After the Emergency Room

What to know and what needs to happen next. 

It doesn’t matter whether it’s two in the afternoon or two in the morning. ER visits are chaotic, stressful, and exhausting.

And when you have older parents, that first visit is a rite of passage. For both of you.

It’s also a milestone that signals your journey is entering a new phase.

Here are some key points about what you need to know and what needs to happen next:

Things Are Changing

Regardless of whether your parent is admitted or sent home, a trip to the ER is a sign they are at or near a tipping point and need more help.

Maybe an existing condition is getting worse. Or an illness or emerging condition is starting to overwhelm their system.

Take falling, for example, the leading cause of injuries for older adults. Decades of research shows that many older adult falls are caused by a combination of personal and environmental risk factors that affect balance. So it’s not just dad’s chronic foot pain. It’s his chronic foot pain, poor vision, and a loose throw rug.

Any one of these risk factors is more than capable of causing a fall. But multiple risk factors greatly increase the likeliness that gravity will overwhelm dad’s ability to stay on his feet.

The Next Several Weeks Are Critical

Older adults are vulnerable for several weeks after an ER visit to conditions that can send them back to the hospital.

These ailments can be connected to the initial reason your parent went to the hospital. But they may also be unrelated, triggered by the stress of the hospitalization experience itself, a phenomenon called “post-hospital syndrome.”

It’s an “all too familiar scenario” writes retired emergency room physician Kenneth Frumkin, M.D.:

“A self-sufficient older patient visits the ER, often for a minor issue or injury. But what at first seems like a small setback begins a rapid functional decline and a loss of self-sufficiency that results in that patient returning to the hospital again and again… for any number of reasons — from opportunistic infections and unrelated injuries to entirely unexpected diseases.

“Each subsequent return to the hospital increases the likelihood of permanent functional loss and makes it more likely that the patient will need to be discharged into a long-term care facility.”

Dr. Frumkin’s clinical experience rings true for anyone who’s seen their parent’s health problem trigger a series of more frequent and debilitating problems.

This is why you need to watch your parent for cognitive, physical, or emotional changes after discharge. Warning signs include confusion, memory, or thinking problems, dizziness or balance problems, loss of appetite, and incontinence.

Falls are always a risk after any hospital stay. So is fear of falling, which can lead to deconditioning and social isolation — exactly the kind of downward spiral you want to avoid.

Mom Needs a Follow Up Visit

A follow up visit with mom’s primary care doc is essential, whether or not you notice any worrisome signs. Sooner is better than later. Here’s why:

  • A doctor needs to reassess mom’s condition. Maybe mom’s urgent need to urinate is nothing to worry about. Or maybe it’s the early stages of a urinary tract infection. What’s causing mom’s dizziness? New meds from the ER doc? Lack of sleep? Or something else? Whatever it is, catch it early and avoid another hospital visit. 
  • You want to better understand the underlying factors that sent mom to the ER. Is this an existing condition or something new? And how does this information affect how you and mom plan for future care?
  • If mobility is a problem, ask the doctor to prescribe a fall risk assessment and care plan from a licensed occupational or physical therapist. The sooner mom starts walking again, the better.

Time’s Up!

Sometimes, an ER visit is what it takes to focus attention and rethink priorities. In other words, if you’ve been waiting to talk with your parent about their wishes for the future, time’s up!

At the very least, you’ll need to find out if dad has a legal health care proxy and advanced directives. What about a financial power of attorney? And yes, you absolutely need to start talking about finances.

Maybe these documents are all part of a comprehensive estate plan that dad has in place. But don’t count on it. Too many families wait too long to discover that’s often not the case. 

Finally, if you’re updating siblings about dad’s condition, use this opportunity to start talking about how you can start working together to support dad and each other. Those conversations may not go the way you hope. But you won’t know unless you make the effort.

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Thanks for caring,

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