Posts Tagged "delirium"

Emergency Response…Or Crisis Mode?

Posted by on Mar 11, 2013 in Health Emergencies | 0 comments

As family members age, it’s more and more likely that we’ll be faced with an “eldercare event” – a sudden, dramatic change in the status quo, usually related to health. Here are some common examples of what can happen: A frail older person, living alone, suffers a fall, a stroke, or a heart attack and is hospitalized. She must now leave the hospital but cannot safely live alone any more. A healthy spouse who cares for a frail senior dies suddenly. Family members are scattered throughout the country or live overseas. Your parent lives alone, several provinces away. Your last few phone conversations have seemed strange; your parent is rambling and, occasionally, incoherent. Your phone rings at work. The local hospital informs you that Dad has been admitted to the emergency department. We hope we will never have to deal with situations like these, but it’s unrealistic to believe either that it won’t happen to us or that “we’ll deal with it when something happens”. When eldercare events occur, it helps everyone if we respond and cope well. Otherwise, we may become part of the problem, not part of the solution. Here are four steps you can take to prevent an emergency turning into a crisis:  Acknowledge your emotions Even if you have thought about how you might deal with an elder care event, you cannot predict how you will feel when it happens. Elder care events can involve complex decisions, time pressures and the need to navigate unfamiliar situations and new relationships. Aim to reach a level of calm before responding to the news. Everyone can benefit from deep breathing and a few quiet minutes to wait for the adrenalin rush to subside. Change your self-talk if it’s making you more anxious. Self-talk can either increase your panic, or guide you to a more reasoned response. Tell yourself:  “I am calm and capable. I have handled other difficult situations and I will handle this one, too.” Remember the resources you have drawn on in the past to calm yourself and make reasoned decisions. Assemble your support team. Who might I ask to come and stay with me? Who can give me emotional support on the phone? Who else do I need to call to let them know what is happening? Who can I contact to help me figure out what the right thing is to do for someone else? Implement an Emergency Plan you have worked out in advance. Make a checklist. Some situations to consider: At home: Will you need someone to look after your children or anyone else at home that counts on your care? At work: Notify your supervisor. Ideally, you will have had a prior discussion that helps them prepare for this type of event. If you are at a distance from the event, who will you communicate with to monitor the situation? Will you need to travel? What will you take with you? What will you need if you may spend long hours in hospital? Can you pre-pack an emergency kit? What information and documents will you provide to help health care professionals?  Having a written plan, assembling your support team, and staying calm are important components of planning ahead for and managing an elder care event. © ElderWise Inc., 2013. You have permission to reprint this or any other ElderWise INFO article,if you reproduce it in its entirety, acknowledge our copyright, and include the following statement: Originally published by ElderWise Inc. We provide clear, concise and practical direction to Canadians with aging parents…and anyone wishing to do “age-smart” planning. Visit us at http://elderwise.memwebs.com/ and subscribe to our FREE...

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A Surprise Call From The Hospital

Posted by on Feb 23, 2011 in Health Care Team and System, Health Emergencies, Powers of Attorney | 0 comments

John’s aging parent,  Mary, 90, lives in another province. One day, he gets the call he has long dreaded: his mother has fallen, broken her wrist, and has been taken by ambulance to the hospital.  She has had surgery and her arm is in a cast. Is she ready to go home? Not so fast.  John is told that his mother is showing signs of mild cognitive impairment and that the discharge planner wants an assessment. John must call the doctor for more information. John manages to talk to the doctor later that day. He learns that Mary is doing very well physically, but the doctor is concerned about the possibility of dementia and has referred her to the Geriatric Team.  John asks if he should take time off work and come. The doctor advises him to wait a few days until the outcome of the assessment. During the next few days, John calls the hospital for updates. He talks to: the Registered Nurse on the unit; the Head Nurse on the unit; the Relief Nurse on shift; and the Discharge Planner. John is confused. Some of these professionals believe that Mary has signs of dementia while others are not sure. The discharge planner is concerned that Mary may not be safe to return home; John worries, because Mom has refused previous attempts to talk about moving to assisted living. Later, John hears from the Geriatric Case Manager that, for now, they have not confirmed dementia. His mother had delirium because of the injury, pain, unfamiliar environment and anxiety. Mary is moved to a transition unit.  Soon after, Mary calls John to tell him that she is discharged and will get home care. John wonders if she will accept strangers coming into her house because she has refused previous offers of household help. John takes a week’s vacation time and goes to help his mother. During his time there, he meets: the community care (home care) coordinator; the home care nurse; a home health aide; the transition coordinator; the geriatric case manager; and an occupational therapist. Collectively, they offer the following advice: Arrange for Meals on Wheels Make changes for safety at home: get a bathroom grab bar; remove scatter rugs; add a night light; get Mary an emergency response system Mary should accept home care services for help with bathing John should get Power of Attorney to look after Mary’s finances Mary should write a Personal Health Care Directive John is told that they will follow-up to monitor his mother’s safety at home. If she is not safe, the team will encourage her to move into assisted living.  John returns home and stays in daily phone contact with his mother. Contacting the health care professionals is difficult, given time zone differences and work schedules. They encourage him to talk to his mother so she can keep him up to date. But John senses that Mary is avoiding detailed questions. He assumes that she wants to appear to be doing well so that she can stay at home instead of living in a care home. Who am I supposed to talk to? How do I reconcile different opinions from the various professionals? Why is the medical team so guarded about what to tell me? When should I go help my mother – right away or when she is discharged? Will I have enough warning to arrange vacation time and travel? Why is Mom moving to another unit in the hospital? What is her diagnosis? What will she need from now on? On the medical team, who is responsible for what? Why are so many people involved? John finds out...

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Dementia, Depression or Delirium?

Posted by on Jan 18, 2011 in Health Signals | 0 comments

Three of the most common mental health problems experienced by the elderly start with the letter D: dementia, depression, and delirium. Their symptoms may, at times, appear similar. Comparing the conditions and highlighting the differences can alert you to when medical help may be needed. The most common form of dementia is Alzheimer Disease. Incidence increases with advancing age. It is not curable.  Depression affects about 10% of the general population, can occur at any age, and affects both men and women. Incidence is higher when other medical conditions are present. Delirium is often unrecognized and therefore not treated. To read the complete article in PDF format, open the attachment below. Dementia Depression Delirium...

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Seniors in the Emergency Room

Posted by on Sep 9, 2010 in Health Emergencies | 0 comments

  Each year in Canada, thousands of seniors arrive at a hospital emergency department (ER) – either by ambulance or accompanied by adult children. Many will make more than one visit within the year. About 50% of patients coming to the ER are over 65 years of age. The major reasons that older adults are taken to the ER include: falls; stroke; heart attack; infections; and delirium (acute confusion). For your parent, it may be more a matter of “when” rather than “if” this happens, so being prepared – with the right information and expectations – is key. It can help you to ease your way through the crisis, know what questions to ask, and to take care of your parent and yourself.  What to Expect The ER is often busy and seemingly chaotic. The experience can be frightening and exhausting – for the senior and for family members. You may be there for several hours and even more than one day!  All this time, your parent may be lying on an uncomfortable gurney. The ER might be drafty, too cold, or too hot.  It is likely to be noisy 24-hours a day. Staff is often operating at full speed to cope with the continued flow of patients, many with urgent or life-threatening illness or injury. Most will welcome your willingness to help a family member. What You Can Do Whatever caused the trip to the hospital is likely to interfere with your parent’s ability to speak and act for themselves. You can provide needed information, be a valuable advocate, provide comfort, and help prevent health complications such as delirium and deconditioning. It’s important to look after yourself at this demanding time, even though it may seem appropriate to set your own needs aside. Although the health crisis might pass within a day or so, what follows might require your ongoing support for a long time. For more details, consult the ElderWise e-guide Seniors in the ER Vol. 5, No. 11, © ElderWise Publishing 2009. You have permission to reprint this or any other ElderWise INFO article, provided you reproduce it in its entirety, acknowledge our copyright, and include the following statement: Originally published by ElderWise, Canada’s go-to place for “age-smart” planning. Visit us at http://elderwise.memwebs.com and subscribe to our FREE e-newsletter.  ...

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Four Signs You Need Immediate Medical Help

Posted by on Sep 8, 2010 in Health Emergencies | 0 comments

With today’s overtaxed health care system, we don’t want to seek medical attention unless it is necessary. Nor do we want to sit for hours in the Emergency Department – only to be told that the problem is a minor one. A senior might ignore symptoms, hoping that the problem will go away. They might think the symptoms are “normal at their age” and not seek treatment for treatable problems. Or they might fear a diagnosis and not want to face treatment. Sometimes, delay and avoidance can have serious consequences. Here are four important signs and symptoms that require immediate medical attention. Changes in mental state Sudden confusion and disorientation, or delirium, is cause for immediate concern. Significant changes in thinking or behaviour are not normal and can be caused by: infection head injury stroke low blood pressure, and/or medications. Seeing flashes of light Very brief flashes of light in the peripheral part of the vision can be a sign of retinal detachment. The retina is a thin layer of light-sensitive tissue at the back of the eye. To save vision in the affected eye, seek immediate medical care.  New or more severe headaches (especially if you’re over age 50) If you never or rarely have headaches and experience a sudden, persistent and severe headache you should seek urgent medical attention. Other symptoms that warrant urgent attention include: Sudden headache with stiff neck, or fever, or mental confusion Headache following a fall, injury, or blow to the head Shortness of breath If you have sudden, severe shortness of breath accompanied by chest pain or tightness, call 911. See your doctor right away if you are feeling short of breath and have other symptoms, such as:  High fever and chills Wheezing and coughing without exertion Swollen feet and ankles and difficulty breathing when you lie down Other worrisome symptoms Many provinces have telephone advice and health information services that operate 24 hours/day, 7 days a week. Trained registered nurses provide advice about health symptoms and help direct you to appropriate services. Here are some examples:  Health Link Alberta  Call from anywhere in the province by dialing: Calgary Health Region (403) 943-5465, Capital Health Region (780) 408-5465, or Toll-Free 1-866-408-5465 Health Link BC Just three numbers – 8-1-1 – on the phone or online at www.HealthLinkBC.ca  for non-emergency health information and services. Translation services are available in over 130 languages on request. For deaf and hearing-impaired assistance (TTY), call 7-1-1. Telehealth Ontario You do not need to provide your health insurance number and all information is confidential. 1-866-797-0000     TTY : 1-866-797-0007 Try searching online under “health link service” for other provinces. Accessing health link services may help you get timely answers and make an informed decision when troubling medical symptoms arise. © ElderWise, 2010. Vol. 6, No. 8 You have permission to reprint this or any other ElderWise INFO article, provided you reproduce it in its entirety, acknowledge our copyright, and include the following statement: Originally published by ElderWise, Canada’ go-to place for “age-smart” planning. Visit us at http://elderwise.memwebs.com/ and subscribe to our FREE...

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