WHAT YOU NEED TO KNOW WHEN HEADED TO THE ER WITH SOMEONE WHO HAS DEMENTIA

Emergency rooms are typically bright, noisy, crowded places. They can be especially overwhelming for people suffering from dementia. You never know when it will happen or what might trigger a trip the ER, but it can be less stressful if you are calm, prepared, and ready to support your loved one.

Have as many of these items handy as possible so they are easy to bring along if a loved one heads to the ER:

• Hearing aids, eyeglasses, dentures, cane or walker
• Prescriptions they take or a list of each one and the dosage
• Social Security card, Medicare/Medicaid info, health insurance information
• Contact information for their doctors and specialists
• Contact information for other family members
• Details of their healthcare wishes in writing, advance directives
• Power of attorney information
• Head phones or earbuds and soothing music
• Favorite blanket and sweater

What NOT to bring:

• Don’t bring your loved one’s jewelry or wallet unless you hold onto it
• Don’t bring children if possible, especially small children
• Don’t bring or give food or drink unless instructed by a physician

Upon arrival, explain the medical reason for your visit, and also be sure to mention the cognitive and physical impairments of your loved one when checking in. Let the triage nurse know if they are hard of hearing or vision impaired etc. Unless your loved one has a life-threatening condition, be prepared to spend time in the waiting room. Music or a favorite book can be a soothing distraction. A blanket or sweater may be needed as hospital lobbies are notoriously cold.

Wait times can be up to an hour or more. To make it less stressful for your loved one, find a quiet corner to sit in and try to keep them as comfortable as possible. Be sure you know where to find the closest bathroom.

As the examination takes place talk with the ER staff about what the goals of testing and treatment will be, and whether it is best to be admitted for observation. Explain what is going on to your loved one as much as possible, unless it will upset or agitate them.

Often a loved one travels to the ER by ambulance or with someone else, a friend or caregiver. If you are not able to go with them, or to meet up at the ER in a timely fashion, be sure to call ahead and provide the ER staff with as much information as possible.

There has been quite a lot of research into ER visits and long hospital stays leading to delirium. It is diagnosed as when someone suddenly becomes very confused and hyperactive or has hallucinations. It happens often to older adults with Alzheimer’s or other forms of dementia who visit the ER, but can be hard to diagnose because of cognitive impairment. Numerous studies have observed that emergency physicians often fail to identify and diagnose delirium in the elderly. Delirium is not a normal manifestation of aging, and often is a sign of a serious underlying medical condition. That’s why it’s important to mention to the ER staff your loved one’s dementia or cognitive impairment.

Remember too that research has shown an extended stay in the ER or hospital itself can bring on delirium. Up to 25% of elderly patients develop delirium after being admitted to hospital. Just being in the emergency department for longer than 12 hours is another proven risk factor for delirium. Why? Patients with dementia can have difficulty processing information and responding appropriately – hence the delirium.

Certain medical practices also propel patients towards delirium such as:

• Inadequate hydration and nutrition: Patients who arrive in an emergency department are often told not to drink or eat anything – just in case they might need to have surgery. Yet dehydration and insufficient nourishment can start a patient on the path to delirium. Once the treatment plan becomes clear – and if surgery is not in the cards – the patient should be permitted to eat and drink.
• Lack of mobility: Confinement on an emergency-department stretcher for a prolonged time can lead to muscle weakness and cause disorientation. Patients quickly lose track of whether it’s day or night. If patients are able to walk, they should be helped to get up and move around at least once every few hours.
• Medication interactions: Many elderly patients are on multiple medications. Adding another pill to the mix can lead to potentially harmful drug interactions. The medical team must take special care to review the existing medications before prescribing new drugs – such as sedatives – that could contribute to a mental fog. In cases involving a broken or fractured bone, for example, a local anesthetic may be a better way to control pain.
• Lack of sleep: It is often hard to rest, nap, or sleep due to the constant beeping of machines and commotion on the hospital floor, and being awakened frequently to check vitals etc.

Visiting Angels caregivers and companions are well trained in the protocols for medical emergencies, and will protect and advocate for your loved one at the hospital until you can get there. Our professionals provide companionship at the bedside while making sure your loved one’s basic needs are met. Being in a hospital can be an alienating experience. Hearing a familiar voice, and having a familiar touch, can sometimes be a source of great comfort. We make sure to have all client particulars, medical history, and medications lists in hand before an emergency strikes so as to be as helpful as possible to the ER staff until you can arrive, or provide instructions. Our CNAs and HHAs contact the Visiting Angels Nurse-on-call for further guidance, and all incidents are reported ASAP to responsible family members, whether out of town or out of touch. We provide peace of mind and care for your family member just like you would – with love and concern. We can also assist with the transition back to home from the hospital.

TILL NEXT TIME!

IRV SELDIN, JD

OWNER AND PRESIDENT, VISITING ANGELS OF THE PALM BEACHES

Article not intended as medical advice