Improving Your Stay in Hospital

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Improving Your Stay in Hospital
Author: Associate Professor Jacki Liddle
Published: Tuesday, May 23rd 2023

While no one chooses to go to hospital as a destination, it can be the best place to go when you are injured or unwell. People living with dementia are at risk for having particular complications during a hospital stay.  Research is currently focusing on how to make the best of it when you need to be in hospital.

What are the risks of being in hospital for someone living with dementia?

Firstly, we need to start with saying that not going to hospital when you are injured or unwell carries very high risks. Historically though, hospitals have not been set up for patients living with dementia.

Researchers have been looking at how best to reduce harms experienced in hospital so have identified risks and steps to reduce those risks. The identified risks for people living with dementia include

  1. Developing delirium (an acute, temporary state of heightened confusion)

  2. Experiencing falls, pressure injuries or infections

  3. More likely to need to be readmitted to hospital.

Importantly there is a large, international body of research that focuses on how to improve hospital outcomes. This has shown important roles for:

●      Workers in hospital (from all areas) – and how they do their jobs

●      Patients (how to prepare and support your hospital visit)

●      Family and friends (how to help someone in hospital).

What is really interesting about most of these strategies is that they are just good care! Many steps that help reduce risks and harms are not expensive, technical or hard to do. Please note that all of these will depend on your health and reason for being in hospital, so work with your healthcare team to check what might suit you. Some of the steps that have been identified as preventing and managing delirium are:

1.Knowing that someone has a higher risk.

For this reason, it is important to let staff know if you have a diagnosis of dementia. They can then monitor you more closely and ensure you have support for your stay.

2.Keep watch for any changes

If you notice any changes to your memory and thinking during your stay, let people know. Care partners and visiting family and friends will also have an important role in letting people know if something has changed. Staff will regularly ask some questions to help them check whether anything has changed in your health or mental state.

3.Personal items and reminders can help

The environment around a person in hospital can help with orientation (knowing where you are, what time it is and who you and others are). Having essentials (glasses, hearing aides, mobility devices), to communicate and stay active are important. Other things like clocks, personal photos, and music can be helpful in setting up your environment to suit you. Bringing these to hospital can be a useful step in reducing risks.

4.Set up for support

Setting up the room and routine in hospital can help with preventing or managing delirium – and make a stay more pleasant. This includes things like:

- having curtains open to have daylight during the day,

-being out of pyjamas and bed during the day if suitable to your condition and treatment,

-having access to such things as news and music, and

-having safe easy ways of getting around and doing things (again if suitable for your condition and treatment).

This may mean having a suitable chair and table, having other areas in the ward for moving to, and having a clear way and support for walking for bathroom and other activities.

5.Work with your healthcare team to eat and drink, and stay active and engaged

One important aspect of preventing delirium and helping with recovery is to make sure you are eating and drinking enough (considering your situation). This can be supported through reminders about meals, having help to reach the meal tray and open containers and having someone around during meals. Family and friends might help here. Staying active (moving in bed, sitting out of bed, walking) and engaged (talking, doing puzzles, reading etc) are also important parts of reducing risks. One program being trialled in Australia is called the Eat Walk Engage program and they work to set up wards and care to prevent delirium.

6.Manage pain

Pain in hospital can present in different ways.  Being in pain can worsen delirium and slow recovery. Some medications for managing pain can make confusion or mobility worse. Taking a team approach to recognising pain and managing it can be really important – make sure you let people know if you are uncomfortable or in pain. If you regularly need pain medication (like for arthritis), it is important to let staff know, even if that doesn’t relate to your reason for being in hospital.

 

Research has shown delirium prevention programs involving the whole team, patient, and family and friends, and considering the environment can be highly effective at reducing harms experienced. Many hospitals and health services note that preventing delirium and managing it well are part of the essential services that a hospital offer (Quality standards).

Preparing for a planned hospital stay could involve planning things to bring that help with staying oriented and having things to do, as well as having information about yourself and your regular routines and care preferences in writing. If you have completed advanced health directives, and have a written copy of your medical history and medication these can be useful too. More information about health care rights and actions can be found locally – this is an Australian resource that gives some information.

For more information -

About delirium: /Community-Information

About actions for consumers: /publications-and-resources/resource-library/better-way-care-actions-consumers

 Guides for consumers, clinicians and services: /our-work/cognitive-impairment/cognitive-impairment-resources

 

Associate Professor Jacki Liddle is an occupational therapist and researcher at the University of Queensland, and Princess Alexandra Hospital in Brisbane, Australia. Her research focusses on quality of life, technology and participation, and she is interested in innovative clinical and research approaches that involve partnering with lived experience experts. She is also co-chair of Dementia Alliance International’s Environmental Design – Special Interest Group. More information about Jacki’s research is here /researcher/1092

 


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