Acute Hospitalization and Alzheimer's Disease

by National Institute on Aging

A new environment filled with strange sights, odors and sounds, a change in the daily routine, medications and tests, and the disease process itself can all be factors that increase confusion, anxiety and agitation in a hospitalized individual with Alzheimer's disease. This booklet will help you to meet the needs of these patients. In it you will find facts about Alzheimer's disease, communication tips, personal care techniques, suggestions for working with behaviors and environmental factors to consider in the ER and in the hospital room.

When hospitalization occurs, the best option for the individual with Alzheimer's disease is the constant presence of a family member or a trusted friend. Because this may not always be possible, this booklet hopes to serve as a guide in helping you understand and practice the many facets of care for your patient with memory disorder.

Remember, family members are your most valuable resource for information about the individual and the caregiving techniques that work best.

Alzheimer's Disease: Just The Facts

Alzheimer's disease attacks the brain and causes problems with memory, thinking and behavior. Most people diagnosed with Alzheimer's are over age 65, but it can occur in people in their 40s and 50s. Symptoms include gradual memory loss, decreased ability to perform routine tasks, disorientation, problems with language skills, poor judgment and personality changes. The time from the beginning of symptoms until death ranges from 3 to 20 years; the average is 8 years. There is no single test to identify Alzheimer's disease. A complete medical evaluation for diagnosis is essential. A thorough evaluation will provide a correct diagnosis of possible or probable Alzheimer's 90-percent of the time. There is no cure for Alzheimer's disease at present. There are FDA-approved drug treatments, designed specifically for memory symptoms occurring in mild to moderate stages of Alzheimer's disease. The causes of Alzheimer's disease are not known. Suspected causes include genes and environmental exposure.

More Than Just Words: Effective Communication Techniques

Communicating with an Alzheimer's patient can be challenging, but remember, decreased verbal communication does not mean decreased awareness. Most patients are very aware and feel a great deal of distress about their increased loss of ability.

General Rules of Thumb:

Reality orientation does not work. Instead, use memory aids such as labeling objects (i.e. closet, bathroom). Be aware that as Alzheimer's disease progresses, an individual's ability to name objects and use words decreases.

Simplify the environment for Alzheimer's patients. Eliminate distracting noises such as the radio or TV, or loud conversation. Do not use the in-room intercom to communicate. The patient may be frightened or confused by hearing a voice only.

Communication Tips

• Always begin by identifying yourself and calling the patient's name.
• Always approach from the front.
• Maintain good eye contact.
• Use short, simple sentences.
• Speak slowly.
• Be specific. Use the name of the person or object instead of "this" or "they."
• Keep tone of voice low and pleasant.
• Keep facial expression warm and friendly.
• Use non-verbal cues: a reassuring touch, a smile, a demonstration stating the emotion.
• Give the person plenty of time to respond to your question (20 seconds).
• Always repeat your question exactly the same way.
• Use concrete language.
• State in positive terms. Constant use of "no" or commands increases resistance.
• Don't test the patient's memory. Erase the words, "Don't you remember?" from your vocabulary.
• Give directions simply and one at a time.
• When helping with personal care, tell the patient what you are doing each step of the way. Add occasional social or reassuring comments to avoid "task-focused talk" only.
• Do not appear rushed or tense. The patient will become tense and agitated.
• Listen to the patient. Try to find the key thought and take note of the feeling or emotion being expressed along with the spoken word.
• Reassure through words. Remind the patient who you are and that you will take care of him.
• Sometimes asking a "Why" question can get to the reason behind a repetitive question and decrease its occurrence. (i.e. "Why are you concerned about what time it is?")

In The Emergency Room: Assessment Tips

Do not leave the patient alone. A family member, trusted caregiver or friend should be present at all times. Continuous cueing to the environment (place) and activity may be necessary. A family member can assist with this and offer reassurance as well. Obtain patient's history from a close relative or caregiver. Pay close attention to the caregiver's description of the patient's usual level of consciousness. Increased dementia or the onset of delirium can be a sign of acute physical illness or metabolic distress. Perform a complete head to toe assessment. The patient may not be able to automatically identify painful or affected areas to you. Before every communication with the patient, make sure you have his attention by calling his name and making direct eye contact with him. Your eyes should be level with the patient's eyes. Ask simple "yes" and "no" questions. Allow ample response time (at least 20 seconds). Watch for non-verbal communication of pain or discomfort such as grimacing, guarding or anger. Apologize each time you cause pain and avoid repeating painful exams. In short, simple statements, tell the patient what you are doing, why and that you will be finished soon. Repeat this throughout the examination. Never talk about the patient to others as if he is not in the room.

About the Author

www.nia.nih.gov
NIA, one of the 27 Institutes and Centers of NIH, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people.