If you watch TV, you know that a hospital is where beautiful people like Dr. Ross and Nurse Hathaway save us from ourselves. Hospitals rank right up there with police stations for the largest number of fictional dramas we've watched forever. In addition to ER, think Grey's Anatomy, Scrubs, General Hospital, Chicago Hope.
Americans have a love affair with hospitals.
Even in real life, we think of doctors and nurses as the people who were working hard to make good grades while the rest of us were skipping class. I am pretty sure my brilliant, doctor friend Heather was walking around with a stethoscope at age four while I was still sticking playdoh up my nose.
This romantic affection for hospitals is not entirely misplaced. There are zillions of people who need life-saving surgery and who live longer because a hospital was able to treat them effectively. ERs in public hospitals handle an onslaught of some of society's toughest cases; drug addiction, mental illness, and homelessness.
But, you don't want to start your caregiver journey in a hospital.
This is sort of like taking your first tennis lesson at Wimbledon. Unfortunately, though, this is often where it starts -- you begin in a lovely state of denial about your parent's frailty. The possibility of something bad happening is hovering there in the back of your mind and then one day you can't ignore it any more because ...you get the call.
And you're off, navigating one of the most dangerous places an older adult can be. Government researchers found that about 14 percent of older adults (65+, Medicare beneficiaries) experienced very serious consequences as a result of hospitalization.
Hospitalizations provide a raft of opportunities for harm that are unique to very frail, older adults, like loss of muscle strength and delirium which trigger and exacerbate the downward cycle of dependency and frailty that often lead to nursing home placement.
The very best way to deal with the trauma of a hospital stay is to avoid the trauma in the first place. The following are three things that can land your parents in the hospital and some tips on avoiding them.
If I were writing a song about it, it might go, "It's all about those falls, 'bout those falls..." Yep.
Seriously, once you turn 65, your greatest chance of injury comes from falling. A third of all older adults fall every year and the direct medical cost to the country in 2013, from older adults falling, was $34 billion, according to the Centers for Disease Control (CDC).
Let's pause here and just acknowledge that, if your mom insists on getting on a ladder to get in her attic, like Roz Chast's mom in her memoir, "Can't We Talk About Something More Pleasant?", there isn't much you can do about it.
One of the key principles of Daughterhood is that letting go of control is an act of power. So, this isn't about doing anything perfectly or getting it all just right. It's about having knowledge that might make a difference. And here's the knowledge from the CDC and other sources.
- Vitamin D supplementation. It seems that Vitamin D may help your body absorb Calcium, which is important to bone health, which in turn provides the stability and strength needed to stay upright!
Medication problems are another big reason older adults fall, but they can cause so many other problems that they get their own category.
Rule of Thumb: The more medications your mom or dad is on, the greater the likelihood for problems with interactions, side effects, and the chance it all gets mismanaged. So talk to the doctor about your parent's true goals and whether there are opportunities to eliminate medications and bring others down to the lowest dose.
Psychoactive medications like benzodiazapines (think Valium, Xanax), over the counter sedatives (like Benadryl), can actually impair balance so your mom or dad -- if willing! -- should ask the doctor: "What medications should I get off if avoiding falls is my number one priority?!" Note that being proactive in your parents' care can cause friction between you and physicians. You have to be prepared to challenge authority even if it's a little bit intimidating.
If there's something in this country that our medical system loves and pays a lot of money for, it's surgery. But, I can't tell you how many times I've heard about how much more harm than good came from surgery. "After the anesthesia, Mom was never the same."
It's just super dangerous and complicated for frail older adults and I encourage you to get multiple opinions. This is a good time to ask yourself and your parent, "What's most important at this point in life? And, will this surgery help accomplish it or put it at risk?"
Hospital interventions that work for a 45-year-old do not work for an 85-year-old. I keep hoping that, as the population ages, medical training will catch up to the reality of these differences.
Perhaps most important of all is to work with a physician who understands and supports your parents goals. And, work ahead of time with the doctor for strategies to avoid the emergency room, even when the after-hours doctor's office recording says, "go to the emergency room!"