That caution has always stuck with Nina Silverstein, a professor of Gerontology at UMass Boston’s McCormack Graduate School. She kept it in mind as a member of a state Alzheimer’s and Related Dementias Acute Care Advisory Committee.
The 16-member committee recently published its recommendations for Massachusetts hospitals treating patients with dementia. Their report is intended to drive future discussion that will ultimately shape best practices to identify dementia and/or delirium and adjust care plans accordingly.
Silverstein said those two goals – improving early identification of hospital patients with dementia and effectively adapting care to their needs during a stay – could make a big difference for discharged patients trying to return to the lives they led before hospitalization.
“Hopefully they return to where they started off rather than deteriorating so much in function they cannot go back to their home, assisted living facility or wherever they had been living before,” said Silverstein.
Legislators will be briefed on the committee’s recommendations at a meeting Nov. 2. The panel’s findings were also timely advice for an informational hearing, “Alzheimer’s and Dementia as a Healthcare Crisis,” conducted by the Joint Committee on Public Health and Joint Committee on Elder Affairs held on Oct. 23.
The acute care advisory committee made three specific recommendations in its report. They include:
— Hospitals should have an operational plan in place to identify dementia and/or delirium in the Emergency Department or inpatient setting and to create a specialized care plan for those patients.
— Hospitals should develop a process to ensure designated caregivers are involved in activities such as transfer and discharge planning when an individual has dementia.
— Hospitals should develop Quality Assurance Performance Improvement measures. Among other things, they should outline how staff receive routine training in the care of individuals with Alzheimer’s and related dementias and their caregivers.
Silverstein was included on the committee as an Alzheimer’s patient advocate. She came to the issue of acute care for people living with dementia long ago while researching wandering behavior. She is the co-editor of “Improving Hospital Care for Persons with Dementia,” a collection of research on the subject published in 2006.
Silverstein’s work on the committee was focused on care in hospital emergency departments – commonly the point of entry and often the location of discharge for many patients with dementia. She said early awareness there of possible Alzheimer’s or other dementia was especially important.
“The first point of contact could be the receptionist and how important it is for that person to be sensitive to the warning signs of cognitive impairment,” said Silverstein. “When you identify that right away, it can make a big difference if the patient is admitted and throughout the treatment plan.”
She said the committee worked hard to produce constructive ideas for caregivers and administrators to help people at particular risk when they arrive at a hospital. “These are the kind of recommendations that should make a difference for the individuals, families and the care team around them,” Silverstein said.