Patients with Alzheimer's disease should be kept out of the hospital unless absolutely necessary, according to research just published in the Annals of Internal Medicine. The prospective study found that Alzheimer s patients who were hospitalized were more likely to develop delirium and to suffer from a cognitive decline resulting in more frequent institutionalization, as well as an increased risk of death. Whether there was a causal relationship between hospitalization, the onset of delirium, and these complications is an open question.
For their study, a team of specialists from Boston area medical and research centers reviewed 15 years of medical records from nearly 800 Alzheimer's patients ages 65 or older. Their aim was to determine what kind of circumstances were associated with hospitalization, institutionalization, delirium, and patient death. What they found was that, among the half of the patient study group who were hospitalized, over a mean duration of three years, 43 percent were subsequently placed in a nursing home or other care facility, 25 percent developed delirium, 20 percent suffered cognitive decline, and 15 percent died. Significantly, those patients who developed delirium had a substantially increased risk of institutionalization and death, compared to hospitalized patients without delirium and those who were never hospitalized.
It remains to be determined whether hospitalization actually accelerates the development of such adverse outcomes, or whether Alzheimer s patients who are already in the poorest health are more likely to be hospitalized. In particular, researchers would like to investigate the correlation of delirium with the other adverse outcomes in order to learn whether preventing it can reduce such events.
While, unfortunately, there's no intervention to recommend, ACSH's Dr. Gilbert Ross observes that "it's clear that hospitalization is fraught with risk for Alzheimer's patients. If there's an alternative available, families of such patients would be wise to consider it. He notes, however, that delirium among hospitalized patients can, to some extent, be prevented by encouraging interaction between the patient and his or her environment. "Talking with staff and family, keeping the room well-lit, and even keeping the TV on can help, he says.