Alzheimer/Dementia and Emergency Care

howhale

I just wanted to offer up a watchout regarding taking a loved one with AD to the emergency room. I have now experienced this personally and heard similar reports from others. The medical community does wonderful things to treat health issues. However, there is a huge gap in what they can do for persons with AD and the bizarre behaviors we experience with them. Taking a loved one with AD to the emergency room because of their behavior ( I am speaking specifically about behavioral issues, not physical injuries) can become a nightmare if you are not careful. Mental health issues seem to have a protocol in an ER setting which may result in your loved one being forcibly committed to a treatment facility for observation. AD behavioral issues are not likely to be addressed effectively there and may make things worse for the loved one. I almost fell into that disaster unknowingly. My dear wife was behaving terribly, I did not know what to do and in a panic took her to the ER. Her behavior worsened in the strange surrounding and numerous strangers poking and prodding her. She attempted to leave, became loud and near out of control in her panic. The doctor was in the process of having her committed when the social worker arrived, recognized what was happening (I had told all that she had AD, it was on her chart) and intervened. She convinced the doctor that forcibly committing my wife was not going to help and would make it worse. She helped us calm her down and then we left to go home. We all know how little the medical community can do for our loved ones but please be careful and do not fall into the trap that might make it even worse for all. Again, I praise the medical community for all they do to help and protect us but the disease with which our loved one suffers is beyond what they can treat currently, certainly in an emergency situation.

Colacho10

I am glad the social worker saved the day. Do you think there should be a dedicated crisis line or team, separate from 911/ER staff, just for behavioural issues in people with Alz. It feels like a standard ER visit just makes the confusion and panic so much worse

howhale

I believe that the ER needs to put more effort into educating the entire staff regarding AD and adjust as necessary their protocols for how these patients are handled. I know most ERs are stretched for enough time and resources to meet the needs of the community and dealing with an AD patient will surely stretch them further. I understand that the Alzheimer Association has a staffed 24/7 hot line but I have not used it so cannot comment. It might be a useful crisis line when the issue is limited to AD related behavioral issues. But understanding how to treat a physical emergency in a patient with AD is a necessary and growing change which needs to happen in the ER. It is a tough problem and I am not at all denigrating any ER service, they are truly life savers. However, as the incidence of AD and related conditions grows, the ER is likely to experience more AD patients. In full disclosure, my own example was solely a behavioral issue which brought us to the ER and, frankly, we should not have gone there but I was at my wits end trying to calm her and protect her. I just did not know what else to do but knowing now what I experienced I would have been a much more vocal, assertive and likely demanding advocate for my wife to ensure her safety. If the ER realizes they cannot do anything to help, then tell me that and we will be on our way but don't just follow some protocol and lock her up.

Quilting brings calm

People here often advise taking your loved one to the ER for severe aggressive or out of control behavioral issues such as you described. We suggest asking for a geriatric psych hold ( what I guess could be called a forced commit) so that medication can be prescribed and tweaked over a period of a couple weeks. Going through the ER is often the only way to get this done.

Given that the ‘ supporting people who have lost someone’ sub-forum gets very little comments, you might want to put your thoughts out on the general caregiving sub-forum so that the group can discuss the subject.

howhale

Thank you for your thoughts. I will copy my initial comments to the general caregiving forum and see what it triggers. In our specific case, my wife had already stopped taking all medications. Regardless of how we (me, caregivers, nurses) tried to hide the meds, she refused, so having her held to get meds in place was not an option for us but could be good for many others. Frankly, I panicked when I could not get her to calm down in large part because I did not know enough about how to do so and I was exhausted (surprise, surprise). Our ER incident happened before I found this forum and, as so many others have said, outside this forum the medical community was poorly equipped to offer techniques to help in the home setting.