First of all, thank you to agingwisely.com for pointing to this article from the Annals of Internal Medicine. The article in question summarizes a study done of elders who were hospitalized and the impact of that hospitalization on cognitive skills and overall health.
In past articles, I have talked about studies that indicate hospitalization can have a very serious impact on folks with dementia, including the trauma they suffer by not understanding what is happening to them. This study is the clearest statement I have seen of the problem.
The article points out that,
Evidence shows that patients with Alzheimer disease (AD) are much more likely to be hospitalized than other older people. If hospitalized, older people often develop delirium, and those with AD are at an even greater risk for this complication. Many clinical observations and small studies have suggested that hospitalization of patients with AD, especially if delirium occurs, causes further cognitive decline, leads to the need for nursing home placement, and increases the risk for death.
The reasons for the higher rate of hospitalization are not discussed. As a non-clinical layman, based on the large number of elders with Alzheimer’s and other forms of dementia that we have served at Support For Home, I believe that a leading factor is the inability of the dementia sufferer to adequately communicate with the medical care providers.
So, what did the researchers find, as a result of this study? Frankly, the data is frightening:
Patients with AD who are hospitalized for any reason are more likely to die than patients with AD who are not hospitalized. If they survive hospitalization, they are more likely to require placement in an institutional facility, such as a nursing home. Of great importance, the occurrence of delirium in patients with AD substantially increased these risks compared with patients with AD who did not develop delirium. The authors estimate that 6% of deaths, 15% of institutionalizations, and 21% of cases of cognitive decline in hospitalized patients with AD can be associated with delirium.
The conclusion is very simple. If there is any alternative to hospitalization, clinicians should explore it. If it is possible to treat the patient at home, in familiar surroundings, do it. If the patient must be hospitalized, the caregiver (family or professional or both) should be with the patient at all possible times, to help prevent delirium and the associated negative outcomes.
This last point was one stressed by several doctors, including Dr. Lee Lindquist, whom I have discussed at length recently, at the National Private Duty Association conference earlier this month. Caregiver presence, in the hospital (or skilled nursing facility or rehab facility) is a critical factor to increasing the chances of a positive outcome.
Best wishes. Bert