As we age, the ability of our body to compensate for minor health issues becomes limited. It’s part of the aging process. I’m not a fan of hospital stays, but sometimes there is no choice, and it usually starts with a visit to the Emergency Department (ED). Kenneth Frumkin, M.D., who has practiced emergency care medicine for over 36 years, describes elder health as a pyramid of oranges, it’s stable unless you remove one of them, then the entire pyramid can collapse.
As I’ve said many times, DO NOT allow your elder loved one to go to the ED alone. My father was in his 90s when he was sent to the ED by his doctor (who I fired after this experience). In this case Dad was not sick, simply dehydrated. The ED experience was the beginning of the end for him. It took about 18 months, but he never quit going to the hospital after the first ED visit. Prior to that he’d been in the hospital twice – one for open heart surgery at 69 and the second at 75 to treat colon cancer. He survived both physically and cognitively. His first visit to the ED at 92 began his downward spiral.
Dr. Frumkin candidly admits that ED discharge papers do not state that there is a 15-35% chance of short-term functional decline, a good chance you’ll return to the hospital, or the failure to regain one’s “prehospitalization state.” What to do? Go prepared.
Find the right hospital. Surprisingly, EDs with a higher number of patients have a lower return rate. They’re bigger, have social workers and tend to admit more ER patients who get more care the first time. If you have time before you go, call your physician, he or she will have the best advice.
Don’t push for a discharge, especially if this is a return trip. Ask if there’s an observation unit where your loved one can stay for up to 48 hours. If your loved one is discharged, make a doctor’s appointment for the following week. Studies show that 50% of ER return visits are from patients who did not seek further medical assistance.
Anticipate a long-term impact. I didn’t. After Dad’s second ER visit in 72 hours, he was admitted, and upon his return home he became wary of his balance and falling. He used his wheelchair more than his walker and slept in his chair so he wouldn’t have to get up from the bed. This is known as post-hospital syndrome. You come back “home” after a three-day stay, you’ve lost some cognitive function and your balance isn’t what it used to be. It’s no surprise that there is a sense of ‘loss of control.’ You’re not the person you were before.
My advice is if you don’t have to go, don’t. But if you do, call the primary care physician and stay with your loved one. I slept on the floor in the ED next to Dad’s bed until they admitted him the next morning. Understand that there might be a long-term impact (weeks, not days) and make a doctor’s appointment ASAP.