Can Hospitalization Lead to Dementia?

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Supposedly, people are hospitalized because they are ill. Then, barring a terminal condition, they are released because they are better. Once home, people recover further, and continue on with their lives as well as their original illness allows them to. Unfortunately, with elderly people, that best case scenario doesn't always happen.

Readers ask about the cognitive decline of a post-hospitalized elder. They want to know what happened. They want to know if their parent will ever be cognitively the same as he or she was before a hospitalization. I tell them that each case is unique, but according to many studies, some elders may not cognitively recover from the trauma.

Why are some elders subject to returning home from a hospitalization cognitively worse? Experts are studying this problem with varying results, but many agree that there are conditions at play which can result in an elderly person suffering cognitive decline after a hospitalization. Although there is no 100% conclusive evidence that a hospitalization can lead to dementia, the medical community calls the condition "hospital delirium," a condition that the American Geriatrics Society estimates affects about one-third of patients over 70, particularly those who are in intensive care or who undergo surgery.

A Personal Experience

My first encounter with this happened many years ago. My dad went into surgery to relieve pressure on his brain caused by fluid buildup behind scar tissue from a World War II injury. Dad went into surgery after being told that it would prevent dementia. He came out of surgery in a severe state of dementia that was never explained. The dementia remained until he died, a decade later.

Seeing my intelligent, gentle, funny dad turn into another man in a matter of hours was life changing. Almost worse, however, was the blank look of the doctors who insisted that dad was "no different" than before the surgery, even though they prescribed a powerful psychoactive drug post surgery, with no logical explanation for why he now "needed" the drug.

Was It a Surgeon's Mistake, the Hospital Environment or the Anesthetic?

While my dad's surgery was brain surgery, and the surgeon could have slipped up, many of the people who write about dementia after hospitalization say their parents didn't even undergo surgery. They were hospitalized for an infection, or a lung ailment or a diabetes complication. They were cognitively stable, even sharp, other than their illness. Cognitive changes became evident when they brought their elder back into the home environment.

When this happens, confusion is often the first thing family members notice. They tell themselves that this will get better with time at home. However, sometimes it doesn't. Memory problems that weren't evident before surgery are noted. Sometimes paranoia or even hallucinations are part of the mix. Family members watch and wait. Eventually, the heartbreaking conclusion is that the elder is now in a significant stage of dementia.

No explanation covers all cases. However, now medical professionals – often led by nurses – are starting to recognize that the hospital environment may be partly to blame for elders' decline.

A sterile, confusing environment, with general noise, high-tech equipment shrilling in the background, and time-strapped personnel, can have a similar effect on a fragile elder as this environment can have on a child.

Pediatric wards have worked long and hard to soften this environment for children deprived of their home environment. The same approach to hospitalized elders seems to be helping, when applied. Studies have shown that when elders' rooms are more homelike, noises muted, colors softened, and staff members trained to be patient with an elder's confusion over hospitalization, the end result for the elders improves.

Anesthetics, and some antibiotics, are also under scrutiny. Researchers are looking into some anesthetics that have been considered safe for decades. Roderic Eckenhoff, of the University of Pennsylvania in Philadelphia, was quoted as saying, "Although cell culture and animal experiments show common anesthetics can cause amyloid-β production and apoptosis, the possible connection in people is hazier." Eckenhoff and his colleagues felt the evidence convincing enough, however, to continue with research around the anesthetic connection. That research is still in progress.

What Can Caregivers Do?

Hospitalizations will continue to be necessary for some elders, but it's helpful to keep that to a minimum. If your elder is in a comfortable nursing home environment and contracts pneumonia or another infection, see if he or she can be treated in their own room.

Think carefully about any surgery. What is the trade-off? Talk frankly with the doctor about anesthetic risk – not just death, but cognitive decline. Ask about different anesthetic options and see if there are choices.

Even if the hospital has not yet bought into the newer, softened atmosphere idea, you can make your elder's room more homelike. Place family pictures around, bring a favorite quilt, bathrobe and pillow if that is allowed. Also, have a family member or friend stay with the elder as much as possible. Familiar surroundings should help limit some of the trauma.

There is much to learn about elders' poor outcomes from hospitalization. We have to work with what we know. Be an advocate and stick with your elder all the way. That's often the best you can do.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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23 Comments

One of the biggest problems in hospitalization, I see, is the nutrition patients get. You should think that with all the so called "nutritionists" let loose in care facilities, they'd have a better grip on important nutrition, such as raw foods, leafy greens in form of smoothies. But no, its all dead food.
Even the best hospitals and nursing homes are very poor places for people to be. The nurses are constantly changing, the new ones don't know the patients, they make multiple mistakes if you are not there to watch your loved one, especially if the loved one is on a lot of medications in the first place.
I've come into the hospital room for both my MIL and my dad when they were weak or out of it... and they don't even feed them! YOU have to be there to do that. This is 3 different hospitals... the cafeteria people are very good about checking what diet, what they like, etc.. but then a cafeteria person DROPS OFF THE FOOD, next to a drugged or sleeping patient and then comes back and gets it in an hour or two... CRAZY.
I started staying with my dad and MIL and feeding them.
It is shocking that hospital personnel do not even note what or if they eat. I guess they do note it but it is a lie.

I sat with my dad from 10 am - 1 pm one day and during that time only a cafeteria person came in. he was sleeping and out of it. No one knew I was there and no one came in to check on him the entire time except a person with a cart dropping off food and picking it up.

My sister-in-law as FURIOUS when she walked into her mothers room 2 days in a row at noon to find cold covered food and her mom asleep or out of it.

The "nursing" staff said family had to be there to make sure they ate.

God only knows what happens to people in hospitals. Educate yourself on your loved ones medications, conditions, and post HUGE notes in their room if they are allergic to anything.

I have gotten hospital records after my dads stays and you would not believe the outright fabrications and misunderstandings written in those NOTES!

My dad is blind and one doctor who visited 3 times in 2 weeks wrote how confused he was and how he did not know who she was after 3 days. LOL She visited 3 minutes, 3 days in a row when he was sick and sleeping/awake. and expected a blind man to know her???

She wrote this up as confusion and dementia? We told them OVER AND OVER he could not see. Finally on the 5th day as he was recovering a speech analysis person came out of his room and said... did you know your dad cannot see.

OMG- but his records do not reflect this ... it reflects from nurses on to that goofy doctor that he could not recognize them and was confused. (this was years ago when he was admitted for low blood sugar and insulin corrections.)

EVERYONE be careful. Hospital personnel are stretched thin, don't care anymore, tired, and just plain not very good.
I can tell you from experience, it does happen. My 85 yr old Mother went into the hospital for minor surgery, trigger finger release, they did not do a block, they used general anesthesia. That was the last time I saw my mother. Someone entirely different came out of surgery that day. Different personality, behavior, reasoning skills, memory, etc. you name it, this 15 minute surgery changed the entire structure of our family. In the last 6 months she has gone from bad to worse. Had we only known BEFORE the surgery........... famous last words. Word needs to get out about the possibilities of this happening to anyone, especially elders. I for one haven't shut up about it since it happened and never will. Such a tragedy.