Going into hospital
A hospital admission can
be daunting for anyone, especially so for a person with dementia.
They may be frightened and confused in addition to being ill or in
pain. They might not
understand what the hospital is and why strange people are trying
to touch them.
Telling a person with dementia about going to hospital
This will depend on a number of factors such as the extent of memory loss and anticipated anxiety about going. Telling the person and involving them in all planning might be best for some people.
For those people with dementia who, when given an appointment
time, want to leave immediately and repeatedly ask, 'When are we
going?' it may be best not to tell until the last minute. This will
mean packing without including them in the preparation. When you do
tell them, be prepared to leave within the next few hours. The
suggestion that they need to go to hospital should be made in a
calm and gentle manner, so that this relaxed approach sets the pace
for their reaction.
Preparation for hospital
Avoid buying new clothes for the hospital stay. With so many other new areas to cope with it may become overwhelming. If new items cannot be avoided, where possible allow the person with dementia to become familiar with them in advance of the admission date. If it is necessary to buy more than one of an item, make them all the same. Label all belongings clearly and leave valuables at home.
Full involvement in packing will be best for some people with dementia. For others, it may be better if you make suggestions about what to take and let the person confirm your choice. In some cases, it may be better to avoid any mention of hospital preparation. You will generally know which approach will be best. Do not assume that a person with dementia understands everything simply because they have participated in their packing.
Arrival at the hospital
Try to arrange admission during a quiet time at the hospital. Pre-planning the trip, including where to park and how to get to admissions will help you to concentrate on the needs of the person with dementia, rather than worrying about finding your way around. If possible, take another person with you to help.
Always let hospital staff know in advance, if possible, that your relative or friend has a diagnosis of dementia. This will assist them to provide appropriate care. Inform staff of the preferred name, normal routine and likes and dislikes of the person with dementia. Include information about any things that might cause agitation and strategies for managing these, as well as advice about settling in at night and hygiene procedures, including if help is needed to use the toilet. Writing this information down can be helpful for the hospital as it can be placed on file so that all staff can read it. The 'This is Me' leaflet can be completed by the person with dementia or their carer with help from the person where possible. Copies of the leaflet are available from the Memory Clinic and the JAA office. Ask to see one of the Hospital Champions in Dementia Care who will help to get your loved one settled and will liaise with the other staff if necessary. Contact Elaine Jackson, Nurse Manager, Assessment & Liaison, on 01534 444805.
Take all medications with you, including alternative and herbal remedies. In addition, write down the names of all medications and dosages as this too can be placed on the file. Inform staff of any preferred ways of taking medications.
There is considerable benefit in packing several familiar objects such as family photos, pillow or slippers. A simple calendar or a statement of where they are, left by the bed, can help reduce confusion.
Keeping an up-to-date list of medications and dosages is a good idea, even if a hospital visit is not planned. It can be very useful to have to hand in the event of a medical emergency. It is useful to keep a bag packed, but out of sight, with familiar clothes, general information and emergency numbers. Don't forget to go through it regularly to make sure that the information is up to date.
Introducing the person to the ward
Try to accompany the person with dementia to the ward. Introduce their nurse as a safe person who they can talk to or ask for help, no matter what their needs may be.
Leaving the person at the hospital
Let the nursing staff know when you are intending to leave the hospital, so that they can take over and reduce the risk of a patient with dementia being left without support. Most families and carers will have had some experience of leaving the person they care for at a day centre or with relatives or friends, and so will know what works best for the person with dementia when it is time to leave.
For some people, it may be less stressful for all if you make an excuse to temporarily leave the bedside. Some people find it useful to leave with a promise to retrieve an item or treat for their benefit. Stating that you have to leave for your own reasons may not be as readily accepted. Meal times can be a good time to leave, as food may offer a distraction to your departure.
Coming back to visit
When you return you may be met with indignation or anger. If this happens, empathise with their reaction then focus on something more desirable such as a treat or other pleasant item. Use quiet, soothing language and positive conversation.
Some visitors can be unsure about touching for fear of hurting the patient or of dislodging medical equipment. It is important that the person with dementia feels close to their visitors. If visitors are used to holding hands or kissing, this should continue in hospital. Touch is important, especially if the person with dementia is feeling unsure or afraid. This is often a good time to give a hand massage. Staff can advise how to continue physical contact if medical equipment is making this difficult. Have a sheet of paper where visitors can leave their names, so that the person with dementia can reassure himself or herself that people have visited.
Wanting to go home prematurely
If a person with dementia is asking to come home don't blame being in hospital on the doctors and nurses. Hospital staff are the people that they need to have confidence in, especially for any future treatment. It may help to pretend annoyance that the stay is so long for them, but at the same time point out that it is an opportunity to get positively spoilt. Don't forget to emphasise that the hospital is looking after them extremely well.
Sometimes it will be best to avoid telling a person with dementia of an impending discharge, because they may wish to leave immediately. Instead, tell them at the precise time of discharge so that they can leave straight away. Ask staff to put in writing anything that you need to know. It is also a good idea to keep in touch with the person's GP so that they can go back to someone familiar and be reassured about any part of the treatment.
Avoid stopping on the way home for any reason. The hospital has been an overwhelming experience and a person with dementia will need to re-establish themselves in their home environment with as little interruption as possible. They may be tired as a result of being unwell. Once at home, be prepared to have a quiet time with a favourite pastime.
Some of these strategies may seem excessive, dishonest or overprotective and you might feel uncomfortable carrying them out.
You may wish to explain every step in the process to the person with dementia as you once did when their memory was intact. However, this may not be effective now, and may cause stress when they cannot fully comprehend the facts. Comfort and peace of mind are essential for both physical and mental well-being.