Responding to the Unique Needs of Hospitalized Patients with Dementia

By Jessie Twerdak, BSN

Being hospitalized can be a stressful experience for many people.

But for individuals suffering with Alzheimer’s and other types of dementia it can be especially distressing and can often lead to further confusion and increased anxiety.

Penn Medicine Princeton Medical Center has taken a proactive approach to creating a dementia-friendly hospital environment that is responsive to the unique needs of patients with Alzheimer’s disease and other forms of dementia.

Seven Million Americans

Dementia refers to a collection of symptoms that affect memory, communication, visual-spatial skills, reasoning, problem-solving, movement, and coordination, often interfering with daily activities.   

The risk for dementia increases with advancing age, and symptoms can vary in severity, from mild to severe, and generally worsen over time.  

There are several types of dementia, with Alzheimer’s dementia being the most common. In fact, nearly 7 million Americans are living with Alzheimer’s today, according to the Alzheimer’s Association. That number is expected to rise as the population of Americans 65 and older continues to grow.

Some of the most common symptoms of dementia, according to the Alzheimer’s Association, include:

• Memory loss that disrupts daily life.
• Challenges in planning or solving problems.
• Difficulty completing familiar tasks.
• Confusion with time or place.
• Trouble understanding visual images and spatial relationships.
• New problems with words in speaking or writing.
• Misplacing things and losing the ability to retrace steps.
• Decreased or poor judgment.
• Withdrawal from work or social activities.
• Changes in mood or personality.

Hospitalization Can Exacerbate Dementia Symptoms

In general, hospitals are busy, noisy and unfamiliar places that can be disorienting for patients with dementia and exacerbate confusion. People with dementia often rely on structured routines for comfort, but a hospitalization disrupts that routine and sense of security, often causing distress and agitation.

Moreover, complex medical terms can further confuse patients and patients with dementia may have a hard time articulating their needs, including pain management. This can cause discomfort that may present as agitation or be perceived as aggression.

Hospitals, however, can take steps to improve the hospital experience for patients with dementia.

Dementia-Friendly Care at PMC

PMC has undertaken several initiatives to promote a dementia-friendly hospital environment, including training for hospital staff, creating safe environments, and offering resources for caregivers.

Many staff participate in a simulated dementia experience to help gain a better understanding of what their patients are going through. During this virtual experience, the staff member is outfitted with special glasses, headphones, shoes and gloves that alter their senses and then placed in a room where they are given instructions for five simple tasks to complete, such as zipping a jacket or putting coins in a change purse. Inevitably, the staff member struggles to understand and complete the tasks and often ends up frustrated and giving up.

The experience has helped to support and improve patient-centered care for people with dementia and their families.

In addition, PMC:

• Works to reduce noise in the patient’s room and reduce the number of people entering the room so as not increase anxiety for the patient.

• Has a pharmacist review medications for those with dementia and make special recommendations to physicians regarding drug prescribing for this population.

• Engages family members and caregivers to learn about the patient’s personal interests and preferences, including food preferences, types of music or particular fears that might exist.

• With permission from the family, places a purple seahorse on the door of all patients who may have a dementia diagnosis. When staff see the seahorse, they are reminded to speak clearly and deliver dementia-sensitive care. The image of a seahorse was chosen for the dementia-friendly initiative because the Latin word for seahorse is hippocampus, which is the region of the brain where memory is stored and that is most affected by Alzheimer’s dementia.

Tips for Caregivers

Caring for a loved one with Alzheimer’s or another form of dementia can be challenging. Here are some practical tips from Alzheimer’s New Jersey, which provides support for local families impacted by Alzheimer’s and other forms of dementia.

• Reduce environmental stimuli like loud noise or overcrowding.
• Provide activities, such as music, physical activity or movies, to reduce boredom.
• If your loved one is prone to wandering, add electric chimes or doorbells to provide an alert if they are leaving.
• Keep to familiar routines.
• Do not move objects or furniture.
• Speak in a reassuring voice.
• Avoid arguing.
• Exercise patience.
• Take care of yourself.

Dementia is a difficult disease for patients and caregivers. If someone you love has dementia and is hospitalized, be sure to talk with their doctors, nurses and entire care team about ways to ensure they receive the medical treatment they need in a dementia-friendly environment.

To find a physician with Penn Medicine Princeton Health, call (888) 742-7496 or visit www.princetonhcs.org. 

Jessie Twerdak, BSN, is assistant nurse manager on the Acute Care for the Elderly (ACE) Unit at Penn Medicine Princeton Medical Center.