Tuesday, June 26, 2012

Alzheimer's Disease and Hospitalization

Picture waking up in an unknown bed with your hands tied down and unfamiliar people around you.  Imagine the desperation that would go through your mind.  Think about the level of stress that would pierce through your entire body.  Then, think about going through this over and over and over again.
Someone with Alzheimer’s Disease experiences this very feeling when they are hospitalized and restrained.  They do not have the cognitive ability to cope with the situation and figure out what it going on.  This is why familiarity is one of the most important components in the care of someone with Alzheimer’s.
As a Geriatrician, I have often told the loved ones of Alzheimer’s patients that hospitals are dangerous places.  This is but one of the reasons.  The other reasons are also quite powerful.  Hospital borne infections, medication errors, unproven treatment modalities.  These are but a few more reasons to keep someone with Alzheimer’s out of the hospital.  
Are there times that hospitalization is required?  There certainly are.  One interesting example is the surgical treatment of a very enlarged prostate.  If the prostate enlargement is so great that a long term catheter is required, the short term risks of hospitalization often outweigh the long term risks of a catheter.  Keep in mind, aside from the inherent increased risk of infection, having a device inserted into ones body when the person will not remember why it’s there can be just as disconcerting as situation we described at the beginning of this article.  
If hospitalization is necessary, how do we approach it?  It is often a good idea to have a familiar person stay with the patient.  Nursing staff must be trained in how to interact with the Alzheimer’s patient.  This means not confronting them with their lack of memory.  It means constant reassurance.  Physical restraints are generally out of the question.  A kind word, a loving touch, often forgotten in the hustle and bustle of the hospital setting, may be enough to soothe the patient.
What are alternatives to the hospital.  Pneumonia, for example, doesn’t always require hospitalization.  Oxygen can be provided in the home.  Antibiotics can be given orally, or intramuscularly.  A loving caregiver, familiar food and surroundings, will make the recovery process easier.  Assisted living or nursing facilities, with staff trained in the care of someone with Alzheimer’s, may actually provide a better and more comfortable surrounding than a hospital.
Now, here’s the kicker.  The approaches that I’ve noted above are usually less costly than the hospital setting.  They are typically fraught with few complications.  Yet, our traditional health care system continues to choose the expensive, less effective approach to caring for our loved ones with Alzheimer’s Disease.  How can we change this?  Through education of health care clinicians.  That will be the topic of my next blog.

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