Recognizing Red Flags for an Emergency
It can be difficult to determine a medical emergency in someone with dementia, as communication can be impaired and pain may be expressed through unusual behaviors. However, several critical signs should trigger an immediate call to 911.
Life-Threatening Symptoms Requiring an Ambulance
Call 911 immediately if you observe any of the following potentially life-threatening conditions:
- Trouble breathing or shortness of breath: This could signal a heart or lung problem, such as pneumonia, a frequent cause of hospitalization for people with dementia.
- Chest pain or pressure: These are classic signs of a heart attack that require immediate medical attention.
- Loss of consciousness or fainting: Unexplained loss of consciousness is a serious sign of a medical problem.
- Symptoms of a stroke: Look for sudden weakness, numbness, difficulty speaking, confusion, or a severe headache.
- Uncontrolled bleeding: Any bleeding that cannot be stopped, including coughing or vomiting blood.
- Seizure: A seizure involves uncontrolled shaking and potential loss of consciousness and needs urgent care.
- Severe allergic reaction: Signs like swelling of the face or throat, or trouble breathing, require immediate help.
- Major injury from a fall: Especially if there is a suspected broken bone, head injury, or if the person is unable to be moved safely.
Sudden Changes That Indicate an Emergency
A sudden change in a person's physical or mental status can signal an underlying medical issue, a state known as delirium. Delirium is not the same as a person's typical dementia symptoms and requires urgent medical evaluation.
Common causes of delirium include:
- Infections (especially urinary tract infections or pneumonia)
- Dehydration
- Medication side effects
- Pain
- Extreme confusion or disorientation that is worse than usual
- Sudden aggression, agitation, or hallucinations
If you observe these symptoms and they are a sudden, noticeable change from the person's baseline, it's best to contact a doctor or call 911 for guidance.
A Comparison of Urgent Situations
| Situation | When to Call 911 | When to Call a Doctor (Not 911) |
|---|---|---|
| Falls | Fall with head injury, severe pain, suspected broken bones, or inability to get up. | Fall with no apparent injury, but increased risk of future falls. |
| Behavior | Sudden, severe, or aggressive behavior where you cannot ensure safety for yourself or the person. | Increased agitation or restlessness that is manageable and potentially linked to a known trigger. |
| Cognition | Acute, rapid decline in mental status, or sudden, severe disorientation beyond baseline. | Gradual, slow progression of memory loss or confusion. |
| Medical | Chest pain, severe breathing trouble, stroke symptoms, uncontrolled bleeding, or loss of consciousness. | Signs of potential infection (fever) or dehydration that are caught early and not severe. |
Preparing for a Dementia Emergency
Before an emergency occurs, it's crucial to have a plan to minimize stress and ensure the best care possible. You can create a personal information sheet to give to first responders that contains vital information.
What to include on the information sheet:
- Personal Information: The person's full name, date of birth, and what they prefer to be called.
- Medical History: Their known medical conditions, including dementia diagnosis and severity.
- Medications: A list of all current medications, dosages, and frequency.
- Allergies: Any known allergies to medications or other substances.
- Emergency Contacts: The names and phone numbers of the primary caregiver and other family members.
- Communication Tips: Best ways to communicate, potential triggers, and methods to help them feel safe.
What to Tell the 911 Dispatcher
When you call 911, clearly state the person's location, the nature of the emergency, and that the person has dementia. Inform the dispatcher that communication may be difficult and that you have important medical information to provide.
Handling First Responders on the Scene
When first responders arrive, a calm environment is best for the person with dementia. Explain the situation clearly and give them the prepared information sheet. If the person with dementia becomes agitated or frightened, calmly explain that the first responders are there to help and reassure them. Don't argue with them about the situation. If the person with dementia is physically aggressive, warn the responders and explain that this is a symptom of their condition. You can provide them with a photo of a loved one or talk to them in a calm voice to help soothe them.
When to Contact a Doctor Instead
In non-life-threatening situations, contacting a primary care doctor first is often the best course of action. Examples include:
- A fever without other severe symptoms, if it's caught early.
- Dehydration if the person is still alert enough to drink fluids.
- Slight increases in confusion or agitation that do not pose an immediate safety risk.
A doctor may be able to provide guidance over the phone or arrange a home visit, potentially preventing an unnecessary and stressful trip to the emergency room. For more advice on hospital visits, the National Institute on Aging offers excellent resources, such as Taking a Person with Alzheimer's Disease to the Hospital.
Conclusion: Prioritizing Safety and Well-Being
Making the decision to call an ambulance for someone with dementia can be challenging, but prioritizing their safety is paramount. Knowing the clear signs of a life-threatening emergency, recognizing that sudden behavioral changes may indicate a medical problem, and having a preparedness plan can make all the difference. Always remember that when in doubt about a person's condition, it is safer to err on the side of caution and call 911 for professional guidance.
