H is for hospital.
Don't go there.
There are times when it is necessary for the elderly person to go to hospital, but this is a discussion and decision you need to make before the occasion arises. Here are some not-nice facts that make it imperative to decide early.
- Most hospitals are experts in acute care and specialities such as obstetrics, diseases (such as cancer etc.) and the various surgeries that go with them. Very few specialise in the treatment of the elderly.
- Many doctors aren't well-versed in treating the elderly.
- Some doctors aren't as familiar with the special effects (interactions, side-effects) drugs have on the elderly. Drugs can build up in a frail elderly person's system to dangerous levels.
- Ageism is rampant in hospitals. Not all hospitals and not with everyone, but it's certainly common. The elderly (especially those with dementia) aren't treated with respect or understanding.
- Going to the hospital is difficult on an elderly person. For those that are cognitive, it is disorienting and frightening. Waiting in emergency rooms and triage lines can be exhausting for those who are frail and ill. If the person is also has dementia, aggression and anxiety can escalate.
Then why would anyone go?
There are reasons for the elderly person to go to hospital, and guidelines to help them through it.
If an elderly person has an "event" that cannot be treated at home, or if they are in a care setting, in the place they live, they need to go to hospital. Sometimes this means just for assessment and treatment, and sometimes it means admission.
Here are some examples:
A fall with pain where a fracture is suspected. The person can't weight bear (and could before) or can only do this with great difficulty. Or, the arm or whatever other limb is affected is in great pain. An X-ray is necessary, possibly surgery (as in a broken hip) or setting or treatment. Whatever the outcome, it's imperative that the person is properly assessed at hospital.
A nosebleed that won't stop.
A respiratory infection that needs IV antibiotics.
Symptoms that suggest a stroke. For this, you should move quickly, as success of treatment is time sensitive.
Possible heart attack. Welllll--this is where it gets dicey. Because if a heart attack is suspected, CPR will probably be performed, and what might be deemed "heroic measures." This is where you need to make decisions.
Does your loved one want to be resuscitated in this kind of a situation? That may sound like a ridiculous question (who wouldn't want to be resuscitated?) A physically frail 94 year old with dementia. An elderly person in chronic pain. Someone with an incurable disease who is at the end of their life. We're not talking mercy killing here, we're talking about needlessly prolonging the life of a person who is close to death.
Because these are difficult conversations and painful decisions, they need to be made before they are necessary. A DNR (do not resuscitate) form needs to be filled out and kept on file, and if the person does need to go to hospital for one of the above reasons, the form should go with them.
This kind of preparation will give you both peace. If a trip to the hospital is needed, you will have have some measure of control of the situation.