The Caregiver Chronicles

Seniors and Emergency Room Visits

 

 

Every year there are about 17 million visits to the Emergency Room by seniors. These visits carry a high price tag for the health care system and for the elderly patients who end up at the ER. Last week, my mother was one of those 17 million. 

It all started at lunch when my mother choked on something she had eaten. It wouldn't be until many hours later that we found out what the culprit probably was. She was able to breathe, so there was no need for the Heimlich maneuver. She was, however, throwing up - in an attempt to dislodge whatever was caught further down her digestive tube  - and unable to swallow anything. I was at Starbucks at the time and knew nothing about the situation until my sister phoned and alerted me. My dad was at home and he had done something to the phone and it wasn't ringing. So, I called a cab and when I pulled up at my parent's house, he was there and I told him about what was going on with Mom. We jumped in the car and took off for the Rehab Center.

When we arrived, Mom was still in the bathroom trying to throw up. I can't remember now who was with her. Whoever it was got her back into bed, I changed her top which had gotten wet, and tried to get her to drink a sip of 7-Up.  She couldn't do it, so I went out to the front desk to let the nurse in charge know and found the speech therapist who came to see what was happening. Then, the center's doctor came in and next thing I knew he was recommending that she go to the ER because she still wasn't able to swallow and the center has no imaging equipment. My mom was not happy. She was unhappy that she was choking and also unhappy about going to the ER because too many visits there have ended up with her being admitted to the hospital. She has been in the hospital more than anyone should have to during the past few years and another stay there was not a possibility she wanted to entertain.

 

Luckily for her, the hospital she goes to has a senior's section in the Emergency Room. ER's for seniors are a new trend, one my mother is benefitting from. This was my third visit to the Senior ER with my mother and probably her 5th or 6th. Mom had been transported by ambulance because of her hip fracture and immediately taken to a room. My dad, my mom and I waited together. Mom was thirsty but not allowed to drink anything. Her pain medication was overdue and the nurse gave her morphine via IV. Then, in less than an hour, a dapper doctor wearing a bow tie came in and spent about ten minutes talking to my mom and checked to see if she could swallow yet. She couldn't, so he placed an order for an x-ray and the wheels began turning.

Then, it was a waiting game. My mom was in pain, had nothing to do, and was anxious about the test results. The hour or so before the test results came back seemed endless. The x-ray showed that whatever had been stuck in my mom's esophagus was now dislodged. The doctor came back in and talked to my mom and said, based on what she said she'd had for lunch, it was probably the carrots. "I don't even like carrots!" by mom said. The doctor urged her to be careful in future and to avoid carrots. Then, we had to wait for an ambulance to send her back to the rehab center. Now, that it was clear that her life was no longer in danger, it was a very long wait. Still, all things considered, my mom's trip to the ER ended better than some. 

                    Elderly woman in hospital (Judy Baxter photo, flickr)

Visits to the ER are not risk free. This is doubly true for seniors. The risk of infection is one of the problems that seniors face after ER visits. Other risks - usually for more long term stays - include cognitive decline and, some experts are saying, even dementia. The bottom line is that hospitals are not a good place for the elderly, even when a hospital makes every effort to mitigate the impact on elderly patients. Elderly patients are also prone to hospital psychosis, which may be a factor in additional cognitive declines. I know this is true because I've seen the impact of hospital stays on both of my parents. And that's the Catch-22. You can't leave an ailing parent at home to die, but the more visits to the hospital they have; the greater their mental decline can be.  

 So, for all of these reasons, I was delighted to see that my mom was not admitted to the hospital last week.  And keeping her out of the hospital is one of the reasons I'm here. Little things can have big consequences. The day after her visit to the ER, guess what was on my mother's supper tray?  You guessed it, carrots. I reminded her not to eat them and sat with her to make sure that she didn't. Meanwhile, coaching her to eat more slowly is going, well, sloowly. I asked Mom why she eats so fast and she said because her teeth hurt when she eats. I remind her as often as I can, that having her teeth hurt is much better than a trip to the hospital.  And that's why I made absolutely sure that the kitchen doesn't bring her any more "evil" carrots. (I apologize to all you carrot lovers and growers out there.) 

Have you had any experiences when your aging parents or spouse worsened after a stay in the hospital?

 

Why you can't park aging parents like cars

There's no substitute for being there.

Anonymous

                    Parking lot, circa 1961 (Justin Cozart, flickr)

A few years ago, I bought a book at a yard sale with the title: Raise Kids in Your Spare Time.  The book was printed in the 1960s and had a cheesy cover. I bought it because most people who have raised/are raising children realize that the concept of "raising children in your spare time," is laugh-out-loud funny. The same thing can be true of aging parents. Calling to check in when they are in a medical facility rarely works. This faith in the power of the phone reminds me of the French woman who used to live down the street from us. She would give her kids - two boys ages 10 and 12 - a cell phone and send them out to play, thinking that she could phone them to check in. That system worked to a point. However, one day when she phoned her boys, they were with some other children in the nearby woods starting a fire, even though they told that everything was fine. About an hour after that conversation, her boys and several other kids - including my 8 year old son - were driven home in a police car.  "But, they told me everything was fine," the woman said, as she wept in embarrassment, when the officers knocked on her door.

In the case of aging parents, it's not that they would purposefully lie to us - although they might do that - it's that things adult children would be concerned about might not cross their minds. A friend of mine who has a mother in the early stages of dementia, told me that recently her mother spent three days without power before thinking to tell anyone. Luckily for her, she lives somewhere warm and no real harm was done. Nonetheless, staying with parents in a medical situation can mean the difference between life and death - at one extreme - and discomfort and confusion at the other. So, as I often like to say, you can't just park your aging parent(s) somewhere like a car. Aging parents are human beings with complex needs that are also unpredictable. You don't have to be by their side 24/7 in most cases, but BEING THERE as much as possible is important. When they are left alone, too many things can fall through the cracks. I speak from experience. In the hospital stays that my mom has had in the past two years, there was rarely a space of more than a few days when there wasn't an oversight that could have affected her health, her happiness, or both. None of these oversights were intentional and in hindsight it is easy to see how they happened. The truth is that my mom is often confused when in the hospital: she was delirious when she had pneumonia, she is in pain and confused from pain medication and mild dementia now. My dad also has limitations and, more importantly, both of my parents come from the generation where you don't question the doctor or worry about what is happening in a medical facility. Trust, not careful observation, is the rule of thumb for them. And, given the fact that when my mother is in the hospital or another facility, both of my parents are anxious and tired, it's no surprise that they can't be the ones on the front line making sure that everything is OK. That's not to say that nurses and other staff aren't doing the best they can. In my experience, they do the best they can, but - if no one tells them otherwise - they may assume that my parents can make complex decisions that they can't or assume that they will bring problems to their attention that they don't. 

Late last week, for example, I accidently discovered that my mom hadn't been given one of her medications for several days. The oversight wasn't immediately life-threatening; however, if she had been without the medication for much longer she might have become confused enough to forget that she couldn't walk: a disastrous possibilityfor her hip fracture. Once back on this medication, she gradually became less anxious and, within several days, was back to "normal."

  Early this week, I noticed a large drop in her blood pressure that didn't make sense and brought it to the attention of my mom's nurse. The nurse retook it and it was actually high, not low, and she called the doctor and he authorized her to give my mother another blood pressure pill and within an hour her blood pressure had returned to normal.

Yesterday morning I had just sat down to breakfast when my cell rang. I picked it up and my sister was on the other end. "Surprise," she said. "Surprise?" I repeated, with a frown. She was with Mom at the Rehab Center and surprises are rarely good ones when it comes to Mom. Guess what, she continued, Mom's going for her x-ray this morning. Mom had been scheduled for her next x-ray on February 26 - or so we thought - but when my sister looked at the date and looked at her calendar, she discovered that there was no February 26 on a weekday and that Mom's x-ray was in fact that morning - January 26. So Dad and I quickly finished breakfast and then he dropped me off at the doctor's office because he had physical therapy and he joined us later.

Meanwhile, Mom was having a mini-meltdown because, as with most elderly people, surprises alarming. But she was calmed down by the time she got to the doctor's office and it turned out for the best that the x-ray was sooner rather than later. The doctor said that there hadn't been much change since the last x-ray two weeks earlier and he said that my Mom should still be non-weight bearing and he would see her again in a month and he recommended that she stay in the Rehab Center until then. 

And so, when I finish writing this post, I'll be headed back to the Rehab Center in time to hear what the facility doctor has to say and help Mom with the little things that can make the difference between a bare-bones stay at a facility and a little more comfort and - hopefully - a sense of safety.