The Medical Words That Can Save Your Life When You’re Older
When my mother went to the hospital for a serious urinary tract infection, that malady got treated.
But she almost didn’t get out of the hospital alive, with something that happened while she was there.
You see, she was 93, and 93-year-olds present illness in different ways from younger folks. Often, “simple” problems, such as infections and pneumonias, that are generally treatable, have symptoms that can become much worse after time spent at a medical facility. Because, for an older person, a urinary tract infection can also impact their mental status. They can appear confused, weak, dizzy, and, yes, like they have dementia.
Hospital providers often consider these symptoms as just part of “old age.” Problem is, often they’re not. In fact, researchers claim that 50% of disability among older adults occurs after a patient is hospitalized.
And the older we are, the chance is greater that when we leave the hospital we won’t return to the level of independence we had before.
I saw that with my mom. As her infection got worse, so did her mental functioning. When I tried explaining that fact to her doctors and nurses, they shrugged it off, saying that people with dementia often reacted this way to infection. I disagreed. I adjured that she did not have dementia, didn’t act like this before she got the infection, and she was growing more and more confused. But to no avail. And, terrifying to see, as my mom’s infection cleared, her mental status did not.
But nothing I could say or do would convince her providers that what I was observing was anything out of the ordinary.
If I had only known the correct medical words, I would have gotten their attention. So much pain would have been avoided if I had only known to say:
“This is not my mother’s baseline.”
Why is that important? Because the word “baseline” is a medical term that describes what a patient, in this case my mother, was like before she got sick. It defines what activities she could do, and her mental status, before she contracted the urinary tract infection. Moreover, it’s the state we wanted her to return to after she’d been cured of what brought her to the hospital in the first place.
Unfortunately, as we were to learn, this critical piece of information is usually overlooked when seniors come to the hospital.
“Failure to assess functional status in hospitalized patients is the norm,” according to a study published in the Journal of General Internal Medicine. The decline that happens during an older person’s hospital stay becomes the patient’s “new normal.”
Research shows that “Hospitalization-Associated Disability” (“HAD”) occur in approximately one-third of patients older than 70 who are admitted to the hospital. Worse, these “step-downs can remain permanent if not taken into consideration at their onset.
This is scary stuff. So, is there anything we can do to protect our parents if they are ever admitted to the hospital?
Yes, say geriatricians — medical doctors who specialize in the care of older persons. . The best thing is to become familiar with that term — baseline. Make certain that your parent has a written “baseline assessment” prepared by their doctor. Encourage them to have their doctor also fill out a “health history form,” that includes their Activities of Daily Living” or ADL’s. ADL’s state what they can and can’t do, their level of independence and how much assistance they need.
Can our mom walk unaided? Can our dad manage his own medications? Can our parents cook for themselves, take care of their own finances? Do they have a good memory? These documents will succinctly describe your parent’s current level of functioning in terms doctors use. Plus, they can be referred to as the status quo to return to after being hospitalized.
For an excellent example of baseline, health history and ADL forms that your doctor can fill out, see The Gift of Caring: Saving Our Parents from the Perils of Modern Healthcare, by Houle and Eckstrom MD, July 2015.
Back to my mom: if I had only had that description of her baseline, including a health history form that defined her ADL’s, her treatment and her outcome while she was hospitalized would have been entirely different. Then, not knowing the medical lingo, I couldn’t get the provider’s attention. Now I know what to say.
I can quote the Journal of the American Medical Association, that reported, “baseline, ADL function, mobility and cognition … should be assessed on admission and in daily rounds (for older persons). …Functional status over the course of hospitalization is a vital sign that can help guide care and serve as a guidepost of clinical wellbeing.”
Then, armed with these medical forms, I can add in my own words,”
“That’s their baseline and I’m keeping to it.”
By Elizabeth Eckstrom, MD and Marcy Houle, MS
This is an excerpt from The Gift of Caring: Saving Our Parents from the Perils of Modern Healthcare