Dementia in the acute hospital
A person with dementia who is a patient in hospital is more likely to be agitated and anxious if they are dehydrated, tired, hungry, sleep-deprived, overstimulated, understimulated, or subjected to unnecessary noise
In many hospitals and ward staff and health carers have been given excellent dementia awareness training that has made it easier for them to sympathise with dementia affected patients and support them to be as independent and comfortable as possible during a hospital stay.
Every member of staff can benefit from this including porters, administrators, and domestic staff - anyone who might ever come into contact with the person who has dementia or their family. Because there has been such an improvement in the recognition and management of dementia in acute hospital wards it seems churlish to complain. When I remember how things were when I first became a nurse things are amazingly better now. In my training I remember seeing rows of people sleeping in bed, and being told that dementia was a wasting disease because the people didn't eat. They probably didn't eat because they were sedated to prevent them exhibiting the commoner forms of distressed behaviour that we see in dementia. Its not like that now but nevertheless I’d like to urge for more improvement.
“The person with dementia who is a patient in hospital is more likely to be agitated and anxious if they are dehydrated, tired, hungry, sleep-deprived, overstimulated, understimulated, or subjected to unnecessary noise.”
It's a lot to have to ask nurses and other staff to do more when they are already so busy, but the reassurance is that doing dementia care well will make life very much easier for staff than doing badly. By paying attention to the dementia you can find that workloads are less and not increased. Anticipating and preventing incidents saves time and effort.
The person with dementia who is a patient in hospital is more likely to be agitated and anxious if they are dehydrated, tired, hungry, sleep-deprived, overstimulated, understimulated, or subjected to unnecessary noise. For some of these problems then maybe system solutions that don't involve the nurses in any extra effort. A good example is hospital design, which combined with changed behaviours can make a huge difference. Single rooms, adjustable temperatures, the capacity to alter lighting levels, placing of clocks, availability of windows with a natural view — loads of things make a difference.
The nurse at night,for example, is much less likely to be trying to manage an agitated person with dementia if the sleeping area can be kept dark and silent at night. This is easier if the person has a private room that can be kept cool and if the light that might come through the window or the window pane in the door of the room can be blacked out completely. Sedation is not a good option and it would be ideal if there is someone who would console and comfort the person with dementia in the night if they won’t sleep, especially if they are moving about or shouting, Staffing levels would never normally allow this so it would need to be a family member or other volunteers. Hospital systems need to change to make that extra support for the nurses and their patient at night feasible. And if the person is already asleep, it would be best if people didn’t come in to do housekeeping tasks at night. These systems and behaviours can be changed.
Some hospitals have appointed dementia champions. I hope that their training or powers give them the capacity to command the respect of the bed managers. The dementia specialist needs to be consulted about the placing or moving of people with dementia with their special needs in mind. Without that power the champion is unable to keep the best environment which allows the person to get well and leave the hospital as soon as possible. That should be our aim.
