As Our Parents Age So Do We

After I my recent post on hospital induced delirium, people begin chatting with me, unsolicited, about their elderly parents’ hospital experiences. Admitting an aging parent to a hospital appears to instill significant anxiety and resignation in adult children.

The spontaneous conversations usually focused on the ways that hospitals, despite commitment to good medical practices, cheerful staff and a focus on providing quality patient experiences, are often not user-friendly for elderly adults. One size does not fit everyone when it comes to hospital patients who are elders, and often various policies unintentionally complicate their problems. Hospitals and medical staff can do much more to improve the experiences of older adults.

Sadly, most of us realized, the trend of emergency departments creating elder-friendly spaces has not accelerated. Neither has the number of geriatricians increased.

Below are a few of the stories that tumbled out in our conversations.

• One friend’s mom was confused in the emergency room — though she was rarely confused at home. The doctor assumed she had dementia and without asking prescribed an antipsychotic.
• A neighbor’s aging parent — in his 90s — was given a fall risk band. No one checked to see what he could and couldn’t do — and in fact, he was agile — but hospital personnel assumed he was a fall risk. After three days in a hospital bed, he had trouble walking.
• The daughter of a neighbor mentioned that her hospitalized father was told to press the button and wait for a nurse when he had to go to the bathroom, which he did. But time after time no one came one for more than 5 minutes, so he got out of bed. Then the alarm sounded and lots of people rushed to his room. Why, my friend wanted to know, would hospital personnel expect an 85-year-old to wait more than five minutes to go to the bathroom?.
• An acquaintance from church offered another, explaining that her strong and confident mom often got out of bed to go to the bathroom. The adult daughter overheard one nurse comment to another that the patient might need to be restrained.
• A stranger on the subway saw me reading an article on elders and medical care. He leaned over to tell me about the time his 90-something father walked into the hospital emergency department with a cold that led to complications and a fever, was confined to bed, and could not walk three days later when he was discharged to rehab. It took two months for him to regain his old mobility.
• A former colleague described how her mom walked into the hospital with a throat infection, was confined to bed, given antibiotics. and then developed a digestive tract infection. She died several days later. “My mom dressed herself and walked into the hospital and spoke clearly about the symptoms she needed assistance with,” the adult child said.

I’ve observed some of these situations when one of my parents is admitted to a hospital. I understand the concern about falls, but I don’t understand why patients aren’t evaluated within 24 hours to see if the fall risk classification is appropriate. Moreover, I really don’t get why medical personnel can’t arrive in a timely fashion to help an elder go to the bathroom.

Nights, I’ve found, are the worst times for elderly individuals who are confined in the hospital. The lights are on, people come in and out (when you do not need them), and there is the constant noise of the monitors. I usually spend the night at the hospital when one of my parents is admitted. It’s hard for me to get any shut-eye in that situation and doubly so for my elderly parent.

In her 2014 New York Times article for the paper’s Well BIog, Pauline W Chen, M.D. wrote that emergency departments are no place for older elders.

Is it too much to ask that when an elderly parent goes to the hospital, he or she gets treatment for the problem, no sleep interruptions, and prompt responses when they push the call button? Oh and then aim to get them out of there as soon as possible?