take shifts.
Have a physical therapist or occupational therapist
evaluate the person for safety risks and suggestions.
11. Monitor food for appropriate intake and to comply
with dietary restrictions, especially since people
with Alzheimer’s disease may need assistance
with eating and, as a result, risk malnutrition and
dehydration.
12. Try to prevent bed sores by monitoring how often
the person’s body is being turned and ensuring
repositioning if he or she is unable to move without
help.
13. Decrease the risk of hospital-acquired infectious
diseases by insisting that everyone who comes in
contact with the patient washes their hands.
14. Bring the person’s eyeglasses, hearing aids and other
assistive devices, if absolutely necessary, but make
sure they are catalogued with hospital personnel.
15. Bring special items from home such as a blanket or
photos in order to provide comfort and “warm up” the
hospital room.
16. Provide a clock or wall calendar for the room to help
decrease a person’s disorientation.
17. Keep the individual mentally stimulated as much
as possible (i.e., puzzles, reminiscence activities or
photos to look through and talk about).
18. Become familiar with hospital resources if you need
additional assistance or if problems arise. Social
workers, hospital patient advocates and patientdischarge planners are among the people to have on
your side.
MARTINE EHRENCLOU, M.A., of Los Angeles, is a
patient advocate and award-winning author of
“Critical Conditions: The Essential Hospital Guide To
Get Your Loved One Out Alive” and “The Take-Charge
Patient.” A former journalist and public relations
professional, she writes a blog and lectures on health
care, patient safety, patient advocacy and other
health issues.