Tips on dealing with the demented patient in the ER

We've all been there: you get an ambulance call that EMS is bringing in an elderly patient who had a ground level fall and now their leg is shortened and externally rotated. Oh and by the way, they have dementia. Ugh...could your night get any worse? Here are some tips for dealing with the patients who are demented:

1. Enlist family support if at all possible. Make sure the nursing home or facility has sent a current next of kin notification and try to get the NH to call the family as they already have a working relationship with them.

2. Provide the patient with their hearing aid and/or glasses or dentures. It is difficult enough to deal with someone who is confused and even more so to try and understand them when they can't hear or see you or answer back because they don't have their dentures in place.

3. Try to keep the interruptions and interactions to as few people as possible. Ensure consistency of caregivers in the ER if at all possible.

4. The ER is a loud and bright place. When you are done with your assessment, try turning off the overhead lights but ensure that a directional light remains on just not directed at the pts face.

5. Confused people have pain. Treat their pain and yes, with narcotics.

6. Keep them close to the nurses station if possible to ensure adequate eyes on them. Some pts will not be aware that they are seriously ill or injured and might try to climb over the bedrails. Keep them in sight.


Reference:

Cohen-Mansfield, 2000