What are the effects of hospitalization on older adults with dementia, and how can they be mitigated?

From the Guidelines

Hospitalization of older people with dementia requires a multifaceted approach to mitigate its impact, focusing on minimizing environmental stressors, promoting mobility, and providing emotional support to maintain cognitive function, physical health, and emotional well-being. The stress and disruption of hospitalization can cause a temporary worsening of dementia symptoms, such as confusion, agitation, or difficulty with memory and orientation 1. The unfamiliar environment and disruption of routines can lead to anxiety, stress, and behavioral symptoms, including fear and aggression. Physical health can deteriorate due to extended bed rest and limited mobility, increasing the risk of falls and weakening strength. Hospital-acquired infections pose additional threats to these vulnerable patients.

To address these challenges, healthcare providers should:

• Minimize environmental stressors by creating calm spaces with familiar items from home
• Use simple, clear language and non-verbal cues to communicate effectively
• Encourage and assist with mobility as appropriate to prevent physical decline, as supported by the 2021 study on physical activity guidelines for older people, which highlights the importance of individualized exercise programs during hospitalization to reverse the loss of ability to complete activities of daily living 1
• Regularly assess cognitive function and be vigilant for signs of delirium, addressing any changes promptly and involving specialists if needed
• Involve family members in care planning and decision-making to provide comfort and continuity, helping to reduce anxiety and confusion
• Offer emotional and psychological support to address feelings of fear, anxiety, or agitation, recognizing that exercise should be considered a leading treatment strategy to prevent functional and cognitive decline in older people 1.

From the Research

The Impact of Hospitalization on Older People with Dementia

The hospitalization of older people with dementia can have severe consequences, including:

• A temporary worsening of dementia symptoms, such as confusion, agitation, or difficulty with memory and orientation 2, 3
• Increased risk of hospital-acquired infections, such as pneumonia or urinary tract infections, which can complicate their recovery and overall health 4
• Decline in physical function due to extended bed rest or limited mobility, increasing the risk of falls and impairing mobility and strength 5
• Isolation and loneliness due to restricted visiting hours or difficulty communicating their needs and feelings 6

Strategies to Mitigate the Impact

To minimize the negative effects of hospitalization on older people with dementia, the following strategies can be employed:

• Minimizing environmental stressors by providing a calm, quiet space and using familiar items from home 2
• Using simple, clear language and non-verbal cues to communicate, and ensuring that instructions are straightforward and repeated if necessary 3
• Encouraging and assisting with mobility to prevent physical decline, and implementing fall prevention strategies 4
• Regularly assessing cognitive function and being vigilant for signs of delirium, addressing any changes promptly and involving specialists if needed 5
• Involving family members in care planning and decision-making to provide comfort and continuity, and helping to reduce anxiety and confusion 6

Delirium and Dementia

Delirium and dementia are distinct but interrelated conditions, with delirium being a risk factor for incident dementia, and delirium in individuals with dementia hastening underlying cognitive decline 2, 5.

• Delirium prevention strategies can reduce the incidence of delirium and associated adverse outcomes, including falls and functional decline 2
• Identifying delirium in individuals with dementia is crucial, and several delirium screening instruments have shown promise for use in this population 3
• The relationship between delirium and dementia is complex, and further research is needed to understand the epidemiological, clinicopathological, neuroimaging, biomarker, and experimental evidence supporting the intersection between these conditions 5