Hospitalization and the Dementia Patient
For a dementia patient, being hospitalized in a strange environment surrounded by strange people and being powerless to “escape” is very confusing and scary .
Whatever the reason is for the hospitalization everyone who interacts with your loved one will need to be aware of the dementia diagnosis and will need to, in some way, deal with the symptoms. A dementia patient requires extra care, extra supervision, and extra understanding.
The dementia caregiver will need to be an advocate, an educator, and a friend. Hospitalization is a challenging time. Here are some things that we learned during the many times our Mom was hospitalized.
Dementia Patient Hospital Admission
A dementia patient is not usually hospitalized for the dementia symptoms. Most of them are elderly and when they are hospitalized it is often for something like cardiovascular disease or diabetes. The added symptoms and pain that these kinds of diseases bring can make hospitalization even harder for the dementia patient.
If your loved one is being hospitalized for scheduled tests or surgery you will have the opportunity to pack a bag with their toiletries and clothes and also to gather needed medical and insurance information.
Talk to your loved one about the upcoming hospitalization. Explain what it is for, what they can expect, and how long they should be hospitalized. Assure them that you will see that they get the best possible care.
Avoid making promises that you may not be able to keep, like it won’t hurt, or that you will always be with them. If you do, they may become even more confused and agitated if they feel pain or if you are separated. Do all that you can, but realize that you can’t do everything.
Dementia Patient Emergency Room Wait Times
Always keep an “Emergency Bag” packed at home to grab as you run out the door. Having the necessities with you while you wait can make the time at the hospital a little more bearable.
Find ways to distract your loved one. Listening to music or singing, talking on the phone, cuddling with a stuffed animal, telling stories, looking at picture books or magazines are all helpful activities. Set aside your own discomfort during this time and make your loved one as comfortable as possible.
Be sure the staff (all of them) knows of your loved one’s dementia symptoms so that they can adjust their care techniques to best serve her. Don’t assume that all of them have read the medical chart or even had any contact with the attending physician.
The Dementia Patient Needs an Advocate
If you are the only caregiver you may be in for a long stay. Many sources recommend that a patient never be left alone when they are hospitalized. This is especially important for a dementia patient. A dementia patient lacks the ability to ask proper questions and to understand instructions. She needs someone to be her advocate.
It is possible that some of the people who provide care and services to your loved may not be familiar with dementia and the symptoms it produces. You, as the caregiver may need to explain why your loved one is acting the way they are acting.
It may be useful to make up a sign to put in your loved one’s room (Hang it on the outside of the door, if possible, so most people who enter the room will see it.) The sign could say something like,
“Hi! My name is ____________. I have dementia.
- Don’t answer your questions
- Speak in gibberish
- Repeat words or phrases
- Am scared of you
- Get out of bed and wander down the hall
- Cannot control my bowels
- Get very restless at night time
- (and any other symptoms your loved one may experience)
Please understand that it is part of the disease. I am normally a very pleasant, friendly, person, but I have not been myself lately. Thank you for your understanding and support.”
Along with educating the hospital staff the dementia caregiver will also have the responsibility of reassuring the dementia patient. The confusion of the disease may make this an ongoing job, but just having your familiar face there as much as possible will help to calm the dementia patient and to reassure them that they are safe.
It is difficult enough for most patients to comprehend the diagnosis of their illness, but for a dementia patient it may be impossible. The dementia caregiver will have to be the one to ask questions and make decisions. If you have a medical power of attorney and an advance directive in place these decisions will be easier to handle.
It is also necessary for the dementia caregiver to insure the safety of their loved one. Check medications and dosages, know why a treatment is being given and what are the expected results. If something doesn’t seem right, ask questions. Get the answers you need even if you have to demand them. Don’t allow the hospital staff to be vague with you.
If possible, enlist the help of friends and family members to stay 24/7 in the hospital room. Be sure that they are familiar with your loved one’s normal symptoms and what they can be expected to act like in the hospital.
Leave a notepad and several pens in the room for the caregiver to write down everything that happens to the patient. Designate a section in the notebook for questions and answers. If one caregiver has a question for the doctor they can write it down and even if they aren’t there when he shows up the caregiver who is on duty can ask the questions and write down the answers.
Dealing with a dementia patient in the hospital is challenging. It is tiring and it can be quite frustrating. Remember that the hospital staff, doctors and nurses included, work for you. You don’t have to be bossy, impatient, or unkind when dealing with them, but you are trusting them with someone very precious to you. Be sure your loved one receives the very best care possible.
While You Are Spending So Much Time At the Hospital . . .
Listening to audio books can be a great source of information and a relaxing distraction.
Dementia Patient Emotions during Hospitalization
No one wants to stay confined to bed, especially if they are kept there with restraints. Being hospitalized brings fear, anger, confusion, sadness, and pain. These emotions are magnified in the dementia patient.
Your loved on may get angry at you for keeping her there and demand that you get her released so she can go home.
Whatever symptoms your loved one experiences under normal circumstances, expect them to worsen while in the hospital. Do what you can to reassure and comfort them, but realize that the treatment they are receiving is necessary and that it is for their good.
Understanding Discharge Instructions
Ultimately the goal of a hospital stay is for the dementia patient to be released well on the road to recovery. As the dementia caregiver it is your responsibility to understand the discharge instructions and to provide the care your loved one will require at home.
If it will not be possible for them to return to their old living arrangements then you will need to research care homes, assisted living homes, or nursing homes, or the possibility of moving the dementia patient into your home or the home of another caregiver.
Work with the doctors and nurses well ahead of discharge time to be aware of what your options may be. Know what level of care will be necessary after discharge and make appropriate plans. If possible have everything in place before your loved one is discharged as trying to hire help, interview care homes, etc. will be extremely difficult if you must bring your loved one along with you.
If you need to apply wound dressings, administer injections, monitor any symptoms or any other special care, be sure that you thoroughly understand these instructions before the patient is discharged.
Depending on the reason for the hospitalization it is possible that your loved one’s dementia symptoms will have worsened by the time they are released. Our Mom got steadily worse following each hospital stay. There is nothing that can prepare you for having a parent or spouse forget your name, but you can prepare yourself for the possibility that your job as caregiver may be more difficult following a loved one’s stay in the hospital.
For more information or to learn more about hospitalization for a loved one who has Alzheimer’s Disease or Dementia, contact ElderCare today at 877-760-9199.
6 Ways to Respond to Aggression in Dementia
Aggressive behaviors may be verbal and consist of shouting or name-calling, or they can be physical, such as hitting or pushing. These behaviors can occur suddenly, with no apparent reason, or can result from a frustrating situation. Whatever the case, it’s important to try to understand what is causing your loved one to become angry or upset.
Here are 6 ways that can help you better respond to aggression:
- Try to identify the immediate cause. Think about what happened right before the reaction that triggered the unwanted behavior.
- Focus on feelings, not facts. Rather than focusing on specific details, consider the person’s emotions. Look for the feelings behind the words.
- Don’t get upset. Be positive and reassuring. Speak slowly in a soft tone of voice.
- Limit distractions. Examine the person’s surroundings, and adapt them to avoid other similar situations.
- Try a relaxing activity. Use music, massage or exercise to help sooth the person.
- Shift the focus to another activity. The immediate situation or activity may have unintentionally caused the aggressive response. Try something different.
It can hurt – physically and emotionally
It’s upsetting when someone you love lashes-out at you or actually causes you harm. It hurts physically and emotionally. Although these tips are designed to give you some suggestions, we appreciate and understand just how hard it is to see someone you care about become so angry that they take it out on you.
Keep in mind that the person before you is the same person you fell in love with. They are angry, lost, confused and scared. They are frustrated and likely to be unable to express themselves.
Whenever there is a change in behavior, it’s important to follow-up with your loved ones physician as soon as possible.
For more information on how to manage difficult behaviors in the Alzheimer’s or dementia patient, reach out to the Alzheimer’s Care Resource Center. Their 24 hour Caregiver Help Line can be reached at 855-476-75600, or visit their website at www.alzheimerscareresourcecenter.org
Helpful Hints for Interacting with People with Memory Loss
It is important to understand the different types of memory storage because a person with severe or progressive memory loss may have one kind of memory loss and not another. For example, people with brain damage on their left side (the left hemisphere holds verbal or word memory) may not be able to remember a shopping list. Or they may not be able to remember the words in a conversation. However, they may be able to use their visual skills (the right hemisphere stores nonverbal memories). For example, they may remember the faces of people they meet at the store.
A person with a great deal of damage on the right side of the brain may not be able to remember and follow directions to a friend’s house but may be able to remember conversations.
1. Organize – Keep items that are alike in the same place. For example, keep all keys on one ring.
2. The Same Place – Make a list of items that tend to get lost and decide where to keep them. Once you decide where you are going to put items, keep them in the same place. Keep shoes by the side door or in the bed-room closet. Wear your eyeglasses or keep them on your bureau top. If you can afford a second pair of eyeglasses, keep one pair for home use and the other pair in your purse or jacket for outside activities.
3. The Same Time – Do a particular activity at the same time each day. For example, awaken and get out of bed the same time each morning. Brush or clean your teeth at the same times each day. Take your medicine at the same time each day. Try to set aside a particular day each week for special tasks, like shopping for food on Thursdays.
4. Remove Clutter – Give or throwaway odds and ends, extra end tables, many knickknacks, piles of old newspapers, broken tools, worn out shoes, pencil stubs, and anything unusable or not in current use. If you have not used it or worn it within the past year, get rid of it. Have a garage sale!
5. Concrete Cues – If somebody has problems with word memory, use concrete cues, such as visual helps, on a regular basis. A visual help, such as a picture of dishes on the door of a kitchen cabinet, may help the person remember where to find a dish. It may take time for the caregiver to make these changes, such as applying picture labels, but more time and effort will be saved over the long run.
6. Other visual helps include showing or pointing. For example, point to the object or the destination, such as going to the front room window and pointing outdoors to the newspaper or mailbox. Another way of cuing is to accompany the person with memory loss to the actual place and point out landmarks to remember along the way.
7. Show Them and Have Them Practice – People with declarative or fact memory problems may have good procedural (how to) memory. Instead of telling a person with memory loss what to do, show them how to do something and have them practice. For example, after they practice unrolling the garden hose, watering the plants, and rewinding the garden hose a few times, they may remember how to water the garden. Keeping busy helps a person with dementia to feel useful and it provides exercise. During these activities, the caregiver has time for other responsibilities.
Hellful Hints for People with Severe or Progressive Memory
Even though there are no medical treatments for curing severe memory impairments, changing the way things are done at home can help. People with memory problems do best when they have a lot of hints or reminders to help them figure things out. Saying you are “making sandwiches for lunch time” tells them what meal is coming next. Also, telling time in terms of purpose-such as lunch time, bath time, or bedtime-may have more meaning than using numbers, such as one o’clock.
People with severe memory disorders do not function as well when there are many changes and surprises. Often they get upset when there are changes in their usual routine. Caregivers should under-stand this and see that the routine changes as little as possible from day to day.
1. Reminders Help – Talk frequently about important information, such as the next thing to be done or events that are coming up. It is best to talk casually about these things in the natural flow of conversation. Try not to make the person feel foolish as if they cannot remember. Reminding them in any way of their poor memory will probably upset them.
2. Keep Clocks and Calendars Handy – Leaving the curtains open during the day will help them keep track of the day-night cycle of time. At the end of each day, cross the day off the calendar so that in the morning, the new day is clear.
3. Use Old Photographs and Songs – People with severe memory problems usually remember events that happened long ago. Family heirlooms, old photos or old songs from their teen years may be comforting to them and should be kept handy. Sometimes these mementos remind them of fun times and friends. These memories can calm down a restless or angry person. The person becomes caught up in the happy mood of the memento and stays that way for a while. When an old photo or song creates sadness or anger, distract the person immediately with a new activity-go to a different room, get a drink of juice, or go for a walk (indoors or outdoors).
4. Limit Choices – The fewest number of items should be kept available; extras should be put away or stored. For example, a kitchen drawer should hold a few spoons and forks. The extra utensils should be stored and unavailable. In the clothes closet there could be two pairs of shoes, two shirts, and a pair of pants. Extra clothes should be kept in a separate, locked closet.
5. Choices could be limited to one item. As much as possible, the caregiver should honor the preferences of the person with the memory disorder. The person has the right to choose. It helps to use “Do you want” questions.
“Do yo want to wear the black shoes?”
“Do you want to wear the brown shoes?”
6. Night Lights – People with severe memory problems often have trouble at night. A night light may help them know where they are if they wake up to use the bathroom. A night light may also keep them from tripping over the edges of furniture and falling.
7. Changes in Sense Systems – People with severe memory problems have trouble when their sense systems change they cannot see, hear, taste, smell, or feel as well as before. When not tuned in to the sights, smells, sounds, etc. around them, people become information-deprived and may suffer in physical or emotional health. Caregivers should make sure that people who need eyeglasses or hearing aids use them. Extra flavoring or seasoning may help food taste better. Taking time to feel the chair may help them to sit safely. Appropriate touching and hugs can satisfy skin hunger, the need all people have for contact or touch from another individual.
8. Show Them How – As discussed before, a person with memory prob-lems may have a strong procedural (how to) memory even when the declarative (fact) memory is very weak. Instead of telling a person with memory loss what to do, show them how to do something and have them practice. Many people with severe memory problems cannot remember the facts of where and when something happened (declarative memory), such as where and when they bought a shirt. At the same time, they may remember how to put on the shirt (procedural memory). Thus, people with progressive memory disorders such as Alzheimer’s disease may be able to learn new skills by practicing in small steps how something is done. It may take them a few weeks to learn a new skill that someone else may be able to pick up in a few minutes. The sense of pride, of feeling capable, a bit self-sufficient and independent, is worth the effort.
9. Routine Versus Change – Specific routines should be set as often as possible. The same activities done the same way every day, such as dressing before breakfast or watering plants before lunch, are easier for people with memory loss to understand and follow. If there is a change in plans, such as a visit to the doctor or a vacation, it is important to tell and repeat the information before the event. A positive, pleasant style of approach with a smile should help. During such changes other parts of the daily routine, such as mealtimes or taking a walk, should stay at the same time to provide some stability.
source: Helping People with Progressive Memory Disorders: A Guide For You And Your Family, 2nd ed.
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13 Ways to Ease Caregiver Stress During the Holidays
The holidays can cause feelings of stress to soar! For millions of Americans who find themselves in the role of caregiver to an older frail, ill, or disabled relative, the holiday season can add to an already heavy load of responsibilities and cause feelings of stress to soar.
Stress occurs when we work too much, sleep too little, try to cope with difficult or troubling situations, and when we neglect to take good care of ourselves—all of which are typically everyday state of conditions for the millions of Americans who find themselves in the role of caregiver to an older frail, ill, or disabled relative. The added physical and emotional demands that are involved in celebrating the holidays can add to an already heavy load of caregiving responsibilities and cause feelings of stress to soar.
The holidays are traditionally a time when we reflect on past memories. For those who are caring for a frail and elderly family member, these reflections often deepen the awareness of the extent of the older person’s losses (for example, memory loss for those with Alzheimer’s) and how much life has changed for them. Holiday-time reminiscing can also underscore the loss caregivers face in the altered quality of their personal relationship with the older person. The emotional pain of confronting such losses can heighten feelings of stress.
The holidays are also a traditional time for family gatherings. While this can be tremendously enjoyable, when tensions among family members or unresolved conflicts surface, it can become a source of extreme stress. Caregivers too often find themselves in the middle of family discord as they try to mediate the needs of the older person as well as express their own position.
13 Ways to Ease Caregiver Stress During the Holiday’s
If you are a family caregiver, consider the 13 suggestions and think about which ones you can put in place during the coming weeks to help ease your feelings of stress during the holidays:
- Set manageable expectations and limits for yourself. Be realistic about what you can and cannot do—as well as what you want to do and don’t want to do.
- Try not to set yourself up for disappointment by comparing this year’s holiday season with the nostalgia of past holidays. Each holiday season is different and can be enjoyed in its own way.
- Ask for and accept help! It’s so often the case that, while people want to be useful, they may not always know what to do. Let other family members and friends know what they can do to share in the responsibility of caregiving. Don’t forget to consider asking people who live at a distance, as well as neighbors and people from faith-based groups or clubs, to pitch in and help.
- Maintain or establish social interaction with friends and other family members. Isolation can further increase feelings of stress. Having the chance to have fun, laugh, and focus on something other than your at-home caregiving responsibilities can help you keep stress at bay and maintain emotional balance.
- Remember the holiday season does not banish reasons for feeling sad or lonely. There’s room for feelings such as sadness, grief and/or loneliness to be present along with other more joyful emotions. If you do feel down, avoid critical self-perceptions, and, instead, try to articulate the understanding you need from those around you. Consider seeking the help of a therapist to help you sort out your feelings and deal with your concerns and troubling issues.
- If the elderly person you are caring for has dementia, avoid overly stimulating environments since that can add to their anxiety and end up increasing your stress level.
- If including the elderly person in large family gatherings creates added work and stress for you, consider alternatives, such as suggesting family members plan to spend individual quality time visiting with their elderly relative.
- Don’t abandon healthful eating and drinking habits. While it’s certainly okay to treat yourself during the holidays, avoid giving in to stress-driven urges for overeating or for overindulging in alcohol.
- Exercise regularly. Even if it means finding someone else to take over your caregiver duties, getting regularly-scheduled exercise—for example, walking, swimming, yoga, biking, or aerobics—can be of tremendous benefit to both your physical and emotional well-being.
- Seek emotional and moral support from other caregivers—there is great strength in knowing you are not alone. Many communities have support groups for family caregivers of elderly persons through local hospitals, churches and/or community centers.
- Use community resources such as meal or shopping services, home-care aides, adult day services, and/or volunteer help from faith-based organizations or civic groups.
- Try to find time for yourself to do something you especially enjoy such as reading, walking, listening to music, gardening and/or visiting with a friend.
- Find ways to ensure you get enough rest. Sleep deprivation can sap your energy, distort your thinking and lead directly to making your mind and your body feel stressed to the maximum.
If you experience any signs of depression (for example, extreme sadness, trouble concentrating, withdrawal, or hopelessness), don’t delay in getting professional help for yourself. Depression is a serious, but very treatable condition. If left untreated, depression does not “just go away,” instead, the symptoms progressively worsen and can even become debilitating.
Throughout the holiday season (as well as year-round!), remember to be good to yourself. As a family caregiver, you’re doing a very hard job and deserve understanding, support and quality time for yourself to help ensure you meet your own emotional needs.