Main content

    Dementia Symptoms & Caregiver Strategies: Tips to Keep in Mind When a Cognitively Impaired Patient is Hospitalized

    At some point hospitalization is very likely to occur when a person has some form of cognitive impairment. Hospitals are meant to be places of recovery but often individuals who have memory loss are going in too often and staying too long.

    Whether a planned stay or the result of an emergency, the caregiver needs to be prepared to manage a stay in the hospital. Hospitalization is disruptive and frightening for everyone; for someone with cognitive impairment the hospital is a scary place. You might assume that a hospital staffed by healthcare professionals is a safe environment.

    Unexpectedly, the hospital requires more vigilance and special skills by the caregiver. The very nature of a hospital and the needs of a person who is experiencing cognitive difficulties are not highly compatible.

    The person with cognitive impairment needs an advocate.

    Every common hospital routine such as drawing blood, hooking up an IV, going to the bathroom, or being transferred to go for an X-ray is bewildering to the person who is cognitively compromised and may result in anxiety driven behavior. Pulling out the IV, getting out of bed with a catheter inserted, or refusal to cooperate with treatment may result. Toileting is a challenge in the hospital as there may be a catheter or an IV that involves special care.

    A person with memory loss is may not realize that he or she needs help to get out of bed. This can result in falls, torn IVs, and urinary tract infections. An advocate who is able to talk with staff and solve problems should be present as often as possible especially since cognitive difficulties are likely to actually worsen temporarily while the person is in the hospital.

    Do not assume that the staff understands the realities of caring for someone with memory loss, much less the specifics of your loved one.

    The call button, the device that alerts the staff to come to the room, can be useless to a person experiencing memory difficulties. A nurse can carefully explain to a patient suffering from cognitive impairment how to use the call button if they need anything. Often the patient will smile and nod, but does not understand and will not remember. Learning to use a call button can sometimes be beyond the learning of someone who has memory difficulties, except in the earliest stages.

    If a patient with cognitive issues needs to use the bathroom or is in pain they will usually have to wait until someone checks on them. Therefore it would be ideal for an advocate (you and/or family and friends) to be there to interpret the individual’s needs and to actively get help.

    While much is out of our control when a loved one suffering from memory loss becomes an inpatient, there are some steps that can be taken to protect them during hospitalizations:

    • Avoid or shorten hospitalization if at all possible
    • Try to have someone visit every day, and be as present as you can during each visit; if not possible, call and insist on being connected to the person
    • Have calendar with schedule of visits posted that aides can use to reassure the person
    • Make friends with the nurses and nurse's aides, compliment them on what they do well; they will be your most effective advocates. Many hospitals will be grateful for your ongoing presence as it can make their job easier. Help the staff to understand your loved one's preferences - limits as well as capabilities. Be direct about the individual's abilities and limitations and identify any specific needs.

      "Dad will try to remove the IV, so please put extra tape over the needle."
      "My uncle likes cranberry juice rather than apple juice."
      "Mom will need to eat more than applesauce before she takes that medication."

      You can even type a list and have it posted next to vital signs chart.
    • Bring "home" directly to the hospital room in the form of family photos, flowers, favorite foods, a pillow or quilt, familiar music, etc.
    • Minimize distress from noise and commotion; shut the door, and if a shared room, draw the dividing curtain.
    • Give your loved one hope, and tell them they are going home soon if it is a short stay.
    • Keep reminding the person about where they are and why
    • Insist on involving the individual as much as possible in decisions being made about them.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: