Seniors: Implications of a Trip to the ER

February 20th, 2018

Recover Better from an ER Visit

When you’re in the emergency room, it’s hard to think beyond your immediate need for medical assistance. That’s why it’s important to consider the implications of a trip to the ER before you have one.

According to the Centers for Disease Control, 12% of adults 65 and older go to the ER with an injury, and 36% go for treatment of an illness. The numbers are higher for those over age 84: 25% for injury and 57% for illness.

These medical emergencies are “sentinel events” that may reveal more serious health issues, or impact your ability to return to your normal lifestyle.

A 2017 Yale University study of older people treated and released from the emergency department noted a “clinically meaningful decline in functional status” – meaning that study participants’ ability to live independently was diminished or lost – in the 6 months following discharge. The upshot for you: You’re especially vulnerable immediately after an ER admission.

This doesn’t have to be your story, however. With some advance planning, a little organization and an active role in your own care, you can avoid or mitigate negative consequences.

What to Do Before an ER Visit

You can complete two tasks right now to improve outcomes from a future medical emergency:

1.    Create a complete medical history. “The best possible thing is to always bring a concise but complete list of medical information, on paper, along for every ED visit,” asserts Ben Hippen, a Decorah, IA-based retired emergency physician. “It’s hard to overstate how important this is. It’s much better for the ED staff to have the full descriptions with medical terminology than an off-the-cuff informal description.” Your medical information should include:

• Current medications, including name, dosage, frequency, and whether you’re actually taking the medication as prescribed (be honest!)

• Allergies to anything, especially medication

• Your medical conditions and surgical procedures

• Advance directive preferences

• Contact information for an alternate decisionmaker if you aren’t able to make your own decisions

PRO TIPS: Ask your primary care physician to help you compile and update this information. Keep it in an envelope by the front door or another easy-to-access location, and upload digital copies or photos to your smartphone.

2.    Identify a “hospital buddy”. When we’re in pain or scared, it’s hard to keep up with a flurry of information and medical terminology. That’s why Nicole Rochester, a Gambrills, MD-based physician suggests finding a family member or trusted friend to accompany you to or meet you at the emergency department. The buddy should have your medical history and “take notes during the ED visit, paying close attention to the tests performed and their results, the diagnosis, treatment or medications, and any follow-up recommendations,” she says. Your buddy can ask questions or request that medical professionals “translate” into plainer language so you both understand what’s going on.

PRO TIP: Choose someone who lives nearby and has the ability to respond quickly. And make sure it’s someone you trust with personal medical information.

Checking off these items in advance of an unexpected trip to the emergency room makes triage faster and ensures the care team has the vital information it needs to deliver the right care. These tactics also help reduce anxiety and uncertainty during your visit, so you can focus on getting better.

How to Recuperate After an ER Visit

The key to doing well after you leave the emergency department is understanding what happened while you were there. Make sure you and/or your hospital buddy understand:

1.    The diagnosis. Confirm what, specifically, was diagnosed.

2.    The treatment. Review the medications given and procedures completed.

3.    Who will inform your primary care physician. Ask who will share information about your ER visit with your regular doctor.

4.    The discharge plan. Know what you need in terms of new medications, home care, mobility aids, personal medical alert systems, etc.

5.    The expectations and signs to watch for during recovery. Understand what you should be paying attention to related to mobility, cognition, healing, etc., to know whether or not you’re getting better.

The biggest mistake you can make after leaving the ER is not following the discharge plan. Sometimes, we don’t comply with doctor’s orders because we’re worried about costs or timeframe, or we think adherence will be hard. Other times, we don’t fully understand what we’re supposed to do or we think directives are unnecessary.

“If you don’t understand the discharge plan once you get home, or don’t feel like you can follow it, follow up with your primary physician or relevant specialist,” Hippen counsels.

Though most seniors go home from the ER and recover well, patients who don’t may pay a steep price physically and financially, especially seniors who’ve fallen down.

For instance, Hippen has seen many patients who fell after tripping or slipping. Regardless of whether the injuries were minor or life-threatening, Hippen would recommend that the throw rugs be removed to safeguard seniors with walking stability issues or decreased mobility (even if that’s short-term). “People almost always indicate understanding and agree, but very often when they get home the intention fades and the throw rugs stay in place,” Hippen laments. “It’s tragic to see a patient come to the ED with a minor injury after fall, be discharged home with clear instructions to remove throw rugs from their environment, and return some months later with a life-threatening head bleed after tripping over the very same rug. Events like this are preventable, and ED doctors try to address them in the post-discharge plan.” Learn more about other causes of falls.

Understanding the consequences of an ER visit before you experience a medical emergency is crucial to a strong recovery. You can prevent a trip to the emergency room from having a lasting impact on your life if you:

• Compile and carry a full medical history to help the ER team provide better care faster

• Understand exactly what diagnosis, tests and treatments you received during your visit

• Follow doctor’s orders to the letter to avoid complications, return trips to the ED and loss of independence and physical or cognitive ability

Be careful, be smart and be prepared!

Don’t disregard professional medical advice, or delay seeking it, because of what you read here. This information is not intended as a substitute for professional consultation, diagnosis or treatment; it is provided “as is” without any representations or warranties, express or implied. Always consult a healthcare provider if you have specific questions about any medical matter, and seek professional attention immediately if you think you or someone in your care may be suffering from a healthcare condition.