Dementia Patients in Hospitals Need Sensitive Care

Fear and confusion – those are feelings many dementia patients often encounter when they are treated in general hospitals. Right now a research project is examining how patients can be helped and why the realisation of good concepts is still failing.

01/11/2010

An emergency operation is hard to
bear for patients with dementia;
© Björn Wuttig/panthermedia.net

The police car lights are blinking, the tires squeal and the sirens fall silent. The paramedics are pushing Kurt Hansen* straight into the emergency room. The 75-year-old’s eyes are wide open and he anxiously keeps looking around. But he only stares into stranger’s faces.

Kurt Hansen suffers from dementia. Since he was vomiting black liquid for many hours, he was transported to the nearest hospital by the emergency ambulance. He does not understand what is happening around him. And nobody has the time to explain it to him.

Sabine Kirchen-Peters of the iso-Institute for Social Research and Social Economy knows about situations like these: “An incidence like this is already very stressful and exhausting for mentally healthy people, but for patients with dementia such situations are a nightmare. “ The patients are typically scared and confused and they don’t know what is happing to them and around them. This is why it happens so frequently that they resist treatments. The staff mostly needs to force them to it: “Patients are retained or sometimes sedated. An experience like this can downright traumatize these patients“, says Kirchen-Peters. But why are dementia patients in hospitals not being better responded to?

Dementia-friendly concepts are still unknown

At the moment Kirchen-Peters leads a commissioned study by the German Alzheimer Society. She is investigating which factors for implementing dementia-friendly concepts in hospitals are conducive and which are more inhibitive. “We want to find out exactly what types of barriers are still out there and incorporate these in our recommended actions“, the project leader explains. This appears to be very necessary. A first tentative conclusion showed that three-quarters of hospital administrators know nothing about dementia-friendly concepts and resolution methods.

Kirchen-Peters sees the essential issue in the fact that the true number of dementia patients is significantly underestimated by hospital management. Apparently only conspicuous and extreme patients are being noticed.

Dementia patients want to have
familiar people around them while
talking to the doctors; © Monkey-
business Images/panthermedia.net

Kurt Hansen smiles. The reason for that is his wife Lieselotte*. After extensive debates she was able to convince the resident physician in the emergency room to let her be with her husband. During the conversation with the physician, she is gently holding her husband’s hand and caresses it. Now Kurt Hansen puts up with the examinations without giving any opposition.

Scenes like these are not rare. “When resident doctors are still inexperienced and uncertain, it can happen that they are not aware of how important it is to include family members to manage the first aid treatment for dementia patients without any complications“, says Kirchen-Peters.

The study’s project leader also criticises that time and again there are barriers to communication, both between physicians and nurses as well as between the staff of the different departments. “Generally the patient’s psyche is being neglected. The focus is only on the acute illness“, Kirchen-Peters states. This is why the real need for help for a dementia patient is often not recognised.

Leading by example

The increased need for nursing care plays an essential role on an economic level: Since there is generally a lack of structures with dementia patients, they require an increased amount of staff. And since treatments are often delayed, frequently there are longer hospital stays. This incurs about a thousand Euros in additional costs per patient.

Kirchen-Peters estimates, that there are about ten geriatric hospitals in Germany that have setup special wards for dementia patients. “Unfortunately, this only touches the tip of the iceberg. Often these wards can handle a maximum of ten patients. In reality though, emergency hospitals actually have significantly more dementia patients. Yet a department like this can be the first step on the way to a dementia-friendly hospital“, believes Kirchen-Peters, who does not want to discount such efforts.

Well educated personell is very
important in dealing with dementia
patients; © Monkeybusiness
Images / panthermedia.net

Generally, such concepts definitely contain good approaches: especially a capable staff provides an important foundation for a dementia-friendly hospital. This is not just referring to specialised dementia trained personnel both on the physician as well as the nurses sides. Indeed all personnel in the relevant departments should be appropriately trained and qualified.

Benefits for all

The hospital environment in particular should be adapted to the needs of people suffering from dementia. The chances for orientation could be increased for instance by working more with colours and by labeling rooms – like for example patient rooms or toilets – with visual material. “Dementia patients need a friendly and less frightening environment. You can learn a lot from nursing homes here“, knows Kirchen-Peters. “I strongly support a patient-oriented point of view. There should be mixed teams of elderly- and nursing care staff, who all communicate with each other and thus ensure adequate treatment.“

Improved quality in treatments with dementia patients leads to them being more willing to be examined and to not having situations escalate anymore. In the short-term this could also relieve the care staff. Personnel costs could be reduced and hospital stays shortened. Right now the hospital stay of a person with dementia is often considerably extended compared to non-dementia patients. The eight days of a regular hospital stay can quickly turn into twelve days or more.

After two weeks, Kurt Hansen is released from the hospital. The pneumonia that had been detected and strange surroundings have severely exhausted the 75-year-old. His wife is glad that he is back home, but she also sees the work that is still ahead of them: her husband got so physically and mentally drained in the hospital that it will require a lot of intense physical therapy and personal attention until he is in better shape. Yet she smiles confidently: together we will make it work again.

* Names changed by the editor

Nadine Lormis
REHACARE.de