If the person being hospitalized has memory difficulties, even when they are medically rock-stable, there should be a Hospital Buddy with them 24/7.

What about an elderly patient or a patient with memory issues?  If the person who is hospitalized has dementia, it is always best to have a companion stay in the hospital overnight.  It is very disorienting to wake up in a hospital, and many patients end up being sedated or restrained due to overnight confusion (Note: overnight confusion is sometimes refered to as “sundowning”).  The best way to prevent or minimize this is by having someone in the patient’s room at all times so that a companion may gently remind the patient where he or she is, help keep the person from getting tangled in any cords or IV lines, and help keep the person calm.  At night, the person’s Hospital Buddy can remind the person that it is nighttime, and that it is time to sleep.

Many times in a hospital, the nurses deal with “problem patients” (those who are awake and confused overnight, and who might fall from bed, pull out i.v. lines, or otherwise pose a danger to themselves), by rolling their beds down near the nurses’ station overnight.  While this allows hospital personnel to keep a closer watch on these people, it also means that the patient is kept in a light environment through the night, with people talking and walking around, which keeps the patient fully awake.  This contributes to a vicious cycle of a person’s having a disturbed sleep/wake schedule, worsening confusion and contributing to delirium.  It is much preferable for these people to have a Hospital Buddy available to stay with them in their room.

In certain circumstances, a hospital may have a “sitter” – an official person hired by the hospital – sit at a person’s bedside to verbally orient the patient when necessary, and remind the patient not to get out of bed.  However, there are not always enough sitters available for every patient who might benefit from having one, the sitter is generally not someone who is familiar to the patient (and thus may not be as easily able to calm the person, who is feeling confused and disoriented in an unfamiliar environment), and many rehabilitation and nursing facilities will not accept a patient who has required an official hospital sitter within the past 24 hours.

What’s wrong with using restraints and/or sedation? 

While these may, at times, be necessary to ensure a person’s safety, there are risks involved with their use.  A person may respond unpredictably to a sedating medication – older patients, in particular, may be more likely to become over-sedated, even with lower doses.  Physical restraints are generally unpleasant for the person to whom they are applied, and restraints may cause a person physical injury.  And again, there are many nursing homes and physical rehabilitation facilities that will not accept a patient who has required restraints in the past 24 hours, which can complicate a patient’s discharge from the hospital.  While a physician may determine in certain situations that the risks of sedation or physical restraints may be outweighed by the risks of not sedating or restraining a person, it is best to try to set up an environment in which those measures are less likely to be necessary.