By Kelly Wilsey

When Susan, an 87-year-old woman with dementia, lost her husband of 53 years, her daughter Kate wanted Susan to have a safe and secure environment, and welcomed Susan into her home. For Kate, it was the only decision that made sense. Susan was incredibly involved in her children’s lives, and Kate wanted to provide her with the same nurturing care. 

Kate thought she was prepared to care for her mother. Though she worked full-time, she was able to have an aide stay with Susan for social stimulation and basic tasks. But when a series of trips to the emergency room caused Susan’s condition to decompensate rapidly, Kate was unsure how to help. One of the most difficult parts about caregiving for a loved one with dementia is the act of role reversal. For adult children like Kate, it feels unnatural to make difficult decisions for a parent – but these decisions are vital to continue providing seniors and loved ones with the quality of life they deserve.

Kate’s situation is not unusual. According to the Alzheimer’s Association, more than 11 million Americans provide unpaid care for people with Alzheimer’s Disease or other forms of dementia. Like many family caregivers, Kate chose to care for Susan out of both love and obligation, after promising her mother she’d never place her “in a home.” However, Susan often doesn’t realize she’s living with her daughter – she often confuses Kate for a childhood friend and some days has no recollection of ever being married or having children.

Like many older adults with memory impairments, Susan’s struggles with dementia cause other health issues. People with Alzheimer’s and dementia have twice as many hospital stays per year as other people in their age group.  Susan frequently forgets to hydrate and suffers from chronic urinary tract infections – which cause her to have delusions. The emergency room trips are frightening for her, because she doesn’t understand what’s happening to her, and the ensuing delirium causes her condition to deteriorate. While the doctors can treat her UTI, the underlying issue of her dementia, cannot be treated, and more trips to the ER follow.

Post-Hospital Syndrome:

Even among older adults without Alzheimer’s or related disorders, hospital readmissions are frequent—a phenomenon known as post-hospital syndrome. AARP notes that one in every three seniors who visit an emergency room results in readmission, even when the visit was for a minor issue. A third of those readmitted will return to the ER within a month, and one in 10 will die within 90 days.

Hospitals are designed for treating acute conditions, and are well-prepared to do so. In treating these conditions, however, other factors make older adults, especially those with cognitive or memory impairments, vulnerable to decline after discharge. Harvard Medical School notes that hospital-related changes in diet, routine, sleep patterns, and activity, combined with the stress of illness and side effects of new medications, are some of the primary causes of this decline. Post-hospital syndrome can include depression, worsening memory, decreased appetite, fatigue, dizziness, incontinence, and other symptoms. 

Two weeks after Susan was released from her five-day hospital stay, she fell and broke her femur. The hospital treats her leg with surgery and then transfers her to a rehab facility to receive the physical care she needs, but again, they are unable to care for her dementia. The after effects of her anesthesia, combined with time spent in the hospital and the unfamiliar rehabilitation setting are overwhelming for her. After returning home in a wheelchair, Susan has lost interest in eating, going on walks, or engaging with her family. Kate feels helpless. She’s done everything she can to keep her mother in a comfortable, safe environment, but her mother’s condition continues to decline. Kate begins to realize that Susan’s dementia needs so much more care than can be provided in her home. She needs constant monitoring, redirecting, and engagement. When Susan becomes incontinent, her primary care physician recommends a skilled nursing facility.

Caring for Dementia in the ER: Guidance for Families and Caregivers

Dementia is not an acute issue, and unfortunately cannot be treated as such. If you have a loved one with Alzheimer’s or a related disorder, special care should be taken during emergency room visits to ensure the best care possible:

• Ensure that everyone on the care team knows loved one has dementia. Ask the care team what the current diagnosis and recommendations for care are.
• Be available to answer questions. Your loved one may not respond – or be able to respond – to doctors and nurses.
• Inform the staff if your loved one begins to act out of character or worsens.
• When possible, take your loved one to an accredited geriatric emergency department. There are more than 250 hospitals nationwide that meet this certification. 
• Plan an immediate follow-up appointment. More than half of the seniors who are readmitted within 30 days do not see a physician in the interim.

The Unique Needs of Dementia Patients:

While Susan’s medical conditions were able to be treated in a hospital, doctors were unable to care for the unique needs presented by her dementia. While most seniors would prefer to age in place, home-based care isn’t an appropriate option for all older adults. Many need access to round-the-clock care to manage their health conditions.

It takes months for Kate to get her mother into a skilled nursing facility. . The process is complicated, and the time involved in finding an appropriate home requires Kate to take time off work. Although she was finally able to get her mom admitted to a skilled nursing facility, she wasn’t happy with the choice. The walls felt sterile, and Susan was confined to a hospital bed until she eventually passed four months later. Kate believed she was doing everything she could to care for her mother, but the journey for both of them was torturous. With every incident that caused her mother to go to the emergency room, she declined a bit more, and never returned to her previous baseline. She wonders if there was another option.

When adult children and a medical team are attempting to make difficult decisions on behalf of a senior, they need assistance from someone who understands the many options available to them. Together, they can determine the level of care needed, select the most appropriate option, and determine how to make the transition. Oasis Senior Advisors are that trusted resource, working hand-in-hand every day with seniors and their families, medical professionals, and senior living communities to make the best decisions for everyone involved. 

To learn more about how an Oasis Senior Advisor can assist you or a senior you know, contact us at (888) 455-5838.