Discharge Day: The Ten Things to Check Before You Leave
Most readmissions within a month trace back to something not understood at discharge. Twenty minutes of questions at the ward prevent a return trip.
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Looking after elderly parents means managing multiple conditions, multiple doctors and multiple medicines — usually while living in a different city. Here is how to make it work.
Consolidate the medical picture
Older adults frequently see several specialists who do not communicate with one another. The result is duplicated medicines, interacting drugs and nobody holding the whole picture. Identify one physician — usually a general physician or geriatrician — as the primary doctor who reviews everything.
Maintain a single file containing a current medicine list with doses and reasons, all diagnoses, allergies, recent reports, doctors' contact details, insurance information and emergency contacts. Keep a photograph of the medicine list on your phone. In an emergency, this file is worth more than anything else you can provide.
Medication review
- Ask annually: is every one of these medicines still necessary?
- Watch for prescribing cascades — a drug given to treat the side effect of another drug
- Certain drug classes carry higher risk in the elderly: sedatives, some antihistamines, anticholinergics and long-term NSAIDs
- Use a weekly pill organiser and set phone alarms
- Check for interactions whenever a new medicine is added by any doctor
- Do not add supplements or ayurvedic preparations without telling the primary doctor
Worth knowing
A confused or unsteady elderly person is far more often experiencing a medication side effect than a new disease. Always review the medicine list first.
Preventing falls
- Remove loose mats, trailing wires and clutter from walkways
- Improve lighting, especially on stairs and the route to the bathroom at night
- Install grab bars in the bathroom and beside the toilet; use a non-slip mat
- Review footwear — well-fitting closed shoes with grip, not loose slippers
- Treat cataracts and update spectacle prescriptions
- Check blood pressure sitting and standing to detect postural drops
- Encourage balance and leg strengthening exercise — this genuinely reduces fall rates
- Ensure adequate vitamin D and calcium
Screening and vaccination after 60
- Blood pressure at every visit; annual blood sugar and lipids
- Kidney and liver function annually
- Annual eye examination including glaucoma screening
- Hearing assessment — untreated hearing loss accelerates cognitive decline and social withdrawal
- Bone density in postmenopausal women and men over 70
- Cognitive screening if there are memory concerns
- Annual influenza vaccine, pneumococcal vaccine, and shingles vaccine where available
- Dental review annually
Warning signs that are easy to miss
Older adults often do not present typically. A urinary infection may cause confusion rather than burning urine. A heart attack may cause breathlessness or a fall rather than chest pain. Pneumonia may cause drowsiness without fever or cough.
Any sudden change in behaviour, alertness, appetite or mobility in an older adult deserves medical assessment, even without an obvious specific symptom. 'He is just not himself today' is a legitimate and often accurate clinical observation.
Caring from another city
- Identify a local relative, neighbour or attendant who can reach them quickly
- Keep the hospital's contact details and their file location known to that person
- Arrange periodic teleconsultation with the primary physician
- Set up automatic medicine delivery so refills are not missed
- Call at fixed times so that a missed call is itself a signal
- Discuss and document their wishes about treatment while they are well enough to express them clearly
Key takeaways
- Designate one primary physician to review all medicines and hold the whole picture.
- New confusion or unsteadiness in an elderly person is usually medication-related.
- Fall prevention — lighting, grab bars, footwear, vision and balance training — prevents hip fractures.
- Older adults present atypically; any sudden change in behaviour warrants assessment.
A note on medical advice
This article is general health education written and reviewed by the Department of General Medicine at SIMS. It is not a substitute for an examination, a diagnosis or the advice of your own treating doctor, and it cannot account for your history, medicines or reports. If a symptom is sudden or severe — chest pain, stroke symptoms, breathing difficulty, serious injury, seizures or heavy bleeding — call 9281862028 or come straight to the emergency department instead of reading further.
Elderly careSenior healthFallsMedication