When most people think of dementia, they likely picture memory loss as the first sign. While memory problems are indeed one of the most common symptoms, dementia can present in many other ways—especially in a hospital setting.
Some patients with dementia have already received a formal diagnosis, while others may not yet have one. Family members often notice cognitive changes but may not realize how serious the issue is or may assume that memory loss is just a normal part of aging. In this post, we’ll explore some common ways dementia presents in hospitals and discuss strategies for providing support.
1. Wandering
Wandering is one of the most common issues that often leads to the need for 24-hour supervision. As dementia progresses, patients may begin to wander out, which poses a significant safety risk. Once this behavior starts, the patient typically requires constant monitoring.
In severe cases where family members cannot provide 24-hour supervision, patients may need to be placed in a specialized dementia unit or an Assisted Living Facility (ALF). At home, families can monitor the patient using tools such as GPS tracking devices, video surveillance, or smart home technologies with motion sensors and smart locks. It’s also crucial for families to arrange for additional caregiving hours to ensure the patient is safely supervised.
2. Falls
Dementia can reduce a patient’s awareness of safety risks, making them more prone to falls. Many older adults also experience gait problems, making walking more difficult. Additionally, medications may contribute to balance issues or confusion.
Patients with dementia may not recognize when they need assistive devices like walkers or canes or may forget how to use them altogether. Family members must be vigilant in ensuring that patients have the necessary support to stay safe and prevent falls.
3. Confusion and Altered Mental Status
Confusion is another common presenting symptom of dementia, but it’s important to distinguish between dementia and delirium. While both can cause changes in mental status, delirium is typically temporary and reversible, while dementia is progressive and irreversible (at least in today’s medicine). Some other medical conditions and psychiatric problems can also cause a confusional state.
When patients present with confusion, healthcare providers will conduct a thorough work-up to rule out any treatable or reversible causes. If no clear cause is found, the confusion may be due to new-onset or worsening dementia. In such cases, the patient may require further evaluation at a specialized dementia center.
How to Recognize Undiagnosed Dementia in the Hospital:
Family members often notice that a loved one is struggling more with daily activities over time. Healthcare providers should gather detailed information about the patient’s baseline cognitive function to assess whether the patient has a progressive cognitive disorder like dementia.
Common Symptoms Reported by Families
Family members frequently observe the following symptoms in patients with dementia:
- Memory loss: Forgetting conversations or asking the same questions repeatedly
- Cognitive decline: Difficulty with complex tasks like cooking, traveling, reading, or engaging in hobbies
- Word-finding difficulty: Speaking less or becoming repetitive
- Behavioral and mood changes: Anxiety, withdrawal from social activities, aggression, depression, paranoia, hallucinations, or inappropriate behaviors
- Declining ability to perform daily tasks: Poor personal hygiene, difficulty getting ready for appointments, missing medications, paying bills late, falling for scams, or losing the ability to use the phone or drive
4. Medication Issues and Assistance
Patients with dementia often struggle to take their medications properly. They might forget to take their meds or take the wrong doses. For example, a diabetic patient may present with uncontrolled blood sugar levels because they forgot to take their insulin or took an incorrect dose.
In these situations, family members often need to step in to help. One way they can do this is by organizing medications in pillboxes and reminding the patient when it’s time to take them. In some cases, families may need to hire a caregiver to manage medications or consider moving the patient to an assisted living facility, where they can receive medication support along with other services.
5. Agitation, Psychosis, and Behavioral Changes
As dementia progresses, patients may experience agitation, psychosis, paranoia, and hallucinations. These symptoms may sometimes be more pronounced than memory loss and can be the reason for hospitalization.
An expert evaluation is needed to rule out other conditions like delirium or primary psychiatric disorders. Once these are excluded, it’s often determined that these behaviors are a part of the dementia process.
6. Difficulty Walking
In the later stages of dementia, patients may lose the ability to walk properly, which increases their risk of falls. This isn’t caused by musculoskeletal problems but rather by the brain no longer sending the correct signals to the muscles for coordinated movement.
Patients in these stages may also struggle to use assistive devices, such as walkers or canes. Unfortunately, physical therapy may no longer be effective because the patient may not be able to follow instructions or perform the exercises.
7. Communication Difficulties
Difficulty with communication is another hallmark of advancing dementia. Patients may speak less, have trouble finding words, or struggle to express themselves. This can sometimes resemble the symptoms of a stroke, but tests usually show chronic changes in the brain that are consistent with dementia rather than a new stroke.
In some cases, a transient ischemic attack (TIA) may still be a possibility, but if the speech issues worsen over time (months or longer), it’s likely due to dementia.
8. Eating Problems and Weight Loss
Dehydration and elevated sodium levels are common presentations of dementia in the hospital. As the disease progresses, patients may forget to eat, have trouble preparing meals, or lose their appetite entirely. This often leads to significant weight loss, which can be distressing for family members. However, the patient may not be aware of or bothered by the weight loss because of their dementia.
Despite efforts to assist with meal preparation or services like Meals on Wheels, patients often continue to lose weight. While we can try to slow this process down, it’s generally not possible to prevent it completely.
9. Swallowing Problems and Aspiration
Swallowing difficulties, known as dysphagia, are common in advanced dementia. This can lead to aspiration, where food or liquids enter the airway, causing pneumonia. To reduce this risk, healthcare providers often recommend modifying the texture of food and liquids to make swallowing safer.
Conclusion
Dementia is a complex condition that affects many aspects of a person’s life and can present in different ways, especially in a hospital setting. In some cases, patients may not have a formal diagnosis of dementia, and the only way to diagnose or consider baseline dementia is through detailed history-taking from family members. A geriatrician, neurologist, or geriatric psychiatrist can help establish dementia as the primary diagnosis.
Family members and caregivers must be aware of the signs of dementia and be proactive in seeking help. Whether the patient is dealing with wandering, falls, confusion, or other issues, support from healthcare providers, family, and caregiving services is crucial to ensuring the patient’s safety and well-being.
If you or a loved one is facing dementia, remember that while the journey can be challenging, there are resources and strategies available to help manage the condition effectively.
