Your 80-year-old father is in the intensive care unit with pneumonia and needs dialysis, likely on a permanent basis. Your 76-year-old mother with severe dementia is admitted to the hospital with sudden abdominal pain and…
Your 80-year-old father is in the intensive care unit with pneumonia and needs dialysis, likely on a permanent basis. Your 76-year-old mother with severe dementia is admitted to the hospital with sudden abdominal pain and faces emergency surgery. With more than 30 million adults in the U.S. over age 70 — a number that’s only increasing as Baby Boomers age — many of us are now or soon will be dealing with an elderly family member being hospitalized for an illness.
The most important thing to ask now is: Am I ready?
Families are often surprised about how illness and injury impact a loved one. Physicians frequently hear about how functional elderly patients were before they entered the hospital, that they were driving or mowing their lawns just the day before and were able to live independently. Although patients’ activity level and health status before they enter the hospital matters, illness in an 80- or 76-year-old is not the same as illness in a 50-year-old. Overwhelmingly, older patients require longer recoveries after serious illness or injury and are less likely than their younger counterparts to return to their prior quality of life.
As our parents and loved ones age, many of us will likely have to confront a hospitalization after an illness. These are the five most important questions you need to be prepared to answer.
1. Do you know what they want? First things first. The most important part of having these types of conversations is to understand what your loved one wants — and needs. Often in critical illness, older patients aren’t able to speak for themselves, and the true role of family members is to serve as interpreters. What would your family member tell us if he or she were able to? What kind of medical care would they want to pursue in this type of situation? Having these types of conversations before people get sick, although seemingly difficult, are imperative to ensuring your loved one receives the care they want to receive.
2. What treatments is your loved one currently receiving? Just as importantly, are these treatments or interventions uncomfortable or painful for the patient? It’s important to ask about expected benefits as well as the potential for any significant side effects or risks that could have long-term consequences on your loved one’s quality of life.
3. What treatment options are available? Modern medicine has afforded physicians and surgeons with a number of treatment options for patients, depending on what they want. As a family member making (or helping make) medical decisions, it’s important to know that there are options — even if that option may be to not pursue further interventions or to decline the current treatment plan. Asking for best-case and worst-case scenarios for treatments and interventions is often helpful in the decision-making process.
4. What’s next after hospitalization? What kind of help do you think they might need after they leave the hospital, and where will they receive this care? Recovery doesn’t end after a patient is discharged; on the contrary, it’s only the beginning. Even if a patient has been living independently at home, your loved one may not be able to return home or live independently after a significant illness or injury. Understanding what type of help or living situation would likely be needed, such as a nursing home or rehabilitation facility, and for how long, will guide discussions about treatments during the hospital stay.
5. What kind of quality of life can you expect after a hospitalization? Is my loved one at an increased risk of further complications or hospitalizations? “Recovery” can mean different things to different people, and it’s important to understand what life will potentially look like after your loved one leaves the hospital. Asking the physicians if your mom or dad will be able to participate in his or her favorite activities is a great place to start. In addition, asking about further risk is important, as a hospital stay now may mean an increased chance of a hospital stay in the future. For example, only a little over half of all elderly patients who sustain a hip fracture are able to return to a level of function similar to that before the fracture. In addition, even though the mortality immediately around a hip fracture surgery is relatively low, many people are surprised to find that approximately one-fourth of these patients will die within one year of surgery because of issues surrounding immobility. Knowing not only what’s happening in the hospital, but also what is likely to happen after the hospital, is key to making the decisions that are right for your loved one.
Navigating the health care of an elderly family member can seem intimidating, and especially so when that family member is critically ill. Asking these questions can help ensure you are truly providing the care that your loved one needs — and wants.