When a person with dementia is admitted to hospital, they are usually there seeking an improvement in their health related to a condition that is not connected to their dementia. However, the confusion and distress that can result from a hospital stay for a person with dementia can contribute to a deterioration in their health. Therefore, not only are early identification of their dementia and appropriate, sensitive care essential to their overall experience and outcome in hospital, they are also vital to avoiding readmission at a later date.
Promoting engagement
Some people with dementia may appear not to understand what is being discussed and give the impression they don't have the ability to contribute to decisions being made about their care. However, if no assessment has taken place to confirm they lack capacity, every effort should be made to effectively communicate with them, and encourage their involvement in their care, and in decisions being made about them (National Institute for Health and Care Excellence (NICE), 2018).
It is difficult for most of us to lose the ability to care for ourselves and rely on someone to do this for us. We require respect, communication, encouragement and support. The same applies to people with dementia. Being in hospital with its unfamiliar routines and environment already poses challenges for the person with dementia who can easily become disorientated and distressed (NHS Education for Scotland, 2011).
Having their personal space invaded is difficult and if they are not effectively communicated with, and don't understand the care that is being offered, they can become very distressed by nurses approaching to carry out tasks such as washing or dressing—and even more so with more invasive procedures that may be required in hospital such as catheterisation or wound dressings (NHS Education for Scotland, 2011).
Although effective communication with people living with dementia can pose a challenge for health professionals, awareness and knowledge of dementia, and training or self-education of appropriate strategies can help. So too can involving carers in care and making appropriate use of their knowledge about the person and their condition to provide a more positive experience for the person, the carer and the health professional.
Self-management
The promotion of patient empowerment, self-care and self-management of chronic illness has become increasingly prevalent—however, this seems to apply to diseases such as cancer or diabetes, and less so to dementia. There is a misconception that people with dementia do not have the ability to become involved in their care—this needs to be addressed (Mountain, 2006).
There has been particular focus on people with early-stage dementia as a group of patients who could benefit from self-management interventions. Quinn et al (2014) noted that self-management interventions share these qualities:
They suggested potential benefits of self-management interventions can include improvement in knowledge, self-efficacy, health status, and performance of self-management behaviours. Their pilot trial of a self-management intervention found that it fostered independence and reciprocity, promoted social support, and offered both information and support for clinicians (Quinn et al, 2016).
Conclusion
NICE (2018) points out that an assessment should be carried out to balance patients' medical needs with the harms they could face in hospital such as disorientation, longer length of stay, increased mortality, increased morbidity on discharge, delirium and the effects of being in an impersonal or institutional environment. The guidance notes that advance care and support plans and the value of keeping the person in their familiar environment should be considered when the decision is being made about whether to admit a person with dementia to hospital.
When a person with dementia is admitted to hospital there are many points to consider that can improve their care. The importance of early recognition of the person's dementia, an awareness of what it entails and how they may react to being in hospital cannot be overstated. Efforts to communicate with the person effectively, involve them and their carers in their care decisions, provide appropriate community referrals and empower them as much as possible both in hospital and for their return home, can go a long way to improving their hospital experience and outcomes—and ultimately to avoiding their readmission.