Recognizing the Difference: Emergency vs. Behavioral Symptoms
Caregivers often face the difficult task of distinguishing a life-threatening emergency from typical, albeit distressing, behavioral symptoms of dementia. A sudden, significant change in a person's condition is a key indicator that something is medically wrong and is not simply a progression of the disease. Conditions like urinary tract infections (UTIs) or dehydration, for example, can cause a sudden onset of increased confusion or agitation, a state known as delirium.
When to Call 911 Immediately
Certain signs and symptoms in a dementia patient are universal red flags for a medical emergency and warrant an immediate 911 call. Do not delay if you observe any of the following:
- Unconsciousness or Loss of Consciousness: If your loved one is unresponsive or difficult to rouse.
- Stroke Symptoms: Use the FAST acronym (Face drooping, Arm weakness, Speech difficulty, Time to call 911). Other signs include sudden numbness on one side, severe headache, or trouble walking.
- Chest Pain or Shortness of Breath: This can indicate a heart attack or a serious respiratory issue. The patient may not be able to verbalize the pain.
- Uncontrolled Bleeding or Severe Injury: Following a fall or accident, if there is a deep wound or bleeding that won't stop with pressure.
- Seizure: A seizure lasting more than 5 minutes or occurring in a cluster is an emergency.
- Major Burn: Severe burns require immediate medical attention to prevent infection and other complications.
When to Call for Urgent Medical Advice
Not every crisis requires an ambulance, but some situations demand urgent medical assessment. Call your primary care physician or a telehealth service immediately for advice if you see:
- Sudden Increase in Confusion: While confusion is part of dementia, a dramatic, sudden worsening can signal an underlying infection or another treatable condition.
- Fever: Especially when accompanied by other signs of illness, as infections like pneumonia or UTIs can be life-threatening in elderly individuals.
- Fall with Potential Injury: If the patient fell and can't move or is in severe pain, especially in the head, neck, or back. Do not attempt to move them yourself.
- Signs of Dehydration: Look for a dry mouth, dizziness, or dark-colored urine. Dehydration can lead to more serious complications.
- Signs of Severe Pain: Dementia can impair communication, so watch for non-verbal cues like grimacing, moaning, or withdrawal. A sudden, significant increase in pain can indicate a fracture or other internal problem.
Preparing for the Emergency Call
When you need to call 911, having a prepared emergency information sheet can be invaluable. This information helps dispatchers and paramedics act quickly and appropriately.
Emergency Checklist
- Introduce your loved one's condition: Immediately state, "My loved one has dementia," so responders understand any communication difficulties.
- State the problem: Clearly and concisely describe the immediate situation, e.g., "He has fallen and is unconscious."
- Provide context: Explain what is normal behavior for your loved one and what has changed, e.g., "He is normally agitated but has been unusually lethargic today."
- Have key information ready: Keep an up-to-date document with:
- Patient's full name, date of birth, and known allergies.
- List of current medications and dosages.
- Contact information for their primary care doctor and pharmacy.
- Location of any advance directives, such as a Do Not Resuscitate (DNR) order.
- Identify Yourself: Introduce yourself and explain your relationship to the patient.
Comparison of Crisis vs. Behavior
| Feature | Medical Emergency | Typical Behavioral Change (not emergency) |
|---|---|---|
| Onset | Sudden and severe, often over hours or a day | Gradual, fluctuating, or part of a long-term pattern |
| Symptom | Unconsciousness, stroke signs, severe pain, high fever | Repetitive questioning, restlessness, harmless wandering |
| Root Cause | Underlying acute illness (e.g., UTI, pneumonia, fall) | Brain changes from dementia, frustration, or confusion |
| Urgency | Requires immediate, professional medical intervention | Can often be managed or de-escalated with calming techniques |
| Action | Call 911 and provide all known medical details | Adapt the environment, distract, reassure, and consult a doctor if persistent |
Actions While Waiting for Help
Once you have called 911, taking a few preparatory steps can help a medical team and keep your loved one safe.
- Create a safe, calm space. If possible, move the patient away from noise and overstimulation. A quiet room with dim lighting can help reduce anxiety.
- Clear a path. Ensure the way to the patient is clear for first responders. Secure any pets in a separate room.
- Have documents ready. Place the emergency information sheet and any advance directives near the front door where paramedics can find them easily.
- Communicate clearly. When first responders arrive, maintain eye contact, use simple sentences, and speak calmly to both the patient and the responders.
- Don't challenge reality. If the person is hallucinating or confused, calmly provide reassurance rather than arguing. Let the medical team know what you observe.
When to Re-evaluate and Plan Ahead
An emergency room visit can be a stressful and disorienting experience for a person with dementia. For caregivers, it's a sign to re-evaluate the home care situation. The Alzheimer's Association offers a 24/7 helpline and other resources to help caregivers better manage symptoms and prepare for future events. Planning ahead with an emergency kit, a list of contacts, and familiar comfort items can make a world of difference during a crisis. Ensure you have a healthcare proxy established to make decisions on your loved one's behalf if they are unable to.
Conclusion
Making the call to 911 for a dementia patient is a difficult decision, but it's a necessary one when a true medical emergency is suspected. The key is to recognize sudden, severe changes and differentiate them from the slower progression of dementia or typical behavioral issues. By preparing an emergency plan, keeping critical information organized, and trusting your instincts, you can ensure your loved one receives the appropriate care when they need it most. Acting swiftly and having a plan in place protects not only their health but also their dignity and safety during a time of crisis.
