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In the past two months I have been to our local ER twice. Once with my mother and once with a friend. The ER is a scary place, even if you do not have memory problems, for many reasons.
When you go to the Emergency Room it’s because there is a problem, a serious problem. Often you don’t know what that problem is so you are waiting and hoping for answers that may or may not come by the end of your visit. If you have memory problems you may not remember the precipitating event that sent you to the hospital in the first place which really limits what the ER staff can do for you if you are alone. The question “why are you here?” is answered with “I don’t know”. Especially if the event that occurred was witnessed by others but you can’t remember that it even happened.
It doesn’t matter how good ER staff are they can only work with the information they have. ER Staff are trained and expected to deal with the emergent issue at hand not all the extraneous other problems someone has. When someone with Dementia is asked if they have pain they may say no or they may refer to a pain that is chronic but not the reason they went to the hospital in the first place. Another problem might be the total lack of memory of the most recent occurrences preventing them from remembering why they are even there. The person with Dementia needs an advocate, someone to speak for them, who knows their history and will correct the misstatements and fill in the gaps of the story so the issue being addressed is the one that is that triggered the visit.
The other thing to remember is that a visit to the ER is not quick. Emergency rooms work by triage – the most life-threatening emergencies are the first to be dealt with- and that is appropriate. This leaves the non life-threatening emergencies waiting longer for treatment. “Waiting well” is not a trait that many people with dementia have. They forget what they are waiting for. They may try to leave. They get more and more confused the longer they are left alone in the noisy chaotic strange ER environment. The calm presence of a familiar face is more than comforting it helps keep them grounded in the moment. If there is no one with them they can become agitated as they become more frightened and end up being sedated with medication they may not need otherwise . This can leave them at a higher risk for falls and increasing confusion as the sedation wears off. This can be a particularly bad situation if you return them to their home environment after the ER visit and they are too sedated to walk.
Let me offer a cautionary statement about assuming that if they live in a facility that the facility staff have sent all the pertinent information with them to the ER. That may or may not be true but a lot of hands touch that information and information can be easily misplaced or overlooked when there is no one there to speak for the person. Do not assume that because they live in a facility they do not need your presence in the ER with them.
Part 2 of the ER visit coming soon.
Click on the link below to access the National Institute on Aging brochure about Dementia and hospitalizations.