Emergency Department Discharge of Older Adults with Viral Syndrome During the COVID-19 Pandemic

Supplement

Danya Khoujah MBBS, Pamela Martin FNP-BC, APRN GS-C, Aaron Malsch MSN, RN, GCNS-BC
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The Journal of Geriatric Emergency Medicine has a mission to improve emergency health care for older adults by providing open access, peer-reviewed, quality education and dissemination platform giving providers in all disciplines the evidence they need to enhance emergency care of older adults.

Below are discharge instructions for older adults and/or their families on discharge from the ED with a viral syndrome.

You or your loved one were seen in the emergency department (ED) with symptoms of a viral illness.

  • We are not sure what exact virus is causing this illness, and it might be COVID-19.
  • We did a rapid COVID test and you do/do NOT have COVID-19.
  • Testing is not available or testing is pending and will be ready on _________.
  • Your healthcare team thinks that you are well enough to go back home, and you do not need to stay in the hospital.

Below is some advice to help you through this time:

  • You have been evaluated by an emergency provider and your condition is stable/good/excellent.
  • You are safe to be sent home and will need to follow some simple instructions to ensure you do well.
  • Monitor your symptoms carefully. If your symptoms get worse or you have new symptoms, call your healthcare provider or your nearest ED immediately. They will direct you to the best place to get care. Examples of worrisome symptoms include:
    • Trouble breathing
    • Persistent pain or pressure in the chest
    • New confusion or the inability to be woken up
    • Diarrhea; Constant vomiting and not being able to keep anything down
    • Bluish lips or face

At Home Self-Care:

  • Separate yourself from other people in your home, this is known as “home isolation”
    • Stay away from others as much as possible. You should stay in a specific “sick room” if possible, and away from other people in your home.
    • Wear a mask if you absolutely need to go to a common space and keep 6 feet away from other people.
  • To prevent the spread of viruses at home:
    • Use a separate bathroom for sick household members (if possible.)
    • Clean your hands regularly with soap and water for at least 20 seconds or use a 60% alcohol-based hand sanitizer. Make sure you clean your hands especially after blowing your nose, sneezing, coughing, going to the bathroom, and before eating or preparing food.
    • Avoid touching your eyes, nose, and mouth with unwashed hands.
    • Cover your cough or sneeze with a tissue and then throw tissue away, or with your elbow.
    • Clean your bedroom and bathroom as needed to avoid contact with sick household members.
    • Avoid sharing personal items such as utensils, food, and drink.
    • Wash all utensils with very hot water after using.
  • Take acetaminophen, as directed, to help with fever and body aches.
  • Older adults are at a high risk of dehydration, especially when they are sick.
    • People need approximately 8- eight ounce (64 oz. total) glasses of fluids a day unless directed otherwise by their doctor.
    • Drink mostly water instead of sugary drinks or soda.
  • When people are as well as you are today, it is best for their health to recover at home. Patients in your condition do not require hospital care. Additionally, staying in the hospital has many risks especially during this time. Risks of hospital admissions include the following:
    • Infections that you may catch as a result of being in the hospital (hospital-acquired infections)
    • These hospital-acquired infections may not respond well to antibiotics (resistant infections)
    • Confusion may develop in hospitalized people (delirium) and falls can occur
    • Blood clots in the legs or lungs may develop in hospitalized people (thrombosis or pulmonary embolism)
    • Physical weakness may develop in hospitalized people (deconditioning) and gets worse with each day in the hospital.
  • Make sure the healthcare team in the ED reviews your home medications before prescribing any new medications.
    • Do not take any new over-the-counter medications or herbal supplements without asking a healthcare provider first.
  • If you have a medical appointment or referral from the ED be sure you call the healthcare provider ahead of time and tell them that you may have COVID-19.
  • The information that we have about COVID-19 is constantly changing as we are learning more about the disease:
    • Most patients will have symptoms such as cough, fever, and shortness of breath. Some patients may have vomiting and diarrhea. Others may have symptoms that look similar to heart attacks or other common diseases. Communicate changes in your symptoms to your doctor.
    • Sometimes patients with COVID do well for the first week of having COVID then suddenly get really sick. This is why it’s important to call your doctor or your closest ED if you have new or worsening symptoms.
    • Get your information from a reliable source only such as the Centers for Disease Control (CDC) or the World Health Organization (WHO).
  • It is natural to feel stress, anxiety, grief, and worry during this illness. Having to stay away from work, family, and friends is hard on the body and mind. While being sick can make it hard to do the things that you usually do, it is important to stay as active as possible.
    • Avoid laying in bed all day. Take walks around the house or outside while keeping 6 feet from others.
    • Watch/read the news in moderation (including social media). Constantly hearing about the pandemic can be upsetting. Read books, complete puzzles, or other activities to keep your mind active and focused on positive things.
    • Take frequent breaks from watching TV or sitting on the computer by walking around the room or stretching every hour.
    • Connect with others using the phone or the internet. It is important to talk about your feelings and concerns, and about things that are not related to the pandemic.
    • If you are feeling overwhelmed with emotions like difficulty sleeping, sadness, depression, or anxiety, reach out to the Disaster Distress Hotline (1-800-985-5990) or your local resource.
    • Being the caregiver of a person who is sick can be stressful and it is okay to ask for help. The Elder Care Locator can help you find community resources in your zip code: https://eldercare.acl.gov/Public/Index.aspx

Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19): Older Adults. March 21, 2020. Available on https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html

Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19): If You Are Sick or Caring for Someone. March 13, 2020. Available on https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/index.html

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