Recent news stories reiterate the link between routine emergency room visits and rapid deterioration in the health of the elderly that often follows. The connection between the two is frequently obscured due to the fact that the actual health condition leading to the ER visit is not necessarily the sole cause of the deterioration.
For example, Kaiser Health News addresses the example of an elderly man falling in his yard breaking his arm. A broken arm is not something one would typically consider life-threatening. In the elderly, it may well be life threatening. However, the broken arm or other conditions leading to the ER are not necessarily a direct cause. Instead, there are many other issues that can lead to a rapid decline in health which go unattended to in the ER.
The American College of Emergency Physicians (ACEP) has put together guidelines to break the link between an emergency room visit and an overall decline in health.
Unexamined Elder Health Conditions in the ER
The ER, as we all know, can be an intimidating, confusing and harried. The elderly may find the ER particularly daunting. Because of the nature of the ER, an overall picture of the elderly patient’s health is typically neither investigated nor treated. Instead, the focus is on the task at hand, a broken arm for example.
The Kaiser Health article sets forth a number of underlying health conditions that are rarely addressed in the ER. These include anxiety and fear associated with the accident itself. For instance, seniors may become very anxious about falling leading them to stop many of their daily activities including exercise, walking, working around the house, gardening and so on. This lack of activity in turn leads to a decline in physical fitness and health.
The Kaiser article also suggests that sudden onset dementia or delirium related to or precipitating the accident and the ER visit may go undetected leading to greater likelihood of additional accidents as well as cognitive declines. In addition, the accident along with diminished capacity can cause or aggravate depression. Depression itself can be devastating to seniors causing them to give up activities and social interactions. In short, a seemingly simple medical condition like a broken arm can be disastrous when the senior is not addressed on the whole.
Emergency Room Geriatric Care Accreditation
The ACEP guidelines call for education of emergency medical staff in basic principles and practice of geriatric care geriatric care. Among the basic tasks are cognitive evaluations, fall risk assessment, functional evaluations, comprehensive medication reviews, referrals to community resources and creating easily understood and easy to follow discharge plans.
To put the guidelines into practice, ACEP will be launching an accreditation program for emergency rooms. The accreditation will certify “at least a minimal level of geriatric competence”.
Protecting Your Elderly Loved One
The Kaiser Health article sets forth several things that you can do to protect your loved one. The gist of it is communication and follow through. It is important to accompany your loved one to the ER. When you do go, you should take a list of all active prescription medications and knowledge of your loved one’s overall health condition. Make sure your loved one is viewed on the whole with consideration of all medical conditions. As part of this, a full review of medications is very important.
Basically, the medical providers should be provided all the information that you have available from both your loved one’s medical history as well as your own observations of how he or she is doing. Make sure the issues are addressed with a prescribed course of action. This should be laid out in the discharge plans which you should go through with your loved one and the medical providers to make sure everyone is on the same page.
The ER Need Not Lead to Disability
Kaiser Health citing research published in the Annals of Emergency Medicine states that:
“Six months after visiting the ER, seniors were 14 percent more likely to have acquired a disability — an inability to independently bathe, dress, climb down a flight of stairs, shop, manage finances or carry a package, for instance — than older adults of the same age, with a similar set of illnesses, who didn’t end up in the ER.”
This need not be the case. With properly trained ER staff and a little help from their loved ones, a senior need not suffer disabilities following a routine visit to the ER.
For Elder Health, Trips To The ER Are Often A Tipping Point | Kaiser Health News
For Elder Health, Trips To The ER Are Often A Tipping Point | Kaiser Health News “Just because someone in their 70s or 80s isn’t admitted to a hospital doesn’t mean that everything is fine,” said Dr. Timothy Platt-Mills, co-director of geriatric emergency medicine at the University of North Carolina School of Medicine, who recounted the story of his former neighbor in Chapel Hill.
Quite the contrary: An older person’s trip to the ER often signals a serious health challenge and should serve as a wake-up call for caregivers and relatives.
Research published last year in the Annals of Emergency Medicine underscores the risks. Six months after visiting the ER, seniors were 14 percent more likely to have acquired a disability — an inability to independently bathe, dress, climb down a flight of stairs, shop, manage finances or carry a package, for instance — than older adults of the same age, with a similar set of illnesses, who didn’t end up in the ER.
Impact of Emergency Department Visits and Hospitalization on Mobility Among Community-Dwelling Older Adults – The American Journal of Medicine
Impact of Emergency Department Visits and Hospitalization on Mobility Among Community-Dwelling Older Adults – The American Journal of Medicine •Older adults experience decreased community mobility without recovery after emergency department visits.•Participants with an emergency department visit did not recover to pre-event life-space level in year after event.•Factors associated with mobility decline after emergency department visits were age and activities of daily living difficulty.