Perhaps no group of nursing home residents is more vulnerable than those with advanced dementia: unable to speak for themselves, suffering the physical as well as the cognitive effects of their terminal disease, prone to confusion or fear when subjected to blood tests or trips in screaming ambulances.
Yet dementia patients are often subjected to aggressive treatments and transfers even though studies show little benefit, as researchers at Hebrew Senior Life Institute for Aging Research in Boston keep pointing out.
So what’s wrong with this picture? “I’d estimate 75 percent of those hospitalizations are avoidable,” Dr. Mitchell told me in an interview. “By and large, research shows they can be treated with equal effectiveness in the nursing home. And it’s less traumatic for a nursing home resident with dementia to remain in place.”
It SO incredibly frustrating when patients are sent to the ER by nursing homes with “increased agitation and combativeness” and a simple urine test in the ER reveals that they have a UTI (urinary tract infection). How do nursing homes seriously not know at this point that a UTI is very likely cause an elderly person to experience a delirium, and why do they let it progress to a point where the patient is so delirious that they’ve become unmanageable?
Too often on the geropsych unit do we find ourselves simply treating a delirious person with antibiotics and sending them back to their extended care facility on the same psychiatric meds they were admitted on. It’s disruptive for the patient (which is extremely unwise with dementia patients), confusing and scary for the patient’s loved ones, lazy and irresponsible on the part of the nursing facility, and frustrating for geropsych staff who are managing a medical issue because that issue escalated to the point of unmanageable agitation because someone didn’t think to have the patient urinate in a cup before shipping them to an ER.
Nursing homes that accept patients with dementia need more training on the three D’s (delirium, depression, dementia) so that they know to look for the things that *aren’t* just the progression of the dementia and are TREATABLE.