Wednesday, 27 June 2012


Thus we see that the all important thing is not killing or giving life, drinking or not drinking, living in the town or the country, being unlucky or lucky, winning or losing. It is how we win, how we lose, how we live or die, finally, how we choose.

Being a hospital patient can be a confusing and somewhat frightening experience for anyone. For someone with Alzheimer's disease or another type of dementia, a hospital stay is much worse. It's dangerous. It greatly increases the chance of quicker mental decline, moving to a nursing home and health problems that can be life-threatening.

Those are the findings of a study of 771 people with Alzheimer's disease. The people in the study were 65 years or older. They were living with family or on their own at the start of the study.

When a defining moment comes along, you can do one of two things. Define the moment, or let the moment define you.

The greatest risk of a hospital stay for people with dementia is delirium. In this study, the researchers found that more than half of the patients developed delirium after admission to the hospital.

Delirium is a confused and scrambled state of mind. It usually comes on suddenly. Memory and other types of thinking become disorganized. The person may see or hear things that aren't there (hallucinations). Most often the person is agitated and restless. But some people with delirium may pay less attention to what is going on around them. They may have little interaction with family and hospital staff.

There is an election going on all the time...the Lord votes for you and Satan votes against you, and you must cast the deciding vote.

It's difficult to know how much a person with delirium suffers. But there's no question about how disturbing it is for family and friends to see the big changes in their loved one. Delirium can last days. There is no specific treatment. And doctors can't predict when it will end.

Bright lights cast dark shadows when shone from only one direction.

By avoiding a hospital stay, people with dementia greatly lower their risk of developing delirium.

The path of least resistance and least trouble is a mental rut already made. It requires troublesome work to undertake the alternation of old beliefs. Self-conceit often regards it as a sign of weakness to admit that a belief to which we have once committed ourselves is wrong. We get so identified with an idea that it is literally a "pet" notion and we rise to its defense and stop our eyes and ears to anything different.

Today, there is a low threshold for admitting patients with dementia to the hospital when something seems amiss. This needs to change. Some patients will definitely need admission, such as those having a heart attack, stroke or very low blood pressure. Otherwise, doctors should tell the family about the high risk of delirium from a hospital stay vs. treatment at home.

Treatment at home will work only if someone can be with the patient 24 hours a day until symptoms improve. I recognize that there is a risk that the patient could quickly become very ill and need to go back to the emergency department or even die. So the decision for home treatment should be consistent with the overall goals of care.

If someone with Alzheimer's disease does need admission to the hospital, here are things family members can do to help prevent delirium.

Bring glasses, hearing aids (with fresh batteries) and dentures to the hospital. Older people do better if they can see, hear and eat.
Bring in a few familiar objects from home. Family photos, a favorite comforter or blanket for the bed, rosary beads, a beloved book or relaxation tapes can be comforting.
Keep easy-to-read clocks and calendars visible. One reason people get disoriented in the hospital is that they can't go by normal cues such as daylight. A few well-placed clocks and calendars can help fill that void.
Help orient the person throughout the day. Use short, simple statements about the date and time. Remind the person where he or she is.
Always speak in a calm and reassuring tone of voice. Relate personal and current events. Mention why the person is in the hospital. In simple terms, explain what is being done to help him or her feel better.
When giving instructions, state one fact or simple task at a time. Do not overwhelm or overstimulate the patient.
Stay with the patient as much as possible in the hospital. When a patient develops delirium, friends and relatives should try to arrange shifts so someone can be there around the clock.
If you detect new signs that could indicate delirium, it is important to discuss these with the nurses or doctors as soon as you can. These signs could include confusion, memory problems and personality changes. Family members are often the first to notice subtle changes.

The Great Way is not difficult for those who have no preferences.

This is such an important study. Doctors have long recognized the risks of a hospital stay, especially for older people. But the size of the increased risk for people with dementia is an eye opener. It's time for doctors to consistently inform family members of delirium and other complications. Doctors should offer a home treatment option more readily. I certainly will.

Each person designs his own life, freedom gives him the power to carry out his own designs, and power gives the freedom to interfere with the designs of others.