Shingles — prevention, treatment, and the pain that lingers

This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.

You got a call at work. Your mother fell. It was bad enough that she went to the emergency room, and they want to admit her to the hospital. Your first feeling is relief. She's going to get care. She's going to be monitored. She's going to be safe in a place where there are doctors and nurses and equipment. You take it for granted that hospital is better than home in a crisis. Most of the time it is. But there's a side of hospitalization that nobody warns you about ahead of time, a reality that becomes visible around day three or four when you realize that the hospital itself is creating new problems as it tries to solve the original problem.

Your father spent two nights in the hospital after a procedure that went fine. When he came home, he was weaker than he was going in. He couldn't walk as far. He seemed confused about things he had understood before. You asked the hospital why this happened and basically got a shrug. They said it happens. You asked if there was something they did wrong and the answer was not quite no. It was more like: your father is elderly, hospitals are disorienting, sometimes people decompensate.

This is the paradox that nobody talks about clearly. Hospitals save lives. Hospitals also, in the case of elderly patients especially, create new medical crises in the process. A person can enter with one problem and exit with that problem plus several new complications they didn't have when they arrived. And because the complications developed while the person was in the hospital, being treated by competent professionals, it gets coded as "complications" or "expected outcomes for someone elderly" rather than as a problem that could have been prevented.

The reality is more honest and more actionable: there are specific risks that older people face in hospitals, and there are specific things you can do to reduce those risks. You can't eliminate them. But you can make a difference.

The Paradox

Start here because it explains the whole situation. The hospital is full of equipment and people trained to use it. When your parent needs urgent care, they need it badly. You would not choose home over a hospital if your parent is having a heart attack or a severe infection. The hospital is lifesaving.

But hospitals are also strange, disorienting environments designed for efficiency rather than for the comfort and safety of confused older people. There are alarms going off. The lighting is artificial and often dim. The noise level is higher than a home. There are multiple people coming in and out. Shift changes happen and nobody tells your parent. Medications are given but the schedule is different from home. The bed is uncomfortable. Nobody has asked about habits or preferences. Your parent's sleep is interrupted. They don't know where the bathroom is. They don't know what time it is. They're hungry or they can't eat. The hospital is solving the original medical problem while simultaneously creating psychological and environmental stress that their body is not well-equipped to handle.

And here's where it gets particularly rough: hospitals are built for younger people who can tolerate noise, disruption, and discomfort. For an older person, the same disruption that's just mildly annoying to a 40-year-old is actually a serious stressor that accelerates decline.

The Risks

Several specific things tend to happen to older people in hospitals, and understanding them ahead of time means you can watch for them and sometimes prevent them.

Delirium is probably the most dramatic. Your parent arrives coherent and oriented. Within hours or a day or two, they're confused. They don't know what day it is. They think they're somewhere else. They're agitated or they're somnolent. They don't recognize people. This happens to thirty to forty percent of hospitalized older people. Most hospitals will tell you it's expected, that it will resolve when your parent goes home. Sometimes it does. Sometimes it doesn't. Sometimes the delirium is so severe that your parent is a safety risk to themselves or becomes aggressive. Delirium is often caused by multiple factors: the medication they're on, the sleep deprivation, the infection that brought them to the hospital in the first place, the dehydration that often happens in hospitals. You can sometimes reduce it by making the environment less disorienting—a calendar on the wall, letting in natural light, having family present, making sure your parent is reoriented frequently.

Falls happen. Your parent is weak, or the medication is making them dizzy, or they don't know where the bathroom is, or they're trying to get up at night without calling for help because they're confused or embarrassed or trying to be independent. Hospitals have programs to prevent falls, but the programs aren't perfect, and older people fall anyway. Then your parent breaks a hip or hits their head, and suddenly the hospitalization is twice as complicated.

Infections develop. Hospital-acquired infections are real. Your parent could go in with pneumonia and come out with pneumonia plus a hospital-acquired infection from being in a hospital. It sounds like it shouldn't happen in a place that's supposed to be clean and staffed with trained people, but it does. Sometimes it's a catheter infection. Sometimes it's a blood-stream infection. The risk increases the longer your parent stays.

Deconditioning happens faster than you'd expect. Three days in a hospital bed without moving much makes muscles weak. Your parent goes in walking and comes out needing a walker. Or goes in with a walker and comes out needing a wheelchair. The medical reason for being in the hospital is improving, but their functional status is declining because they've been immobile. By the time anyone thinks to get them up and moving, days have passed and the muscle loss is already starting to compound.

Medication errors happen. Someone transcribes a medication list incorrectly. Someone gives the wrong medication or the wrong dose. Someone doesn't know that your parent is allergic to something and gives it. These events are rare, but they happen. They happen in good hospitals with good people. It's a system problem, not usually a people problem.

Pressure ulcers develop. If your parent is immobile, if they're not being turned regularly, if they're incontinent—which can happen in a hospital if nobody's paying attention to bathroom schedules—skin breaks down. A pressure ulcer can start forming within days. Once it starts, it's hard to heal, especially in older people.

Depression and trauma can result from the hospitalization itself. Your parent is sick, they're scared, they're in pain, they're in a strange place, their dignity is being compromised. After discharge, they sometimes have anxiety about being in hospitals again, or about being alone, or about their health. Some older people come out of a hospitalization with depression that didn't exist before.

What You Can Do During the Stay

You cannot prevent all of these things. The hospital is going to do what it's going to do. But your presence and your advocacy matter more than you might think.

Be present when you reasonably can be. Your presence alone reduces some of the risks. Your parent is less likely to fall if someone is there with them. They're less likely to be confused if there's a familiar face. Your presence tells them they're not completely alone in this strange place.

Be informed. Know why your parent is in the hospital. Know what they're being treated for. Know what the plan is. This information matters because you can then ask questions if things don't seem to be going as planned. If your parent's condition seems to be getting worse instead of better, ask why. If they're giving a medication your parent told you they can't take, ask about it.

Be an advocate. If something doesn't seem right, say something. If your parent is confused and nobody's addressing it, mention it to the medical team. If your parent hasn't eaten in a while, ask about it. If your parent fell and the incident report says something that doesn't match what your parent told you, ask questions. You're not trying to catch someone in a lie or accuse anyone of negligence. You're trying to make sure things are getting noticed and addressed.

Review the medication list. When your parent is admitted, get a copy of the medications they were on at home. When medications are changed or added, make sure everyone agrees on what's being given. Ask the pharmacist or the nurse about any medication you don't recognize. Ask about side effects. Ask if the medication could be interacting with anything else.

Keep the environment less disorienting. Bring a calendar. Bring a clock if the room doesn't have one. Bring something that smells like home,a familiar pillow in a colored pillowcase, for example. Talk to your parent about what day it is, what time it is, where they are, and why they're there. These small things reduce delirium.

Make sure your parent is getting moving. If they're capable of sitting in a chair, they should be. If they can walk, even with help, walking should happen. The longer someone lies in a bed, the harder it is to recover. Work with the physical therapists. Ask about getting your parent up and moving.

Keep track of what your parent actually eats and drinks. If they're not eating or drinking, the hospital staff needs to know because it affects healing and medication absorption. If there's a reason your parent isn't eating,they don't like the food, they're having trouble chewing, they're confused about when to eat,that's something to mention to the nursing staff.

Keep a list of your parent's medications and conditions. Tape it to their hospital chart or give it to the nursing staff. Include allergies. Include medications they can't take because of reactions or interactions. Include the names and contact information of their doctors. This becomes especially important if your parent is transferred between units or if shift changes happen.

The Discharge Problem

Here's where a lot of families get ambushed. Your parent is discharged from the hospital and suddenly they're your responsibility, and they're weaker and more fragile than they were before, and nobody gave you a clear plan for what's supposed to happen next.

Sometimes your parent is sent home too soon. They're still weak. They're still recovering from the original problem. They have a new medication they don't understand. They need physical therapy but can't figure out how to arrange it. They're supposed to follow up with their doctor but the appointment isn't scheduled yet. They get home and then within days they're back in the emergency room because something went wrong, or because they fell, or because the medication wasn't right.

Sometimes the discharge instructions don't make sense. Your parent is supposed to restrict salt but they also have a medication that makes them retain fluid and they're supposed to drink enough water to prevent kidney problems but not too much or something else gets worse. It's contradictory. It's overwhelming. Your parent doesn't know what to actually do.

Sometimes there's no bridge from hospital to home. Your parent is discharged during the day, your parent gets home, and it's evening and something is wrong and your parent doesn't know if it's serious or normal or who to call. The hospital said "if you have questions, call your doctor," but the doctor's office is closed. Is this worth an emergency room visit or not? There's nobody to ask.

Be in the discharge planning process. Before your parent is discharged, talk to the discharge planner or the social worker. Ask: where is my parent going after this? Do they need physical therapy? Do they need home health nursing? Do they need equipment like a walker or a shower chair? Is any of that being arranged or is that my responsibility? What are the new medications and what are they for? What side effects should I watch for? What should my parent be able to do when they get home? What should they avoid? What's the follow-up plan with the doctor?

Get instructions in writing. The discharge paperwork should explain what to do, what medications to take, what to watch for, who to call if there are problems. If it doesn't, ask for that information. Don't leave the hospital without understanding the next steps.

Schedule follow-up appointments. Don't assume they're scheduled. Call the primary care doctor and the specialists and confirm that appointments are actually scheduled. Don't wait a week hoping the hospital will arrange it.

Make sure your parent has the medications. Sometimes discharge happens and the medications haven't been filled yet. This should have been handled before discharge. If it wasn't, it's your job to make sure your parent gets them filled as soon as possible.

Planning for the Next Time

Here's the thing nobody wants to think about: if your parent needed hospitalization once, they probably need it again at some point. This isn't pessimism. This is statistics. Most people who are hospitalized will be hospitalized again.

So while your parent is still recovering from this hospitalization, think about what you'd do differently next time. Did something go wrong that could be prevented? Did communication break down somewhere? Did your parent get confused about what was happening? Did the discharge go smoothly or was it chaotic? Use what you learned to improve the next experience.

Keep that master medication list updated. Keep a record of your parent's conditions, allergies, and previous hospitalizations. If your parent has to go to the hospital again, you'll already have the information organized.

Have conversations with your parent about their preferences for care. If they're very old or very ill, they might have preferences about what kind of interventions they want if something serious happens. Do they want to be resuscitated if their heart stops? Do they want to be on a ventilator if they can't breathe on their own? These conversations are hard, but having them ahead of time means your parent's wishes are known. If you don't know what your parent wants, ask them. Don't wait for a crisis.

The reality is that hospitalizations happen, and they can be complicated. But they're more survivable and your parent comes out in better condition when someone is paying attention, asking questions, and making sure the system is actually working well for your parent specifically, not just in general.

How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. If a loved one is hospitalized or facing a hospital stay, speak with their healthcare team about their individual risks and what you can do to support their safety and recovery.