People with dementia have a higher chance of being hospitalized than those who have no cognitive decline, and the way transitions between care settings are handled can make a big difference in outcomes and re-hospitalizations, said a panel of speakers today in a care transitions webinar.
The event, “Care Transitions to and from the Hospital for Individuals with Alzheimer’s and Related Dementias,” discussed the programs hospitals should use to inform families and caregivers in the challenges of admitting a person with cognitive decline to a hospital and discharging him or her either back home or to a nursing home.
Making a hospital visit can be one of the most confusing upheavals for people with dementia. Unfamiliar surroundings, unfamiliar staff, interrupted routines, different foods and other things can upset their internal balance and cause outbursts, behaviors and even increased cognitive decline, explained Alan Stevens, PhD, the director of the Center for Applied Health Research. “Families often say, ‘Things were going very well until,’ and that ‘until’ is most often a hospitalization.” Dementia also is a key factor in hospital length of stay, he added. “Even good hospitals that watch length of stay very carefully will still see a higher length of stay for those with dementia.”
The panelists discussed some of the things that caregivers can do to reduce anxiety before, during and after hospital visits:
- Be conscious of the day/night cycle and avoid night interruptions if possible.
- Get them up and out of bed when possible, even just for a short walk across the room. “Mobility should be viewed as a vital sign,” said Kathryn Agarwal, MD, assistant professor of medicine at Baylor College of Medicine.
- Be proactive about medication reviews, obtaining detailed documentation of any medications prescribed at the hospital as well as how long they should be taken.
- Serve as a coach to families and help them learn about the facts of the disease and the supportive services available to them.
- Be willing to serve as interpreter for families in terms of managing their expectations, especially after discharge. That includes the involvement of home healthcare services, added Karen Rose, PhD, RN, FGSA, FAAN, University of Virginia School of Medicine. “Many families don’t understand what home health is, and what it is not,” she said. “Many think that home health is going to come in and take care of everything.”
- Take every opportunity to educate families of the difference between palliative and curative care, including the importance of POLST and MOLST documentation.
Skilled nursing facilities should be proactive about finding out what education their acute care partners are providing for patients and families at discharge and as follow up afterward, Agarwal added. “It may be of value for skilled nursing facilities to ask their local hospitals to help them understand what programs they have, Nursing homes may decide that hospital A is going to give better geriatric care than hospital B. Interview them on how well equipped they are to care for their patients.”