When Admitted to the Hospital

Be an Advocate. Once admitted to the hospital, the most important role of a caregiver is to serve as attendant and advocate for their loved one.  This means asking questions, being persistent, and understanding WHY treatments and services are being recommended as part of the care plan. (See more advice.)  When possible, have more than one person present to take notes and listen to what the medical professionals are sharing. In addition, the following are steps to consider: 

• Check to make sure medical records are on site. If your loved one is at a hospital outside of their usual system, it is unlikely that their care team will have access to their medical records automatically. When admitting your loved one, make sure to provide copies of your folder of legal healthcare documents, including: updated medication list, allergy, illnesses and diagnosis, contact information for specialists, pharmacy and primary care physicians, MOLST, and any health care proxies. 
• Make sure that your contact information is also included so that the care team can easily keep you informed of any updates. (A MOLST is a portable, medical document that specifies a patient's preferences for end-of-life care, including resuscitation, intubation, and other life-sustaining measures. It includes all directives previously included in a DNR) 
• Inform emergency department staff if the person has dementia, has had a history of hospital-delirium, is dehydrated, or needs caution with IV ports and blood work. If the person you are accompanying has dementia or memory issues, ask the staff member to record this information in the medical record.  When seniors are brought to emergency rooms with non life-threatening concerns, they can be left for long periods of time unattended.  In unfamiliar places without friends or family nearby, they may experience anxiety, anger, depression or delirium. Share any insights on approaches to proceed with communication and care.   

“I found out about my father being in the hospital two days after he was admitted.  By then he was so aggressive they had to restrain him so he wouldn’t pull out his IV or hurt someone.  Being able to speak with the nurse about his anxieties would have made a world of difference in managing his hospital delusions.    As soon as you can, talk with the nurse on duty and let them know what you do about how your loved one experiences hallucinations or hospital delirium. ” - Caregiver 

Limit or avoid hospital delirium and hallucinations -Also called “sundowning”, managing hospital delirium requires a collaborative effort from healthcare professionals, caregivers, and the patient. 

Patients experiencing sundowning may have difficulty remembering names, dates, or locations.  They may see or hear individuals not present, act out of character or ask for relatives long passed. They may be agitated, nervous, acting out or being unusually withdrawn. These patients are at a greater risk for long hospital stays, functional decline, risk of complications, and mortality. Once experienced, they tend to experience delusions with greater severity and regularity during future hospital stays. Here are some practical steps as you advocate for your confused loved one: 

• Encourage orientation: Help the person stay oriented to their surroundings by placing familiar objects in their environment and providing regular updates about the date, time, and location. 
• Maintain sleep routine: It is difficult to ask nurses to allow patients to rest through the night, but encourage daytime activity to promote restful sleep. 
• Stay hydrated and nourished: Encourage loved ones to continue to eat.  Some hospitals have protein shake “ice cream cups”. Do what you can to keep them on a balanced diet with regular fluid intake. Dehydration and nutrient deficiencies can exacerbate delirium. 
• Promote social interaction: Encourage social engagement, whether through conversations, visits from loved ones, or movement around the hospital. 
• Create a calm environment: Reduce noise, ensure proper lighting, and minimize disruptions to create a relaxed and reassuring atmosphere. 
• Support sensory stimulation: Provide sensory stimuli such as familiar music, photographs, or tactile objects to help maintain cognitive engagement. 
• Communicate with healthcare providers: Keep an open line of communication with the medical team, promptly sharing observations of any changes in behavior or cognition. 
• Be patient and compassionate: Individuals experiencing delirium may become frustrated or agitated. Maintain a patient and empathetic demeanor while providing reassurance and support. Don’t try to force them to live in our world.  Allow them to feel comfortable in their reality. 

Mobility & UTIs -  If your loved one has been admitted due to falls or weakness when standing and suffers from incontinence, it is possible that the care team may recommend the use of a catheter rather than a portable toilet.  Using a urinary catheter increases the risk of developing a urinary tract infection (UTI). About 75% of UTIs developed in hospitals are associated with a urinary catheter, especially when they are left in place, rather than used periodically.  If your loved one presents as delusional, this can be an indication that they have developed an infection, been exposed to Covid, the Flu or some other illness while in the hospital.  NOTE: If the patient is placed on IV vs oral antibiotics, there may be a delay in being discharged from the hospital.  Discuss medical treatment if an infection is determined.

Dementia & Anesthesia - While general anesthesia doesn't directly cause dementia, it can potentially worsen existing dementia symptoms in some individuals. To limit the impacts of anesthesia on dementia, the most important steps are to consult with a healthcare professional before surgery, discuss the patient's specific cognitive status, and opt for the least invasive anesthetic options like regional anesthesia when possible, while avoiding medications that can worsen cognitive function, particularly benzodiazepines and anticholinergics; additionally, meticulous post-operative care with close monitoring and cognitive stimulation can help manage potential cognitive decline.