Managing dementia in hospital

There are strategies we can use to improve care for patients with dementia. These can include working with family and carers, staff and other health professionals, as well as adapting the environment.^1,2,3

Involve family and carers

• By involving family and carers in assessment, care planning and in delivering care we can improve outcomes for people with dementia, provide comfort, and also help family and carers understand and cope.
• Use the TOP 5 initiative to draw on their knowledge and experience of the patient and their care needs. Family and carers understand what is normal for the patient with dementia and this knowledge helps us identify changes that may be indicative of delirium, pain or other treatable conditions.
• Collect information from family and carers. Use forms such as the ‘This is me’, Information about ‘me’ for planning care in hospital. These forms include questions related to the patient’s social care needs and preferences, and behavioural management strategies (including mobility, toileting, medication administration, and what comforts or distresses the patient).
• Inform them about what to expect during an admission and how they can work with hospital staff.
• If possible, provide one contact person within the organisation for any queries.

I really got to know her and her husband. He had a lot of behaviours and caused a lot of problems on the ward. But I sat down with them both and did the Key to Me [a form similar to the ‘The information about me for planning care in hospital’] … I think that was really good. I’ve been nursing for a long, long time, and sometimes you forget …they’re not just a patient… It made me realise that he’s not a naughty patient who caused a ruckus on the ward. He was a very kind man. After that I had a lot more patience with him…he was wonderful remembering his past, he had the most amazing life… it blew me away.… You don’t get the same sense completing the form compared to when you talk to someone and fill it in with them.
- Enrolled nurse

Alert all staff

• Consider a method for informing all staff that a patient has dementia, for example a discreet bed-based sign such as the Cognitive impairment Identifier.
• Ensure that all staff are trained to respond appropriately to the needs of patients with dementia.

Communicate clearly and effectively

• Introduce yourself and explain your role.
• Make sure you have eye contact at all times.
• Remain calm and talk in a matter-of-fact way.
• Keep sentences short and simple.
• Focus on one instruction at a time.
• Give time for a response.
• Repeat yourself – don’t assume you have been understood.
• Do not give too many choices.
• Involve family and carers.

Assist with activities of daily living

• Assist the patient with toileting, eating and drinking; encourage regular movement, prompt with self-care and other activities of daily living where required. These interventions play a key role in minimising the person’s risk of under-nutrition, falls, pressure injuries and delirium.

Change the environment

• Place familiar personal belongings around the patient and, where possible, follow familiar routines.
• Have large faced clocks and calendars and clear signage to the toilet to assist the patient with orientation. If not available on your ward, talk to your team about purchasing them.
• Normalise the surroundings and reduce environmental stimuli as much as possible.
• Keep walkways clear to prevent falls.

Consider referrals

• Access the expertise of comprehensive geriatric medical services or on-site geriatricians or psychogeriatricians, or in emergency departments, dedicated aged care staff.
• Where appropriate, consider alternatives to hospital admission, for example, hospital in the home or return to their residential aged care facility with Residential In-reach services.
• It’s important that the person living with dementia, as well as their family and carers, maintains their social networks. Explain how this can reduce the risk of becoming socially isolated or experiencing loneliness, both of which can have a negative impact on a persons’ health. Local councils, local newspapers, neighbourhood houses and libraries can be a good place to find out what activities exist in each neighbourhood. Alzheimer’s Australia can help with information about local activities and groups. Ask a social worker for ideas.

1. Ballarat Health Services, Understanding dementia: a guide for hospital staff. [undated].

2. Joosse, L.L., D. Palmer, and N.M. Lang, Caring for elderly patients with dementia: nursing interventions. Nursing: Research and Reviews 2013 3: p. 107-117.

3. Alzheimer's Australia, Dementia care in the acute hospital setting: Issues and strategies. A report for Alzheimer's Australia. Paper 40 2014.

4.Moyle, W., U. Kellett, A. Ballantyne and N. Garcia, Dementia and loneliness: an Australian perspective. Journal of Clinical Nursing. 2011 20: p. 1445-1453.