Hospital and Emergency Department Preparedness for Patients with Dementia

While one always tries to avoid hospitalization or an Emergency Department (ED) visit for patients with dementia, it is inevitable that some patients require emergency care or hospital admission.  Patients with dementia have higher rates of ED visits and hospitalization compared to those the same age that do not have dementia for reasons including a sudden change in mentation (can relate to infection, seizure, or medication toxicity), uncontrollable behavioral symptoms that cause harm to patients or caretakers, and falls.  There are other medical conditions such as stroke and heart attacks commonly seen in elderly patients that require urgent evaluation and care. Occasionally, some conditions result from the natural progression of the dementia disease process. For example, wandering, delusion, hallucination, sundowning (patient is confused in the evening), and other behavioral and personality changes do not require a hospital visit. If a visit to the ED becomes necessary, our Memory clinic staff and nurses are always ready to help. To ensure a smooth visit to the hospital, it may be helpful to prepare a few items:

• Have the patient’s Kaiser medical card ready so providers can quickly have access to medical records including labs, medications, imaging studies, and your previous visits/hospitalization.
• Patients with dementia frequently are not able to give history or make medical decisions. Bring a caregiver or family member prepared to speak so providers and ED staff will have reliable information.
• Bring in the lists of current medications, supplements, and over-the-counter medications the patient is currently taking.
• If possible, please provide copies of the Advance Directive along with Physicians Orders for Life-Sustaining Treatment (POLST).

We anticipate patients with dementia will become confused in the hospital because it is a new and unfamiliar environment; it is not uncommon that patients to become more delirious. Our hospital’s staff will be able to respond and create appropriate treatment plans given a patient’s dementia history. Some patients may need a “sitter” or medication to limit aggressive behavior. Most medications used for behavioral symptoms (like controlling offensive personalities) will not interact with commonly used dementia medications. The hospital and ED staff will regularly communicate with you or your caregiver about any changes in the treatment plan, side effects, and long-term goals.