The Importance of Routine and Familiarity During Hospitalization

Picture this common hospital scene…

You're 75 years old and have been on a water fast for a week, being woken every 2-4 hours to have your vital signs checked while another patient shrieks all night in the bed next to you. You get upset and want to leave or just get up to go to the bathroom. But because you have an IV, the nurse won't let you up. So you complain—perhaps loudly. Next thing you know, you're strapped down to your bed in a restraining posey jacket. Now immobilized, the nurses stick a catheter up your bladder and rectum and leave you to lie there half naked. This leaves you even more upset, so the staff drugs you with sedatives and antipsychotics. Then the catheter triggers a bladder infection, which disorients you even further. Now you're drugged out, paranoid and panicked, which leads to, you guessed it, more drugs.

You're in a completely unfamiliar environment and nothing identifies you as human. You're just the "Dementia in room 7." No one knows you from before your hospitalization to know that this is not who you normally are. And by now, you're near psychotic and of course unable to go home.

Your family is told the disturbing news. And though your deteriorated mental state was entirely preventable, the hospital staff packs you off to a nursing home, all the while continuing to pump you with psychoactive drugs to keep you "manageable," able to be handled like a child.

Welcome to "Hospital-Induced Delirium and Dementia"

Until recently, "hospital-acquired delirium" was attributed to old age and not considered important to prevent or treat. But it is critical. People who develop delirium in the hospital end up in nursing homes a staggering 75% of the time, five times higher than those without hospital induced delirium. It also leads to longer stays in the hospital, an average of nine days compared to four without delirium, costing an average $60,000 per hospital stay.  Add to that the average $70,000 yearly cost of being in a nursing home, and the emotional and financial benefits lost from missed prevention become staggering.

How to Prevent Hospital-Induced Delirium and Dementia

Begin by simply remembering to provide familiarity for your hospitalized loved one. Doing so will also remind staff that this is a real human being with a loving family, not just the "demented gallbladder in 26." Here are simple ways to help your family member avoid hospital-induced delirium and the vicious cycle it can lead to:

Tips for Avoiding Hospital-Induced Delirium and Dementia

1. Keep pictures of your loved one, their spouse, children, grandchildren and even pets all over the hospital room. Even put them on the walls. This not only offers familiarity to them, but helps the (sometimes exhausted) staff see them as people worthy of respect.
2. Keep comforting and familiar items from home in the room, like their slippers and coffee mugs.
3. Take advantage of 24/7 visiting hours. Catching disorientation early has a very different outcome when done by a family member who can be soothing and reassuring, and has the time and inclination to help. This also allows your hospitalized family member's needs to be met more quickly (like a glass of water or help to the bathroom), while offering socialization and interaction.
4. If your family doesn't have the time or resources to have someone there all the time, give the staff the phone number of a family member or friend who can be called if disorientation or agitation occurs. Better yet, tape it prominently on the wall by your loved one's bed, with an order to call that person to ask for help in calming your loved one down—simply hearing from a trusted voice can do wonders to someone in distress. Again, catching it early before the above vicious cycle gets a foothold is key.
5. Keep in mind that the more severe the illness, the greater the need to encourage family presence.
6. In a word to hospital staff themselves: Understand that most families in this situation would want to know how best they can help, including the option of having family present outside of visiting hours. But in the rare case that you have a patient who's family seems less than supportive, you might consider tactfully reminding them that the government can confiscate a patient's assets if needed to pay nursing home costs, including any assets that may have been transferred by them to others during the last five years, a tactic some use in a misguided effort to shield their assets. This can do wonders to motivate family members who might be hoping for an inheritance to be more supportive, and by doing so possibly reduce the $70,000 a year that a nursing home might otherwise take.

Other Helpful Tips?

1. Have a list of all your hospitalized love one's medications and their prescriptions. Over-medication can trigger delirium.
2. Bring their glasses and hearing aids with them to the hospital.
3. Watch for obvious signs of an oncoming cognitive episode, like intermittent confusion, as that's a warning sign to have a family member stay with them until the confusion passes.