WASHINGTON (AP) — For people with Alzheimer’s disease, a hospital stay may
prove catastrophic.
People with dementia are far more likely to be hospitalized than other older
adults, often for preventable reasons like an infection that wasn’t noticed
early enough. Hospitals can be upsetting to anyone, but consider the added
fear factor if you can’t remember where you are or why strangers keep poking
you.
Now a new study highlights the lingering ill effects: Being hospitalized
seems to increase the chances of Alzheimer’s patients moving into a nursing
home — or even dying — within the next year, Harvard researchers reported
Monday. The risk is higher if those patients experience what’s called
delirium, a state of extra confusion and agitation, during their stay.
It’s not clear exactly why, although specialists say delirium is especially
bad for an already damaged brain. But the researchers, and independent
Alzheimer’s experts, agree that caregivers need to know the risk so they can
help a loved one with dementia avoid the hospital if at all possible.
“It’s a very stressful time, being in the hospital,” says lead researcher
Dr. Tamara Fong, of the Harvard-affiliated Beth Israel Deaconess Hospital
and Hebrew SeniorLife in Boston. Often families tell her, “Dad was never the
same after he had that surgery and he was confused.”
It’s a challenge even for health professionals. Psychiatrist Leslie Fuchs
watched in disbelief as her mother, who’d had slowly worsening Alzheimer’s
for several years, rapidly disintegrated during a stay in a New York City
hospital last year.
Relatives had called 911 when Thelma Fuchs, 79, suffered what appeared to be
a brief seizure. That problem quickly cleared up but the hospital was
reluctant to discharge her with it unexplained. Over a few days, Fuchs
became increasingly distraught, tried to sneak into other rooms, and wound
up being prescribed some antipsychotic drugs, her daughter recalls.
Leslie Fuchs insisted her mother be sent home, where she calmed down and no
longer needed the medications. The family has taken steps for more at-home
care in hopes of avoiding future hospitalizations.
“She has to be in an environment that’s familiar. She can’t make a new
memory but her old memories, that’s what kind of keeps her together,” Leslie
Fuchs says. At home, she notes, family members “still are the
decision-maker. As soon as you’re in an emergency room, you kind of can lose
that.”
Some 5.4 million Americans have Alzheimer’s or similar dementias, and the
disease is on the rise as the population rapidly gets older. The disease
will cost Medicare and Medicaid about $140 billion this year alone,
according to the Alzheimer’s Association. There is no cure, and much of the
cost is from treating not the dementia itself but other health conditions
that dementia can aggravate. Alzheimer’s patients gradually lose the ability
to manage their diabetes, high blood pressure and other chronic ailments, or
even to convey that they’re feeling symptoms until an illness becomes
serious, explains William Thies, the association’s scientific director.
Earlier this year, University of Washington researchers reported people with
dementia are more likely than other seniors to be hospitalized, especially
for conditions such as pneumonia, urinary tract infections, worsening heart
failure or dehydration that might have been treated in the doctor’s office
if they’d been caught early.
The new study took a closer look at potential health consequences of
hospitalizations. Fong’s team examined medical records for 771 Alzheimer’s
patients who were living at home and fairly high-functioning, to see what
happened if they wound up in the hospital. About half did, mostly for things
like fainting or falls, pneumonia and chest pain. A quarter suffered
delirium during that hospitalization.
Each year, about 4 percent of the patients who weren’t hospitalized entered
a nursing home and 2 percent died. Yet 29 percent of the hospitalized
Alzheimer’s patients wound up in a nursing home — as did a surprising 43
percent of those who suffered delirium, Fong found.
Of those who survived the initial hospitalization, 9 percent died in the
following year, as did 15 percent of those who’d suffered delirium, Fong
reported Monday in the journal Annals of Internal Medicine.
The study can’t explain the link. It’s possible that people who wound up in
the hospital or delirious already had begun deteriorating more than their
non-hospitalized counterparts. Fong would like to compare hospitalized
Alzheimer’s patients with those who get at-home care for the same
conditions, such as advanced urinary tract infections, to see if avoiding
the hospital makes a real difference.
For now, “it is perfectly clear that hospitalization is very hard on people
with Alzheimer’s disease,” and that delirium especially is a threat, says
the Alzheimer’s Association’s Thies.
What’s the advice for families?
—Be alert for any new symptoms, which could be as vague as irritability from
pain, and seek care early to avoid a hospitalization. Also learn to manage
Alzheimer’s behavioral problems — such as hallucinations at dusk — before
they escalate into unmanageable anxiety, Thies says.
—If a hospital stay can’t be avoided, ask if the medical center tries to
minimize delirium with private rooms, avoiding waking the patient at night,
and limiting time in the emergency room.
—A family member also should stay with and reassure the patient, make sure
they have their glasses or hearing aids, and bring in familiar items, Fong
adds.
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