Examples: Going overboard with certain foods at holiday dinners (if you take a blood thinner, eating more than usual amounts of vitamin K–rich foods, such as brussels sprouts, broccoli or spinach, can interfere with your medication—or eating too many salty foods can worsen congestive heart failure)…indulging in too much alcohol (if you have diabetes, this can cause dangerous changes in blood sugar, as well as other problems for everyone else)…or falling (this can lead to a head injury or, if you have brittle bones, to a bone fracture).
Beware: Emergency medical care often precipitates the start of a serious decline for older adults. About one-fourth of adults over age 65 who required emergency treatment return to an ED within 90 days, and their chances of dying during the next year are significantly increased.
To get optimal emergency care—for yourself or for a loved one…
The older you are, the greater the odds that you’ll be making a trip to an ED. For example, in one recent year, 60% of 75-year-olds paid a visit to a hospital ED compared with 40% for the general population.
Many ED visits aren’t for true emergencies but rather for chronic medical conditions—such as a slight rise in average daily blood pressure in a patient with chronic high blood pressure—that could be better cared for by an internist or family doctor in his/her office.
Because most older adults have at least one—if not several—chronic illnesses, the best way to stay out of the ED is to have a primary care physician who regularly tends to your health needs. This way you’re less likely to have a health crisis.
Older adults also are at greater risk for ED visits due to their medication use—more than half of US adults ages 57 to 85 use five or more prescription and over-the-counter drugs, according to recent research. Any single medication can cause adverse effects, but taking more than one introduces the risk for serious interactions.
Caution: The risk for a dangerous drug interaction requiring emergency care is greatest if you’re under the care of several different doctors—each of whom may prescribe a new medication without knowing what else you are taking.
My advice: Make sure there’s someone—your internist or family doctor is the likely candidate—who knows all the drugs you’re taking and, ideally, is in communication with your other doctors.
Unless the situation is life-threatening—for example, a heart attack or stroke—emergency medical technicians and paramedics are usually obligated to take you to the hospital of your choice.
What you can do now: Before you become ill, call several hospitals near your home and find out whether board-certified emergency physicians practice in any of those facilities. Board certification ensures that a doctor has met a stringent set of goals for training and standards of care established for his specialty. Whenever possible, it’s best to be treated at a hospital where your primary care doctor has admitting privileges—he knows you best and has ready access to your medical records.
My advice: Check hospital Web sites and/or call the hospital’s main number and ask to speak to the “patient care coordinator” or “patient care administrator.”
Be sure to ask: How many older patients do you see? (At least one-fifth of the hospital’s patients should be age 65 or older.) Also, the hospital should have a geriatrics department or service.
You probably already know to bring a list of all medications you are taking with you when you visit any doctor or go to the hospital, but many people fail to include up-to-date information on dosages for each drug…any medication allergies they have…and/or supplements they’re taking. A complete list greatly improves the chances that you’ll get the drugs you need and won’t get those that will cause a dangerous interaction.
If you have heart disease: Carry a laminated, wallet-sized copy of your most recent electrocardiogram (ECG or EKG)—a test that measures electrical activity of the heart. If you have had bypass surgery or have a pacemaker or defibrillator, carry the information card that you received when you had the procedure.
Another smart idea: If you have a chronic medical condition, such as diabetes or lung disease, keep a copy of relevant medical records attached to your refrigerator with a magnet. Emergency medical technicians know to look there.
Your own doctor can’t make medical decisions or administer treatment at a hospital where he doesn’t have admitting privileges, but he can provide crucial details about your medical condition.
My advice: After you’ve made arrangements to get to the hospital, call your regular doctor to say you’re going to the ED—or give his name and phone number to a staff person once you get there.
It’s often recommended that you ask a friend or family member to accompany you to the ED if circumstances permit. This person can serve as your advocate, speaking with nurses and attendants to get you a glass of water, a urinal or help walking to the bathroom. In general, a familiar face and voice can be very comforting.
My advice: To be most effective, your advocate should remember to cooperate and respect the rules. For example, space is often tight in the ED, and it may be necessary to clear areas of everyone but patients and staff from time to time (such as during rounds when those coming off shift transfer information to the incoming team).
If your advocate must leave temporarily, he should ask the staff to let him know when he will be able to rejoin you. If your advocate believes that his presence will help calm you, he should try to stay by your bedside as long as possible.
