Alzheimer’s in the Philippines…
The Emergency Department (ER)
When I was about eight years old, a playmate accidentally pushed me through a glass door, severing my left wrist. I was surprised and fascinated as I watched blood pump out of the artery, unaware of how serious the situation was, while a man applied a tourniquet to my upper arm and called an ambulance. There was no pain or fear, but the speeding ambulance and its siren left me speechless. It’s a good thing I had no idea what was going to happen. As my hand was bound down on the operating table, I overheard bits of conversation. “Internal stitches—sewing inside—veins, arteries, nerves—stick her palm—can she feel that?” No, she has to feel something—fingers moving?” “I know it hurts, honey, just a few more minutes,” a nurse reassured me. If you were there that day, you most likely heard my screams, and it felt so good to scream. I eventually left the ER with three or four outside stitches—and the scar remains.
Routine ER care, but you can’t count on it when the patient has Alzheimer’s and you never know when an emergency will arise. Being prepared is advantageous. Make a list that includes the patient’s primary physician, any specialists, and anyone with legal permission to discuss medical problems. Include a summary of the patient’s dementia condition as well as any other health issues, allergies, medications, vitamins, and supplements, as well as dosages. Have duplicates of your insurance, Medicare, Medicaid, or HMO enrollment cards on hand. The majority of this can be typed on one page and carried in your wallet. Give the list to others who provide care, such as adult day care centers and other places your loved one may go without you.
You may also have a health care proxy, advance health care directive, living will, power of attorney, and ‘do not resuscitate’ order, which are documents that are difficult to carry around, but you should know where they are in the house in case someone needs to go get them. If you and your loved one are both in the ER as a result of an accident, you may be unable to participate, so keep your identification in your wallet along with the phone numbers of two or three people to call in an emergency. If you are alone with your loved one, it is preferable to call an ambulance to the ER rather than driving alone with someone who is confused and agitated; stress can make driving dangerous for both of you. Different hospitals have different ER policies, and you never know where you are or what the situation is. Although it is unlikely that you will need to visit the ER, it never hurts to be prepared just in case.
There are numerous reasons why people visit the ER, so stay adaptable enough to deal with unexpected problems. It is advantageous if the patient wears an emergency medical bracelet that indicates Alzheimer’s disease. Much depends on whether someone has mid-to-late-stage Alzheimer’s, and it is critical that staff are informed about Alzheimer’s.
Staff will take vital signs to determine the severity of the situation and how quickly it will be treated. It is critical that you mention the patient has Alzheimer’s disease once more. They can conceal their dementia in some cases. Remember that you are the patient’s advocate and the boss. You may have to wait a little longer; staff may be dealing with another patient who is experiencing a more serious event; be patient and reassuring.
Stay as close to your loved one as possible. ERs can be frightening and disorienting for someone suffering from dementia. Many questions will be asked, and the patient may be unable to respond clearly, and your loved one will be touched numerous times by strangers, all of which adds to the stress. Inform each new person who comes into contact with the patient about the Alzheimer’s.
Pay attention to the physician’s discharge instructions. The patient will almost certainly forget or misunderstand. Before you leave, read and comprehend any discharge papers. If you require clarification, ask questions. If you require it, hospitals have social workers who can provide information about resources available after the visit, such as a visiting nurse or geriatric care manager.
I had a few occasions to take my 90-year-old sister to the ER, and she did not have dementia. However, the hospital environment is very confusing, and as is often the case with the elderly, she became quite difficult, not knowing where she was, what was going on, and saying strange things. It can be even worse for someone suffering from Alzheimer’s. Prepare accordingly.