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Harvard Reviews of Health News

Hospital May Speed Decline in Alzheimer's

A hospital stay greatly increases the chances that a person with Alzheimer's disease will enter a nursing home or die in the next year, a new study finds. Other recent research showed that people with Alzheimer's have more hospital stays than other older adults. The new study showed the consequences. It focused on 771 Alzheimer's patients. All of them were living at home and fairly high-functioning. Medical records showed that about half of them had a hospital stay. About half of this group had delirium in the hospital. People with delirium may be extremely agitated and confused. Among those who did not have a hospital stay, about 4% entered a nursing home each year. About 2% died. But in the year after a hospital stay, 29% went into a nursing home and 9% died. Among those who had delirium, 43% moved to a nursing home in the next year. About 15% died. Researchers could not explain these results. They said family members should be alert for new symptoms in someone with Alzheimer's. Early care may help to avoid a hospital stay. The Annals of Internal Medicine published the study. The Associated Press wrote about it June 19.

What Is the Doctor's Reaction?

Being a hospital patient can be a confusing and somewhat frightening experience for anyone. For someone with Alzheimer's disease or another type of dementia, a hospital stay is much worse. It's dangerous. It greatly increases the chance of quicker mental decline, moving to a nursing home and health problems that can be life-threatening.

Those are the findings of a study of 771 people with Alzheimer's disease. The people in the study were 65 years or older. They were living with family or on their own at the start of the study. The results were published in the June 19th issue of the Annals of Internal Medicine.

The greatest risk of a hospital stay for people with dementia is delirium. In this study, the researchers found that more than half of the patients developed delirium after admission to the hospital.

Delirium is a confused and scrambled state of mind. It usually comes on suddenly. Memory and other types of thinking become disorganized. The person may see or hear things that aren't there (hallucinations). Most often the person is agitated and restless. But some people with delirium may pay less attention to what is going on around them. They may have little interaction with family and hospital staff.

It's difficult to know how much a person with delirium suffers. But there's no question about how disturbing it is for family and friends to see the big changes in their loved one. Delirium can last days. There is no specific treatment. And doctors can't predict when it will end.

By avoiding a hospital stay, people with dementia greatly lower their risk of developing delirium.

Today, there is a low threshold for admitting patients with dementia to the hospital when something seems amiss. This needs to change. Some patients will definitely need admission, such as those having a heart attack, stroke or very low blood pressure. Otherwise, doctors should tell the family about the high risk of delirium from a hospital stay vs. treatment at home.

Treatment at home will work only if someone can be with the patient 24 hours a day until symptoms improve. I recognize that there is a risk that the patient could quickly become very ill and need to go back to the emergency department or even die. So the decision for home treatment should be consistent with the overall goals of care.

What Changes Can I Make Now?

If someone with Alzheimer's disease does need admission to the hospital, here are things family members can do to help prevent delirium.

  • Bring glasses, hearing aids (with fresh batteries) and dentures to the hospital. Older people do better if they can see, hear and eat.

  • Bring in a few familiar objects from home. Family photos, a favorite comforter or blanket for the bed, rosary beads, a beloved book or relaxation tapes can be comforting.

  • Keep easy-to-read clocks and calendars visible. One reason people get disoriented in the hospital is that they can't go by normal cues such as daylight. A few well-placed clocks and calendars can help fill that void.

  • Help orient the person throughout the day. Use short, simple statements about the date and time. Remind the person where he or she is.

  • Always speak in a calm and reassuring tone of voice. Relate personal and current events. Mention why the person is in the hospital. In simple terms, explain what is being done to help him or her feel better.

  • When giving instructions, state one fact or simple task at a time. Do not overwhelm or overstimulate the patient.

  • Stay with the patient as much as possible in the hospital. When a patient develops delirium, friends and relatives should try to arrange shifts so someone can be there around the clock.

  • If you detect new signs that could indicate delirium, it is important to discuss these with the nurses or doctors as soon as you can. These signs could include confusion, memory problems and personality changes. Family members are often the first to notice subtle changes.

What Can I Expect Looking to the Future?

This is such an important study. Doctors have long recognized the risks of a hospital stay, especially for older people. But the size of the increased risk for people with dementia is an eye opener. It's time for doctors to consistently inform family members of delirium and other complications. Doctors should offer a home treatment option more readily. I certainly will.

Author: Howard LeWine, M.D.
Date Last Reviewed: 6/20/2012
Date Last Modified: 6/20/2012