Alzheimer/Dementia and the Emergency Room

howhale

This was posted in the support after loss forum but was suggested to also be posted here>

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.

harshedbuzz

@howhale

I am sorry if the trip to the ER didn't play out as you hoped.

For many caregivers, the ER/ED is the point of entry for a much-needed geri psych stay for medication management. In many communities there are no geriatric psychiatrists and even when there are, the wait for an appointment can be months. In an emergent situation, when a PWD is a risk to themselves or others, this is exactly how they can access the help their LO needs.

HB

Timmyd

I dread the idea of ever having to seek ER care for DW regardless of symptoms. I have heard of circumstances when it turns out about as well as can be expected but other times where it goes completely sideways and creates a whole new set of problems to deal with.

If there are people with experience, I would appreciate reading some tips on how to approach ER visits so as to have the best possible outcome.

tboard

https://alzconnected.org/discussion/74329/alzheimer-dementia-and-the-emergency-room

There is a hospital ER with a strong psych department. I have been told that I could bring my DH there when he gets violent and that they can help. I have no intention of doing that but I can see why a person would want to. Sometimes I get really scared.

harshedbuzz

I wonder if there is a gender difference in play here.

The "Never would I ever" sentiment seems to be expressed by husbands caring for their wives. The situation is different when the PWD is agitated, aggressive and strong while the caregiver 6" shorter, 100 pounds lighter and has osteoporosis.
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@Timmyd— I was at the ED with my mom 7 times last year. She doesn't have dementia but can develop hospital-induced delirium under certain circumstances. My suggestions:

Avoid the ED if you can. If something seems to be brewing with DW, try to be seen at her PCP's office instead even if it means seeing a different doc or a NP.

I favor urgent care over ED if you suspect something like a UTI, stitches or need an X-ray after a fall. One caveat is the after a fall where she hit her head, they'll want a CT scan which urgent care doesn't typically do so you'll need the ER.

With mom, I tend to favor the ED in the local hospital where her pulmo practice is. His team almost always gets involved and their ED tends to be less chaotic than the one where her other doctors are.

I have a go-bag. I make sure I have a jacket of sweater for both of us, mom's regular meds, charging cords for my phone and our iPads, a copy of mom's advanced directive. I use her iPad to track test results as they come in and mine to keep her entertained with You Tube if she's not asleep.

I have a plan to stay until mom is transferred to a room. When mom isn't doing well emotionally, I tend to stay bedside most of the time.

HTH— HB

trottingalong

I have been very lucky with ER in our small rural hospital that does not have any type of psyche ward. When I have called an ambulance I explain he has dementia. When I arrive at the hospital I always say he has dementia and I need to go in there immediately. They have been wonderful. They ask him questions and I will answer. I’m his calming influence. The nurses have been great with him. He does get hospital induced delirium when he’s been admitted for an illness, but so far all has been ok in ER. Hopefully that doesn’t change.

Quilting brings calm

The point I made in the other forum is that we often advise to go to the ER for behavioral issues because that’s often the only way we can get our loved ones into geriatric psych to get medication prescribed or tweaked. I’d also comment that it’s often how you can get someone to be placed on MC or a skilled nursing facility. The original poster here feels like going through the ER for this is the exact wrong thing to do. What is everyone’s experience with taking a LO to the ER for behavioral issues.

howhale

Just to clarify, I am the original poster. I am not suggesting that going to the ER for behavioral issues is "the exact wrong thing to do". I am just offering a caution to be sure you understand how things can proceed once there. Knowing your hospital, the resources available, how they would handle one with AD, etc. is information to have before you go. Be prepared in advance. Perhaps talk to your loved ones PCP or other doctor in advance about what to do should a need arise. I was not prepared and expected resources that were obviously not available and stumbled into a scary situation. We each have to decide the best course of action for our situation and loved one, just be aware of risks. Do better than I did and get informed ahead of time is my message.

tboard

I took my DH to urgent care a couple of times a month for a year until a doctor who had a mother who died with Alzheimer’s helped us out. She made some changes to his medications and I haven't had to bring him to the ER or urgent care since.