Bob is married to Allison, who was diagnosed with Alzheimer’s disease in 2006. Bob writes about his wife’s hospitalisation in 2009 for her second knee replacement. Bob was cautious the second time as Allison had climbed out of her hospital bed after her first knee replacement operation in 2004 (prior to her formal diagnosis of Alzheimer’s disease). On that first occasion, Allison had post-operative delirium and tried to leave the hospital as she was convinced that she was being held captive by a secret sect. As Allison’s second knee replacement operation would involve surgery under heavy anaesthetic, followed by five days in a private hospital and 10 days in a rehabilitation centre, Bob and Allison decided it was necessary for Bob to stay with Allison in the hospital and rehabilitation centre. Bob says “someone with dementia should be kept under constant surveillance immediately following a major operation.”
The effect of the anaesthetic caused considerable confusion for Allison during her hospital stay for her second knee replacement operation. She didn’t know why she was in hospital, that she had a catheter in place, needed a bed-pan or should walk to the toilet. Even though there was an en-suite toilet in her room – she was unable to work out where it was on her own.
Allison also never remembered the instruction to ‘press the red button’ if she needed help or was in pain. She was unable to answer important questions, including those related to her pain level and if she had eaten that morning. All questions and medical advice had to be directly to me.
When planning the hospital admission, I requested a fold-up bed to be placed next to Allison’s bed. Initially I thought that I would only need to stay in the hospital for a couple of days until Allison got the hang of things, but it soon became apparent that I would need to stay for the total time of her hospitalisation. It really would have been difficult for Allison without my presence.
To my pleasant surprise, both the private hospital and the rehabilitation centre granted my live-in requests without hesitation and at no extra charge. At the rehabilitation centre, I set up a computer work station in Allison’s room to stay in touch with work, and also brought in a keyboard to practice hymns (using earphones) required for our local church. The hospital provided me with free meals, while the rehabilitation centre had a visitor meal charge. In both locations, the selection of wines was quite acceptable!
Being in the hospital with Allison made such a difference. I was able to repeatedly reassure her as to where she was and tell her the reason she was there. I was also there to call a nurse when Allison needed assistance that I was incapable of providing.
On Allison’s behalf, I was able to answer daily questions from staff and discuss matters related to her care and discharge. I learnt things that I could do to make it easier for her – giving stomach injections was just one of the many new skills. Being part of the conversation meant I could then prompt Allison to follow the instructions given by staff.
A simple and cost effective method of observation would be to install closed-circuit television cameras in hospital wards to keep continuous watch for at-risk patients, such as Allison. However, this is not possible without modification to current privacy laws.
I would suggest those who are able to, request a fold-up bed and if possible organise a roster so that a family member can be with the patient at all times. As a side-note, those fold-up beds are extremely comfortable! If or when it’s not possible to be in the room, make sure the patient is in a bed in a ward that is visible at all times from a nurse’s station.