Skip to 0 minutes and 8 seconds Someone with advanced dementia might get admitted to hospital because they are physically seriously unwell. For example, they may get pneumonia or a urine infection. They may have a fall and break a leg. They may also be admitted because the caring environment is not meeting their needs. For example, the family carer is exhausted or is ill themselves. So a person living with dementia might be admitted to hospital in a range of circumstances. I suppose they can be broadly split into two types of situation. One is a planned decision to admit somebody to hospital and one would be an unplanned or an urgent situation. So an example of a planned situation would be somebody who needs a particular operation.
Skip to 0 minutes and 55 seconds That admission to hospital would be very carefully thought through and a lot of thought would go into deciding whether it would be in the person’s best interests to have the operation or not, and what the likely effects of admitting that person to hospital might be and how the person’s needs could be met whilst they were in hospital. Other circumstances might happen someone might need to be admitted in an unplanned or in an urgent situation. That often happens after someone’s health has deteriorated in some way. Those deteriorations might happen outside of normal working hours when people who don’t know the person and their particular circumstances might need to make that decision very quickly on that person’s behalf.
Skip to 1 minute and 44 seconds One of the most important things for someone with advanced dementia is ensuring they’re comfortable and they get good quality care and that they stay and remain in their preferred place of care, which is usually their home or it may be a nursing home. If you’re thinking about admitting to hospital it’s usually because they’re seriously ill, physically ill, or because their caring situation has broken down. It’s important to discuss this well in advance because people may not want to be admitted to hospital under any circumstances and may wish you to continue care in their usual place of care for as long as possible.
Skip to 2 minutes and 26 seconds If that’s the case, then it’s important to write that down and communicate it to other people involved in the person’s care. You have to reassure them and their family that you will review that decision if an emergency should happen because the decision may be that it’s overidden for the person’s welfare, but equally it can ensure that they stay in their preferred place of care for as long as possible. Hospitals are very disabling environments for all of us really. Most of us don’t function at our best in a hospital. So for someone with dementia to be admitted to a very new environment, often a very noisy environment, a very busy environment can be very stressful.
Skip to 3 minutes and 14 seconds People with dementia can work, function well with good routines often, and being admitted to hospital changes that significantly. We’re often bound by hospital routines and ward routines, so it’s certainly not ideal for someone with dementia. And they may need a lot of support with nutrition, perhaps getting to the toilet and that can be difficult in hospital. They may need a lot of time actually and they may also need to be occupied. If you’re able to plan and predict or look at potential causes of admission to hospital then you can have some structure and guidance around what to do.
Skip to 4 minutes and 7 seconds Emergency health care plans provide a really good framework to have that discussion because they take into account where the person is in their dementia. They require a capacity assessment and if the person lacks capacity to make decisions around their treatment and where they want to be treated, it means that the family if they have LPA for health and welfare are involved, but obviously it would be good practise to speak to the family anyway and to capture any previous wishes and preferences the person might have. Often when we are having to make a decision about a hospital admission it’s in a very stressful time. People are ill and we are worried and we’re not quite sure what to do.
Skip to 4 minutes and 54 seconds So the best thing to do is to think about that situation in advance. So if something happens, what would you want to do? So when you’re faced with that decision and professionals potentially are asking a carer what they want to happen, the carer feels ready for that question. They might have paperwork in the house which is really useful, emergency health care plan, for example. I think managing hospitalisation requires again the collaboration of professionals because you have to consider again where the person was in the dementia, the events leading up to the admission, what the purpose of their admission is, and whilst the person’s in hospital have things changed? So has the person’s needs changed?
Skip to 5 minutes and 48 seconds And we can often talk about the person having to go back to the original place, if it was home, and conversations need to be had, is that still the right place for the person to go, and if it is how can that person be supported? I think it’s also important that the families have the right information to make their informed decisions while a person’s in hospital, it can be quite overwhelming. And I think decisions can sometimes be made on the behalf of the person with dementia whilst not necessarily including the family and those person’s wishes. So it’s really important to capture them, and also what information do the family actually need?
The person you support may become unwell or suffer an injury. Sometimes, this means that they may need to be admitted to hospital for necessary treatment. As dementia progresses, some common conditions such as infections can lead to hospitalisation. However, with the right plans in place, these may be managed in the person’s usual place of care, and hospitalisation can be avoided.
Our healthcare professionals talk about some of the benefits and risks to hospitalisation. They explain how planning ahead and the plans you can make can help you, and others, decide if hospital is the best place of care for the person you support.
You will hear Julie Young talking about a range of plans which we first explored in decision making in Week 1 Step 1.14. These plans are also explained in your course glossary.
© Newcastle University