This blog was created by Gayle Yarbrough an Advocate and caregiver Gayle is bringing more awareness on how it will be necessary for hospitals to rethink on Dementia Patient in the Emergency Room. Perhaps to provide another area in the hospital for the Dementia Patient in the Emergency Room. Gayle has created the following letter to be sent to many Hospital Administrators for suggestions on the pending crisis for the Emergency Room and the Dementia Patient.
CHANGING THE EMERGENCY ROOM AND HOSPITAL ENVIRONMENT TO BETTER ASSIST ALZHEIMER’S/DEMENTIA INDIVIDUALS
I’m writing to seek Information on what protocol your hospital has in place, when a person comes into the ER room who has severe Dementia? This has nothing to do with anyone who has been brought in. I am trying to raise more awareness to ER’s and hospital settings, some that really have NO clue what is coming!
The scenario may be of a patient being out of touch, highly agitated, hallucinations of being hurt by someone? What would be your approach to this scenario? Does your staff have adequate training on how to deal with Dementia Patients? I’m sure you realize there are over 50 million people with dementia worldwide and that nearly 10 million more new cases per year will happen! How prepared is your hospital? Are you ready for the Influx in care when they arrive in your setting?
As a caregiver of someone with Dementia, there are many suggestions I’d like you to think about and share with staff. When a person comes in like this, it could be due to the stage and type of Dementia they are dealing with. It could be due to a side effect of the medications they are on. It could be due to an infection or UTI. Most aren’t able to communicate exactly what they are feeling, if they are in pain or are scared. In one sense it’s almost like having a person with a mental condition come in, except it’s all about behavioral issues. If there is a family member with them that can articulate that their loved one has dementia, they need to be the ones that speak with the staff. The patient cannot always give truthful answers, as they don’t understand the question given. I’m not saying to ignore the patient as they need to be treated humanely and with “kid” gloves. They are still human and not just another person with Dementia…. they get more agitated and sacred when they have a load of people piling into their room, asking all these questions, hooking up blood pressure cuffs ECT. Bright colors, bright lights and a lot of hoopla going on bothers them and escalates the citation. Especially upon arrival.
What I see the ER’s needing is a quiet room that has less lighting and softer colors on the walls, as well as the sheets being more neutral in color. A room that is more like a home bedroom; like the maturity wards have. Most of the time when they are brought in it’s because they need help de-escalating. It may be they need to be put on a medication to help them calm down, they may just need a medication adjustment or it could be they are having a side effect to something they have been put on. So many anti-psychotic meds mess with their brains in a BAD way. Another huge issue at ER’s is the time it takes for them to be seen. Time is of the essence as the longer they are out of their setting the worse the confusion gets and then they get even more out of hand. Because they aren’t considered to be in a level that is a true emergency, they are made to wait in the waiting room for a long period of time. I realize health care has a lack of staff at times, but there has to be a solution to be able to move dementia patients quicker thru ER’s. Possibly just a quiet room to begin with, maybe a monitor to observe the dementia individual. This could help them to be less anxious when they are looked at by Nurses & the Doctor.
Something to consider as well is to ask a family member to stay overnight in hospital with them, if they are admitted. This keeps the patient calmer when they see a familiar face (if they’re able to still recognize) or can hear that familiar voice. I saw a scenario where a gentleman was admitted. When the nurses left his room he felt abandon, I believe. He got really scared…he had no idea where he was. He kept trying to get out of his bed and would have fallen because he was so unsteady. I told him to stay in his bed but he was determined and getting more frustrated. Then his meal came and they set his tray near him and left room. He wasn’t able to communicate well, but I could see he couldn’t move his utensils to his face. I called a nurse and no one had time to feed him right then. She said he’d have to wait a bit. After 10 min, I thought oh heck I’ll go help him, that’s when an aide came in. I told her he has to have someone to help him to eat and why. She made a note in chart. He wasn’t interested in his meal by now, as it was cold and gummy. Shortly after the kitchen staff person came and took his tray away saying you didn’t eat much sir. This made me a lot more aware of how lacking the training is for dementia patients. I also observed no staff checking on him in 2 hrs. I am not sure what the answer is, but this gentleman didn’t have family that wanted to stay with him, they just dumped him, figuring he’d be getting the best of care. He didn’t know how to push the call button either, even though the aide said here’s your call button. Such a sad memory!
Geriatrics Including Alzheimer’s and Dementia Care should be mandatory for all health care staff. Staff needs to know what to say and how to understand them. What is the dementia individual’s reality at the moment? It’s usually not in the present day. Adapt their care approach with calm voices, slower speaking skills, reassurance, and maybe calm music on a headset. These all would be a few suggestions to start out with. In a perfect world it’d be great if Doctor’s made house calls or did video visits, so that we as family and caregivers didn’t have to subject the dementia individual to the ER unless it is a true Emergency!
I believe a standardized form, when an individual enters a hospital setting, should be made available to the family or caregiver…..to fill out regarding the dementia person. Questions such as; does the person go by a nickname? Are they living in the moment right now? A lot are not in the present day. What causes triggers that lead to more agitation or aggressiveness? Noises, lights or someone coming at them to fast. What are some dislikes and likes this individual may have? Do they have signs they show of being in pain or discomfort, especially if they aren’t very verbal? Do they like to wander? Do they yell out at night? I will be working on a form to mail out to local hospitals that would list these questions. I believe it will help the staff better understand the incoming dementia patient more thoroughly. If the medical professionals especially in hospital/ER settings are not fully equipped for the Influx of individuals diagnosed with Alzheimer’s and Dementia…what does this say about out Health System? Will our Hospitals just throw these people to the curb? I surely hope not! Let’s help be the change!!!!
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