I work as an RN on the night shift in a community hospital. One of my biggest challenges involves the care of the elderly, specifically those suffering from delirium or some form of dementia. It is difficult dealing with these patients for many reasons: they often refuse care, they frequently have worse symptoms at night, and the family often have a lot of stress, namely shock, at the patient's unfortunate condition.
Being in the hospital is hard for everyone, but oftentimes the elderly are particularly vulnerable to acute episodes of confusion and disorientation. The least serious variety is the aforementioned delirium which is often quick in onset, short in duration, and the patient can usually be restored to their baseline. UTIs can often cause delirium, but being transferred to the hospital can be enough to trigger an acute episode of delirium. When this occurs within the hospital, this is an important red flag that the patient has had an important change in mental status (dubbed "altered mental status").
It is our fellow humans suffering from dementia that are more difficult to deal with.
Several of my patient's suffering from dementia have reminded me of my grandmother who suffered from schizophrenia. It is difficult for us to imagine how stressful and dangerous the world can seem when we lose our ability to orient our selves to the world, lose our ability to form new memories and retrieve old ones. People appear to regress into earlier modes of coping, including refusing to cooperate with staff for treatments.
There are drugs that are effective at halting the progress of dementia. But these people are faced with a bitter irony: they suffer from a progressive neuro-degenerative disease and their best hope, currently, is to faithfully take their daily medications. But the medications will only slow the progress of dementia. So what happens when they start to forget taking their medications? It is a sad, but inevitable fate that awaits them.
It is frustrating for staff to deal with these patients too. We receive no special training in dealing with these types of patients. We perceive their unruly behavior as something that must be controlled, and quickly too. There are far too many patients to see, too much paper work, and not enough time. It doesn't help that many of these patients are "sundowners" - meaning that their symptoms are worse at night. Behavior can range from moaning in bed to yelling and cursing at staff, becoming physically violent, and wondering the halls. The last two are the most important. Often times an elderly person's ability to walk safely is greatly compromised and they are at high risk for falls. Falling and breaking your hip in your golden years can be a death sentence - my grandmother died within one year of falling and breaking her hip.
Seeing the families - particularly relatives who live a distance away and whose last memory of the patient were from when they had slight to no impairment, is particularly difficult. Severe shock and disbelief are common. Many people cry and some never come back to visit. When the moment dawns on them just how devastating dementia is, its as if they have lost that loved one. The person they knew is effectively dead.
This is a subject that often leaves me pondering about the real difference between humans and other animals. It seems very clear to me that what makes us human is our consciousness. Dementia is one of, if not the worst disease a human can suffer from. It robes us not only of our ability to care for ourselves, to love and be loved, but it robes us of the very essence that makes us unique.