When Arriving at the Hospital 

Pack your patience.  Whether your loved one suffers from dementia or not, visits to the hospital are often lengthy and uncomfortable.  Make it easier with the following tips: 

***TIP: Ask if the hospital is a NICHE Member organization - NICHE (Nurses Improving Care for Health-system Elders) is a national program that helps hospitals and healthcare organizations improve the care of older adults.  NICHE member organizations gain access to resources, tools, and support to improve care for older adults, including evidence-based practices, resources and guidance from experienced NICHE nurses.  For a list of NICHE members, look here.

Be prepared - Develop a two-part emergency department visit plan that is ready long before it’s necessary. 1) Ensure you understand Chronic Health Issues and have discussed Goals of Care; and 2) Have at the ready a folder including medical issues,  surgery history, medications, primary care, pharmacy and specialists’ contact (including after-hours numbers), advanced directives, and other allergy or helpful emergency care insights for you or your loved one. If the patient has an activated health care power of attorney (HC-POA) or MOLST, health insurance card or prescription card have these documents ready. Use long waiting time to make sure you have access to this information, if you don't already.

Be patient - It takes a couple of hours for diagnostic testing, such as blood tests, X-rays, and CT scans, and any interventions, such as medications. It is important to be prepared for a lengthy visit. Bring reading glasses, cell phones, hearing aids, warm comfortable clothes, reading materials, headphones and music, or a device on which to watch television programs. Always ask staff before eating or drinking anything or taking medications to ensure it will not interfere with any planned tests or treatments. Let the emergency department staff know if you need something. They don’t want patients getting dehydrated or missing a medication, either. 

“People with dementia are twice as likely to seek emergency care compared to older adults who don’t have dementia. The emergency department can be a loud, bright, fast-paced environment, which can amplify cognitive issues and present communication challenges for someone with dementia. But there are steps you can take to improve an emergency department visit for someone with Alzheimer’s disease or another cause of dementia.” - : 6 Tips for Emergency Visits with Dementia Visitors and Their Caregivers, See more. 

Don’t hurry back home - The leading causes of emergency room visits are falls and/or changes in appetite and behavior that may be indicative of severe dehydration, urinary track infections, congestive heart failure and/or TIAs (Transient Ischemic Attack). Congestive heart failure can also present as overnight weight gain or breathing difficulties. TIAs, or mini-strokes, refer to a temporary interruption of blood flow to the brain, causing stroke-like symptoms that typically resolve quickly. 

Patients may have difficulty speaking or understanding others or weakness/numbness in the face, arm, or leg. 

***TIP - Although all of the above may be resolved by the time a doctor is seen in the emergency room, they can be precursors to larger events and should not be minimized. Make sure to notify primary doctors right away and monitor loved ones over the next few days and hours. 

For next time.... Know what to watch for and monitor suspected health concerns. Stay on top of your concerns with regular check-ins with primary care physicians. If your loved one has dementia, familiarize yourself with the various stages of the disease and its process so that when medical issues arise or changes occur, you know what to expect and how to approach them. An example of this might be behavioral changes or difficulty swallowing, eating, and drinking. Don’t ignore the warning signs. Older adults, particularly people with dementia or chronic illnesses, can get sick quickly.