Ask Your Doctor
Good communication can enable you to get the most out of your visit to a physician or other healthcare professional. Being open and asking questions help toward understanding, and proper diagnosis and treatment. When accompanying your loved one to a doctor, bring current medications, notes on symptoms and other issues and a list of questions.
- What is the diagnosis?
- What other tests should be taken?
- Should we see a neurologist, geriatrician or other specialist?
- How does the disease progress (symptoms, time span)?
- What are all the available treatment options?
- What is the effectiveness of each medication, in terms of memory, behavior and other symptoms?
- What are the side effects, dosage, possible drug interactions, and pros and cons of each treatment?
- What changes in condition should we report to you?
- In addition to medication, what do you recommend in terms of diet, vitamins, physical exercise and other lifestyle changes?
- What mental exercises can we do to stimulate the brain?
- Are there any clinical drug trials that would be appropriate to participate in? What are the risks and benefits?
- What advice can you provide regarding care?
- Do you have information about community resources, such as support groups, educational workshops and services for my family?
- Will you be speaking with my loved one’s other doctors?
- How often should we make an appointment to see you?
Emergency Room Visits
An emergency room can be frightening and agitating for anyone, let alone for individuals with dementia. They almost always become more confused when they are brought to a new location, especially one as chaotic as an emergency department.
- If at all possible, a caregiver should discuss the need for an emergency department visit with the individual’s visiting nurse or primary physician first before going to the hospital.
- A physician should evaluate any individual with an acute change in functioning either cognitive or psychomotor. It is not always necessary for the person to visit the ER for this evaluation. However, if X-rays, blood testing, or other treatment and diagnostic modalities are necessary that are not usually available in a physician’s office, an ER is the only choice.
- In transporting someone with dementia to the ER, it is safer to use an ambulance, rather than one’s car, because they can be strapped onto a stretcher and monitored. Cars pose a risk since the person may open the car door while it is moving or fall during transfer in and out of the car.
- It is critical for one responsible caregiver or relative to remain with the person with dementia at all times. This is to help with the individual’s orientation, and to provide a measure of support and safety.
- The accompanying caregiver has a major role in providing critical information to the physician. They should be prepared to give vital information about the individual, help the physician and staff position the person for the examination if they are able to do so, and minimize unnecessary interactions with the fully occupied staff members.
- At the initial encounter with the treating physician and nurse, caregivers should present their “credentials.” They should inform the physician and nurse about their background, experience, continuity, insights, and vantage points they may have concerning the individual.
- Caregivers should pack an ER kit and have it ready to go. It should include 1) A preprinted summary containing the individual’s medical history; key contact numbers such as family and friends, and health insurance provider; list of problems; allergies; and medications, including prescription drugs, over-the-counter and vitamins 2) Health insurance cards 3) Copies of legal documents, such as advance directive, do-not-resuscitate order, health care proxy, power of attorney and living will 4) Item of comfort, such as a family photo 5) Change of clothing, including adult briefs, if necessary.
- ER physicians will do a mental status examination on the individual with dementia to decide how to use the information they present.
- It is always advantageous to have a team approach to evaluate individuals with dementia. A gerontologist is a key member of this team.
- ER rooms triage priority cases in the following way: Each presenting complaint, vital signs and history at triage provide an Emergency Severity Index (ESI) level. Hospitals use a five level system, with number one representing the sickest clients. Within each level, the frail elderly, including the geriatric person with dementia, would come first.
- If an individual is stable and waiting for test results, consultation or perhaps, in some situations, an in-patient bed, it is best for caregivers to take them out of the main emergency department to a quieter place.
- The caregiver is entitled to a complete debriefing about the individual’s condition. But be patient. Until all of the information has been obtained and evaluated physicians prefer not to have to stop what they are doing to answer questions that will be covered more comprehensively once the evaluation is completed.
Based on an interview with Sheldon Jacobson, M.D., chairman of the Department of Emergency Medicine at the Mount Sinai School of Medicine in New York City, and one of the founders of New York City’s first emergency medicine and paramedic training programs.