My mother-in-law had lived in an excellent nursing home for a couple of years when she contracted pneumonia. Her personality, even before her dementia set in, was shy, anxious and extremely modest, physically. She didn’t like people touching her. With dementia, her anxiety became worse, which generally happens to people who understand less and less about their environment. She never wanted to leave the nursing home for any reason, even for a visit to family members.

I was at the time, and still am, very grateful to the nursing home staff members who made the call at the time she got sick to keep her in her comfortable, familiar room and treat her pneumonia there. They did so successfully, and she was not subjected to the anxiety of a hospital stay or emergency room visit. They could have saved staff time by passing her off, but they didn’t.

I have no doubt that the trauma of being whizzed off in an ambulance and taken through the admissions part of ER, to say nothing of the rest of the journey, would have left her emotionally shaken, at the very least. It’s entirely possible that her dementia could have worsened from the trauma.

A post by Paula Span on The New Old Age Blog at the New York Times, supports my feelings. Span’s article addresses a study about the hospitalization of dementia patients. In Dementia Patients Hospitalized Too Often, Study Finds, Span addresses the issue of dementia patients and whether they are better off being treated in the nursing home where they live, or taken to a hospital.

Span interviewed Dr. Susan Mitchell, a researcher at Hebrew Senior Life Institute for Aging Research in Boston. Dr Mitchell was quoted as saying, “Being in an emergency room where people are taking blood and putting in IVs in this crazy, noisy setting–it’s been described as an ‘assault,’ and I concur…”

The researcher’s findings appeared recently in Archives of Internal Medicine.

Span concludes her post with this thought, “But families have a role to play, too. If they understand that dementia is a terminal disease, that treating recurring infections may prolong life but won’t restore health or bring comfort, that such treatments, if desired, can be usually administered in nursing homes themselves…”

Surgery and broken bones will generally mean at least an ER run, if not hospitalization. Sometimes, these things can’t be avoided. But my experience with watching elders react to hospital and ER settings tells me that the more we can keep elders in their homelike setting, whether that means that they have hired in-home care, or they stay in their assisted living or nursing home setting, the better it is for all. If the elder has dementia, this is even more important, as confusion is a huge part of most dementias.

Posted in Alzheimer’s, Dementia, Health | 4 Comments »