Education and Care - Emergency Room Visits

Alzheimer's Foundation of America

An emergency room can be frightening and agitating for anyone, let alone for individuals with dementia. They almost always become more confused when they are brought to a new location, especially one as chaotic as an emergency department.

Here are some points that can help:

• If at all possible, a caregiver should discuss the need for an emergency department visit with the individual's visiting nurse or primary physician first before going to the hospital.
• A physician should evaluate any individual with an acute change in functioning -- either cognitive or psychomotor. It is not always necessary for the person to visit the ER for this evaluation. However, if X-rays, blood testing, or other treatment and diagnostic modalities are necessary that are not usually available in a physician's office, an ER is the only choice.
• In transporting someone with dementia to the ER, it is safer to use an ambulance, rather than one's car, because they can be strapped onto a stretcher and monitored. Cars pose a risk since the person may open the car door while it is moving or fall during transfer in and out of the car.
• It is critical for one responsible caregiver or relative to remain with the person with dementia at all times. This is to help with the individual's orientation, and to provide a measure of support and safety.
• The accompanying caregiver has a major role in providing critical information to the physician. They should be prepared to give vital information about the individual, help the physician and staff position the person for the examination if they are able to do so, and minimize unnecessary interactions with the fully occupied staff members.
• At the initial encounter with the treating physician and nurse, caregivers should present their "credentials." They should inform the physician and nurse about their background, experience, continuity, insights, and vantage points they may have concerning the individual.
• Caregivers should pack an ER kit and have it ready to go. It should include 1) A preprinted summary containing the individual's medical history; key contact numbers such as family and friends, and health insurance provider; list of problems; allergies; and medications, including prescription drugs, over-the-counter and vitamins 2) Health insurance cards 3) Copies of legal documents, such as advance directive, do-not-resuscitate order, health care proxy, power of attorney and living will 4) Item of comfort, such as a family photo 5) Change of clothing, including adult briefs, if necessary.
• ER physicians will do a mental status examination on the individual with dementia to decide how to use the information they present.
• It is always advantageous to have a team approach to evaluate individuals with dementia. A gerontologist is a key member of this team.
• ER rooms triage priority cases in the following way: Each presenting complaint, vital signs and history at triage provide an Emergency Severity Index (ESI) level. Hospitals use a five level system, with number one representing the sickest clients. Within each level, the frail elderly, including the geriatric person with dementia, would come first.
• If an individual is stable and waiting for test results, consultation or perhaps, in some situations, an in-patient bed, it is best for caregivers to take them out of the main emergency department to a quieter place.
• The caregiver is entitled to a complete debriefing about the individual's condition. But be patient. Until all of the information has been obtained and evaluated physicians prefer not to have to stop what they are doing to answer questions that will be covered more comprehensively once the evaluation is completed.