Stages of Dementia and the Effect of Hospitals

Stages of Dementia

I remember it like it was yesterday. Once again, Mom spiked a fever and her doctor told us to immediately take her to the emergency room. Sudden fevers and infections happen frequently when your loved one is going through dementia.

The middle stage of dementia is when paranoia and delusions frequently happen. Hospitalization is a perfect storm. What I thought would be a quick in and out turned into a 10-day ordeal that I wouldn’t wish upon my worst enemy.

Mom was in the middle stages. She had a fear of hospitals and doctors, so it came as a major surprise to me that she willingly got into my car. Once Mom got checked into the ER, they put us in a small room where they hooked her up to machines that made enough noise to wake the dead. Or keep a person with memory loss on high anxiety, hyper-alert. 

Then they left us for hours. No, seriously, I kept looking at my watch – it was hours! With each passing moment Mom’s agitation increased. No amount of talking, singing, diversions, or massaging on my part was working.

No one was checking in to let us know what was going on. I was forced to leave her to find out. Informing the staff we were “having a major melt down behind curtain #2″ got no response. I guess being in the middle stages of dementia means absolutely nothing to hospital staff. 

They either didn’t believe me or blatantly ignored me until Mom went into a full Chernobyl meltdown and in raced the ER social worker, psychiatrist, a newbie doctor in training, and a security guard. It would have almost been comical if this weren’t happening to my mother and I.

Immediately, they started bombarding her with questions to see if she was oriented – told you it was comical. I told them (once again) that mom was in the middle stages of dementia. The more they questioned, the louder and more out of control mom got.

Truth be told, I was getting out of control. These people were supposed to be professionals and yet they had no clue how to deal with an Alzheimer’s patient. After they sedated mom, they admitted her into the hospital.

If you think this story is going to have a happy ending, you’re wrong.

Once in her hospital room, I was informed that she would need to have around the clock aides (three eight-hour shifts). Mom’s private home aide would only be allowed to spend 8 hours. This meant spending even more money for a person who had never even met my mother.

When we came back the next morning, Mom’s arms were tied to her bed rails to physically restrain her. According to one of the hospital’s aides, mom kept trying to get out of bed. The next night I visited after hours. Mom was tied to the bed while their aide was sleeping.

Mom kept trying to get up to use the bathroom. The doctor had ordered a foley catheter. Why? I have no idea. But it sure made the hospital clean up team’s job much easier. Just an observation.

As a caregiver, it didn’t make my job easier because Mom was in distress and continued to want to get up and use the bathroom! All of us want the ability to go bathroom by ourselves. Mom would have been able to if the hospital would allow it. Instead, because of her hospitalization, she became incontinent.

Every day that mom was at the hospital, I spent all day and half the night with her. The constant noise on the floor, the intercoms going off in the room, a steady stream of strangers bringing unfamiliar meals, taking blood, giving medication, undignified bed baths… it’s no wonder she became delusional.

No matter what stages of dementia your loved one is in, hospitals should be avoided at all costs.

But let’s face the facts. There will be times that your loved one will need more than a trip to the doctor and the hospital simply can’t be avoided. Mom went into the hospital continent. She came out incontinent. Ten days on a foley will do that. It took me 4 months to retrain her to use the toilet when she returned home.

Thank God she was in the middle stages of dementia and still able to make her needs known to me. However, restraining was common in the hospital, and they used this technique as they felt necessary.

The cause of Mom’s fever was from impacted bowels. You need to be aware that in hospitals, despite all of the advances in medication and technology, you will need to be proactive. Staff training and responsiveness, which should be top notch, is not always ideal. 

Know that no matter what stages of dementia that your loved one is in, sensory overload from intercoms, bright lights, being prodded, probed and poked by strangers will cause confusion, delusions and anxiety.

When you are providing Alzheimer’s dementia care you need to be prepared for not only what happens in the hospital, but equally as important, what will happen when you both come back home.

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Photo courtesy of Francis Bijl

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