Dementia and Hospitalisation - Dementia Australia

Dementia Australia supports carers and people with dementia to increase their awareness of the higher risk of hospital admissions for people with dementia. Research has identified that the person with dementia is more likely to be admitted to hospital as a result of falls, urinary or chest infections or delirium. The person with dementia will often stay in hospital longer than the person without dementia.

We encourage clients and carers to have regular checks with their General Practitioner (GP) and report issues of concern early. The person with dementia may require support to do this e.g. due to impaired mobility or lack of effective family or social support or knowledge. Carers can also phone the Dementia Australia Helpline1800 180 023 to discuss concerns such as night wandering or aggression earlier and thereby reduce carer stress and reduce presentations at hospitals.

Reducing Potential Risks related to Hospitalisation

To avoid hospitalization and minimize any adverse effects if hospitalisation does occur:

Develop healthy meaningful lifestyles and goals.
Investigate early signs of illness, agitation and depression.
Practice early intervention and prevention strategies.

These recommendations will apply to both the person with dementia and their carers. Recommendations include enjoyable exercise daily, maintaining optimal independence, diets with a variety of nutrient rich foods including high fibre, low fat, low sugar and adequate fluids, moderating alcohol intake, stopping smoking, maintaining frequent familiar socialization and age appropriate stimulating recreational and learning opportunities, adequate sleep and addressing loneliness, boredom and helplessness issues.

Review hearing, sight and dental health. Organise regular medical reviews with GP or specialists which could include strategies such as influenza and pneumonia vaccine, breast examinations, prostate checks, blood screening, monitoring falls risk and osteoporosis. Request a medication review that includes prescription and non-prescription (over-the-counter) e.g. vitamins and minerals, herbal and natural medicines. Seek help early to manage repeated behaviours of concern which cause carer stress.

By implementing these recommendations we may slow the progression of dementia and attack the risk factors which include hypertension, high cholesterol, stroke, obesity, diabetes, chronic kidney disease, anxiety, depression, frailty, lack of mental and physical stimulation and social isolation and stress. Optimal quality of life can be promoted and cognitive, social and physical decline will be better controlled.

Medicare and Health Services to maintain or restore health and wellbeing

Ask your General Practitioner (GP) about a GP Management Plan (GPMP) and Team Care Arrangements for chronic disease management. If you are eligible Medicare will fund five treatments per calendar year e.g. from a podiatrist, physiotherapist, dietitian. These strategies promote good quality of life outcomes for the person with dementia and also their carers.

Helpful Hints when Hospitalized and to avoid Readmission

The patient’s advocates/family/friends need to advocate for person-centred care:

Inform staff of the diagnosis of dementia on arrival.
Inform staff of any new changes to cognitive state in recent hours or days.
Ensure an advocate is with the patient to give an accurate history of recent health events and usual level of function and quality of life.
Take certified copy of an Enduring Power of Attorney and Advanced Health Directive with you.
Have an emergency care plan and carry an emergency care card (phone Carer Gateway on 1800 422 737 to obtain an Australian Government emergency care kit)
Seek updates from medical staff, dietitian, physiotherapist, speech pathologists, pharmacists and other staff involved in the care planning to ensure:
- Full access to services
- Carers are involved in all informed decision-making
- Appropriate discharge services are discussed and organized early.
Be aware that mobility declines with bed rest. Reduced activity leads to muscle weakness, impaired balance, decreased confidence and increased falls risk. Recruit family, friends and staff to walk with the patient at every opportunity if not medically contraindicated. Ask about deep breathing, leg exercises in bed and physiotherapy review.
Be aware that continence may deteriorate – advise staff of previous level of continence and request regular toileting and repeat orientation to toilet areas. Ensure buzzer is within reach.
Be aware that confusion, agitation and depression may occur or increase due to changes in valued routines such as bathing, meals, sleeping, recreation; unfamiliar faces and places; changed level of function including incontinence; pain, noise, bright lights; changed medication and anaesthetics; lack of cultural knowledge by staff; separation from pets.
Be aware that swallowing difficulty may occur related to confused states and nutritional state and hydration may deteriorate. Dietary changes e.g. vitamised diets made in hospital may not be long-term – check with the dietitian prior to discharge.
Ensure dentures, hearing aids, spectacles are used and stored safely at night.
Take some familiar items to the hospital such as family photos, photo album, familiar aftershave and clothing, a clock, music with ear phones.
Ensure all discharge medication is explained and understood.
Ensure adequate aids, services, supports are in place at home to avoid readmission to hospital.
Ask about the Transitional Care Program where additional services are organized in your home to ensure a return to the previous level of function after discharge. An ACAT assessment while in hospital is required.
Home and Community Care under the Commonwealth Home Support Program and Home Care Packages can also be beneficial.

Hospitalisation, Future Planning and Transition to Residential Aged Care Facilities

Hospitalisation for the patient with advancing dementia may be accompanied by a decline in their level of function and independence that results in a need for the person to live in a Residential Aged Care Facility (RACF) and not return home. This decision should be made following discussion with the patient, the family or advocates and the health team.

A social worker from the hospital will often be asked to work with the family to plan this transition. Big decisions are being made in short time frames, choices can often be limited and patients may need to be moved to other hospitals pending placement in a RACF that is not their first choice.

With the knowledge that dementia is a progressive chronic disease, as part of future planning and to avoid having to make decision during crisis periods in hospital or during emergencies at home, families are advised to:

Prepare an EPoA with a solicitor and have certified copies of EPoA
Prepare an Advanced Health Directive (AHD) discussed with the GP

(Both EPoA and AHD is done when the person with dementia is able to understand and communicate these decisions)

Register on the My Aged Care site (MAC) online http://www.myagedcare.gov.au/ or phone 1800 200 422 to arrange an assessment by the Aged Care Assessment Team (ACAT).
- A letter of approval for Residential Aged Care, Residential Respite and Home Care Packages is given to the consumer by ACAT.
- This ACAT approval is required prior to accessing some government subsidized aged care services.
- The family and person with dementia are then able to make an appointment to visit RACFs near them and assess if they are appropriate for their loved one and themselves in the future.
- A checklist of questions to consider when looking at RACF is on the My Aged Care site http://www.myagedcare.gov.au/considering-aged-care-home/finding-aged-care-home or by phoning the Alzheimer’s Queensland Advice line 1800 639 331.

The transition process to RACF is more positive for both carers and the person with dementia when informal and formal emotional and practical support contributes to timely, informed, planned decision-making.