Mary walks toward the hospital, unsteady and confused. Her daughter Susan gently guides her toward the door. As they sit in the waiting room of pre-admission testing, Mary barely hears her name called and doesn’t know what to do when she hears it. Susan helps her to stand and to walk toward a smiling stranger. Mary doesn’t understand the questions the stranger asks.
For someone like Mary, who has dementia, the world can be an unfamiliar and even frightening place. People with dementia experience a deterioration in memory, thinking, behavior, and the ability to perform everyday activities. Penn Medicine Princeton Medical Center has taken a proactive approach to creating a dementia-friendly hospital environment that’s responsive to the unique needs of patients with dementia.
This work is especially important as dementia diagnoses are on rise in the U.S. and around the world. In fact, dementia is now one of the leading killers in the United States, with the rate of deaths linked to the disease more than doubling over the past two decades, according to U.S. News & World Report.
“Treating a patient with dementia has unique challenges, including the fact that it’s often difficult for caregivers to relate to exactly what the patient is experiencing,” explains David Barile, MD, medical director of the Princeton Medical Center (PMC) Acute Care of the Elderly (ACE) unit.
One method that PMC is using to help its staff get a glimpse into how individuals with dementia experience the world is Virtual Dementia Tour® (VDT) training. Much like Mary’s story above, this training offers caregivers the opportunity to view things from the perspective of someone with dementia.
The 10-minute training is provided as part of an hour-long educational course on the effects of dementia. During what has been described by participants as a “humbling and enlightening exercise,” trained facilitators guide participants as they try to complete everyday tasks, while wearing devices that alter their senses. The caregivers experience for themselves the physical and mental challenges faced by those with dementia. After the training, participants often talk about the positive impact it has had on the way they interact with individuals with dementia—both in and out of the hospital.
“By putting ourselves in their shoes, nurses and other caregivers gain a new perspective and connect with these patients on a deeper level,” says Allison Healy, MSN, RN-BC, a clinical nurse leader and the senior care coordinator for the ACE unit at PMC.
Since 2017, caregivers in the hospital’s ACE unit and 398 staff members from across the hospital have also voluntarily attended the simulation. PMC is also developing a program through which the Virtual Dementia training course will be offered to local emergency medical services teams and interested members of the community.
Several hospitals in the U.S. are using another method of creating a dementia-friendly hospital experience — a purple seahorse identification system that signals to caregivers that a patient may have memory impairment or may be easily disoriented in a new environment. When caregivers see the seahorse posted on the door of a patient’s room, they’re reminded to use their dementia-friendly skills as they provide care. The seahorse was chosen as a symbol because the Latin word for seahorse is “hippocampus,” which is also the word used to identify the region of the brain where memory is stored and the area that is most affected by dementia.
Princeton Medical Center has seen success with this program, which is just one of several bedside approaches that are considerate of the needs of older patients — which has long been a focus for PMC.
In fact, in planning the patient room design for its newest facility, which opened in 2012, PMC administrators took into consideration an older patients’ increased risk of hospital-related health issues, such as falls, pressure ulcers, incontinence, delirium, and malnutrition. This research led to the creation of the hospital’s Acute Care of the Elderly (ACE) unit.
“Hospitalization for those with dementia can be traumatic. That’s why we created a dementia-friendly environment at Princeton Medical Center. Our staff are trained to identify and appropriately interact with dementia patients and offer support for their caregivers and decision makers,” Barile said. “Studies have shown that dedicated ACE units reduce the risks of hospital-related health issues, shorten the average length of a hospital stay, better preserve a patient’s ability to function normally, and increase patient and staff satisfaction.”
At PMC, the ACE unit — only of one a few such specialized units in New Jersey — has 24 single rooms, each of which feature special beds with pressure relieving mattresses to help prevent bed sores and are set low to prevent falls. To address sight issues, wall surfaces and door frames are highlighted with contrasting colors for enhanced depth perception, and signs and display boards have larger-than-normal type. In addition, units throughout the hospital include other patient safety design features such as non-slip floors, low-level lighting, and railings from the bed to the bathroom.
As the impact of dementia becomes even more significant, hospitals and other healthcare providers will be challenged to better understand the needs of patients, their family members and other caregivers. As evidence-based research continues to inform and transform care for a rapidly growing elderly population, Barile noted that by incorporating specialized design elements, staff training programs, and distinctive personal touches that address the needs of seniors, Princeton Medical Center continues to enhance the patient experience, and improve health outcomes.