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Pause before hospitalizing the elderly, Stanford researchers say

Putting patients with dementia into the hospital, unless absolutely necessary, can do more harm than good, according to an editorial recently published in the Journal of the American Geriatric Society.

"One night’s stay after a hip replacement surgery or recovering from a urinary tract infection, can cause permanent damage to the brains of these patients," said Clifford Sheckter, MD, a fellow at Stanford’s Clinical Excellence Research Center and co-author of the piece.

"They should be treated at home," he said.

Preventing hospitalization or shortening stays as much as possible while also adopting various treatment protocols to mitigate potential harm should be a matter of routine for all hospitals, the authors write.

"Although we deliver care with the best of intentions, the health system fails to appreciate cognitive impairment as chronic organ failure and thus does not take proper steps to protect brains in the same manner it protects other organs," the authors write.

Sheckter said few people are aware of these risks, but the public needs to know about the dangers of putting elderly relatives in the hospital.

"One of the greatest risks is delirium," Sheckter said. "These patients already have difficulty with cognition and executive function, but then you put them in a foreign environment where they are exposed to dangerous medications and where they can’t sleep in their own bed. They can take a hit from delirium, and it’s permanent."

Delirium, often used in the vernacular to refer to drowsiness or disorientation, has a different medical definition. In medical terminology, it is defined as an acute state of brain dysfunction that causes confusion, disorientation, sometimes hallucinations and paranoia. Medications that can work well for the general population, such as certain pain killers, can cause delirium in dementia patients.

According to the paper: "An estimated 66 percent of community-dwelling persons with dementia are hospitalized at least once a year. Considering the 56 percent risk of delirium from hospitalization, upwards of one in three community-dwelling individuals with dementia will experience some degree of accelerated cognitive decline from hospitalization per year."

It doesn’t have to be this way, Sheckter said.

Models of emergency department–based geriatric case management exist, but they have not been widely used, the authors write. Interventions such as the Hospital Elder Life and Acute Care for Elders units provide individualized hospital care for patients with dementia to help diminish the risks of harm while in the hospital.

Hospital at Home, a program developed at Johns Hopkins University, provides a model for home care. Co-author of the editorial piece, Bruce Leff, MD, a geriatric specialist, helped develop this model.

Previously: Care for dementia patients disproportionately falls on women, Stanford neuroscientist discusses the coming dementia epidemic and Stanford biostatistician on how to save your aging brain
Photo by Jeremy Wong

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