The elderly going into hospital
I’ve had a number of clients who have had bad experiences in hospital and it is worthwhile considering the reasons why in more detail and considering what, if anything can be done to make the experience better.
The issues are often around confusion and mobility, although not exclusively. Mobility means that they need more support to get around, which often means that the hospital will catheterise them, so that they don’t have to be assisted to the loo so often. They can end up sitting in the same place for an extended time and therefore can end up with pressure damage, although fortunately this doesn’t happen that often.
The confusion can be a big issue though. They are in a new confusing environment, a place that can be active 24hrs a day, a place that they are unfamiliar with, the food tastes different, they can’t find the loo and all the faces are different. And on the basis that they are in hospital for an acute reason, add to that that they may be in pain and it is easy to see why problems arise. They get upset at the change and can get aggressive, which makes caring for them even harder, but even if they are not aggressive, they are struggling to adjust to the change of environment, only to be moved on in a couple of weeks.
Families will sometimes choose not to have a loved on admitted into hospital and go through all of this, when they think that the end is inevitable anyway. There is no short right or wrong answer to this dilemma. If the end is inevitable, it is easy to understand why the families would want their loved one to stay in the environment in which they are familiar, to die as peacefully as possible.
The problem with the “inevitable end” is that I’ve been told it is really hard to predict, so may in fact not be as inevitable as we think. Hospital may be the answer to resolve the acute problem, with the aim to get them back home to a familiar environment as quickly as possible. Or if not a familiar environment if the acute episode has changed their presentation sufficiently that they have to go to a new place, but again the aim should be to have them into a long term environment and out of the short term environment of hospital, which simply isn’t designed for people to stay in for long periods of time.
As for what is to be done, it is for the individual and their families to decide there is no one right or wrong answer. The point is to understand the issues, take advice and try to make the best decision possible with the information that they have. And very importantly even if hindsight indicates a different decision may have worked better, remember that hindsight is a perfect vision that we are not blessed with at the time of making the decision.
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