Hospitals are an essential part of the Canadian healthcare system but they can also be dangerous places for frail older adults. Hospital borne infections, poor continuity of care and bright, noisy environments can hasten a loved one’s demise if we are not careful.
It is important to understand that hospitals are focused on acute care. They diagnose and treat injuries and illnesses but are not equipped to support the long-term ongoing needs of individuals with chronic conditions. Older adults may be admitted for a specific reason but other existing diseases such as dementia can complicate diagnosis and treatment. What’s more, the longer they remain in the hospital, the greater their risk of experiencing a secondary infection and possible delirium.
If you have an older family member or friend in the hospital, here are some tips to help you to better support and advocate for them.
- Ensure that doctors and nurses have a thorough history about your loved one including existing diagnoses, medications, allergies, and baseline behaviour.
- If their family doctor has hospital privileges, ask that they be involved – they know your loved one and can help provide much needed familiarity and continuity of care.
- Visit as often as you can and if their stay is prolonged, bring in familiar items from home such as pictures, blankets, reading material, hearing aids, glasses, comfortable clothing and toiletries.
- Insist on remaining informed. If you can’t be there every day, call in and ask to speak to their nurse for a daily update. Leave instructions for the doctor to call you if you have specific questions that remain unanswered.
- Watch out for changes in behaviour. Delirium is very common among the elderly when they are hospitalized especially if they have dementia. It is considered to be a medical emergency and may cause the person to be excessively sleepy if they have a hypoactive delirium or uncharacteristically restless or aggressive if they have a hyperactive delirium. Infections (such as a urinary tract infection), constipation, dehydration, mineral deficiencies, and reactions to medications are common causes.
- If delirium does not improve after the underlying cause has been treated, consider that pain or the environment itself may be contributing factors. It may take some time for your loved to recover from a delirium. While they may not fully return to their pre-delirium selves, be cautious about accepting explanations from hospital staff that this might be their “new normal”. Make sure clinicians have a true sense of your loved one’s previous baseline mood and behaviour. Advocate for doctors to address other factors such as pain or disrupted sleep patterns.
- Display pictures of close family and friends to help orient loved ones and remind hospital staff that they are caring for someone else’s parent, spouse or grandparent. These pictures help to humanize the clinical nature of care and also provide a conversation starter for visitors.
- Provide them with a notebook and pen so they can keep track of important information. If they cannot take their own notes or have a poor short-term memory, post notes on their wall to remind them about where they are, what has transpired and that they are not alone.
- Look for ways to brighten their day. Inquire if the hospital has a H.E.L.P. program (Hospital Elder Life Program) and can have volunteers pay them a visit. Enrich your own visits by bringing them photos and updates about family. If possible, take them downstairs for a bite to eat or some time outside.
- Help them remain entertained and connected to the outside world by activating phone and television services.
- Muscle atrophy can happen very quickly especially for individuals who are spending a lot of time in bed. They should receive daily visits from a physiotherapist to help them to maintain their flexibility and mobility.
- Do not forget to help them exercise their brain. Bring puzzles and trivia for them to do or consider booking a few Fit Minds sessions for them while they are in the hospital. They are the perfect combination of social and cognitive stimulation.
- Once they are ready to be discharged, make sure you understand if they will need any special support when they return home. If home is no longer appropriate, ensure you request a meeting with the discharge planner and LHIN coordinator. It may be necessary to consider temporary support either at home or in a retirement home until a move into a long-term care home can be arranged.
This blog has been brought to you by Joanne Spiller who is a Gerontology Activation Professional and Fit Minds Certified Coach at the Oakville Naturopathic Wellness Centre. To book an appointment with Joanne, please call 905-825-9996.