What a Patient With Dementia Experiences

John Gotelli, Geriatrics Nurse Practitioner at UNC Hospitals Hillsborough Campus

John Gotelli, MSN, GNP, a Geriatrics-trained Nurse Practitioner at Hillsborough says, “Somebody with dementia lacks the ability to process information that you and I take for granted. If a foodservice person delivers a tray of food, you or I (if we were in the hospital), would understand that interaction. Yet someone with dementia may think that that person is trying to poison them.”

With dementia, a primary impact is often use of language and verbal ability. So, patients struggle both to understand information they receive and to express their wishes and needs. For example, a dementia patient who is fearful, confused, or in pain may not be able to describe what they’re experiencing. They may not understand why they are at the hospital or how they got there. Or they don’t understand the motives are of the people who keep entering their room.

“Imagine if you don’t know what’s going on. You’re in this place, it’s very bright or it’s dark, you’re connected to wires, people are doing things to you…With a dementia patient their go-to is often to lash out and tell people to ‘leave me alone, stop bothering me.’” Krista Wells, MSN, RN, CCRN, Hillsborough Hospital’s Clinical Nurse Education Specialist

Stopping behaviors versus understanding the dementia patient

Without awareness of what the dementia patient actually experiences, staff focus first on stopping behaviors. Instead, staff should focus on understanding what’s creating problems from the patient’s perspective. Too often, if difficult and unsafe behaviors (including striking out, pulling IVs, or trying to leave the room) can’t be stopped, medication is the default remedy.

However, with medication comes increased risk for delirium, falls, and further cognitive decline. Consequently, dementia-friendly training helps staff create an environment of trust among patients. Furthermore, with greater trust comes more cooperation and fewer difficult behaviors. In turn, this helps prevent over-medication and poor health outcomes after hospitalization.

“The biggest piece of this is awareness and understanding. We have to change our behavior, because patients with dementia can’t change theirs.” Jenny Van Gils, OTR / L, an occupational therapist at Hillsborough

Krista Wells, MSN, RN, CCRN, and Clinical Nurse Education Specialist at UNC Hospitals Hillsborough Campus describing DFHI at a dementia and Alzheimer's caregiving conference in February 2019. — Krista Wells, MSN, RN, CCRN, and Clinical Nurse Education Specialist at UNC Hospitals Hillsborough Campus, speaks on the Dementia Friendly Hospital Initiative at a regional caregiving conference.

Benefits of trained, dementia-friendly staff

What are the benefits of training all staff who interact with patients? Now, every encounter with dementia patients has a better chance of going smoothly. Due to their training, dementia-friendly staff gain a new set of skills to use in various situations. Also, the training empowers staff to act with greater empathy and understanding.