Knowing When to Call the Doctor

The three levels

Level 1: Call 112 now (emergency). A life or serious function is at risk. Do not wait, do not drive yourself if an ambulance is possible and do not give food, drink or medicine unless advised.

Level 2: Call the doctor or go to urgent care today. Something significant is going on, and it should be checked within hours, not days, even if it is not an emergency.

Level 3: Book a visit or raise it at the next appointment. A change that should be assessed but is not urgent.

When you are unsure which level applies, choose the higher one, or call your doctor's number for advice.

Level 1: Call 112 now

Call 112 (or the ambulance number that works where you live; see ambulances and emergency numbers in india) for:

Heart and breathing - Chest pain, pressure or tightness lasting more than a few minutes, or spreading to the arm, jaw, back or stomach, with sweating, nausea or breathlessness. In older adults, a heart attack may show as breathlessness, weakness, sweating, indigestion or confusion without clear chest pain. - Severe breathlessness, difficulty speaking in sentences, blue or grey lips, gasping; see when breathlessness is an emergency. - Choking that does not clear.

Brain and nerves - Signs of stroke: face drooping, arm or leg weakness, slurred or confused speech, sudden loss of vision, sudden severe headache, sudden dizziness or loss of balance; note the time they began; see stroke warning signs and the first hour. - A seizure, or sudden unresponsiveness or inability to wake. - Sudden severe confusion or drowsiness, particularly with fever, breathlessness or a recent head injury.

Injury and bleeding - A fall with a head injury (especially on blood thinners), severe pain, a suspected fracture, an inability to move or a deformed limb; see what to do after a fall. - Heavy bleeding that does not stop with 10 to 15 minutes of firm pressure; vomiting blood or passing black tarry stools with weakness. - Severe burns, electric shock or heatstroke; see heat stroke and dehydration in seniors.

Metabolic and other - Low blood sugar with drowsiness, confusion or inability to swallow in a person with diabetes; see diabetes and low sugar emergencies. - A severe allergic reaction: swelling of the face, lips or throat, breathing difficulty, widespread rash. - Suspected poisoning or overdose. - Fever with confusion, fast breathing, shivering or cold clammy skin; sepsis can be rapidly dangerous. - Severe sudden abdominal pain or repeated vomiting with severe pain. - Thoughts or actions of self-harm; stay with the person; see depression in older adults.

While waiting: stay with the person, keep them calm and positioned safely, and bring the medicine list and emergency bag; see emergency bag for a hospital visit.

Level 2: Call the doctor today

Contact the doctor (or visit urgent care) the same day for:

• Fever (temperature at or above about 38 degrees Celsius, or a low temperature with feeling unwell), shivering or chills; see fever in older adults and digital thermometer guide.
• New or worsening confusion, drowsiness, agitation or a change in behaviour that is sudden; this can be delirium from infection, dehydration or medicines; see delirium in older adults.
• A fall, even without obvious injury, particularly if repeated, with dizziness or on blood thinners; see falls risk assessment at home.
• Cough, breathlessness or wheeze that is new or worse, a chest infection, a need for the reliever inhaler more often; see pneumonia prevention and recovery in seniors.
• Urinary symptoms: burning, frequent urination, cloudy or bloody urine, no urine for many hours, new incontinence.
• Vomiting or diarrhoea lasting more than a day, or with dehydration signs: dry mouth, very dark urine, dizziness, weakness; see diarrhoea and dehydration in seniors.
• Not eating or drinking for a day, or a rapid fall in intake.
• Swelling of the legs, face or abdomen, rapid weight gain (for example in heart failure); see heart failure at home guide and swollen legs in older adults.
• High or low blood pressure readings beyond the limits the doctor has given, or with symptoms; see how to measure blood pressure at home.
• Blood sugar persistently high or repeatedly low, or readings outside the doctor's range; see how to test blood sugar at home.
• Skin: a wound with spreading redness, heat, swelling, pus or smell; a new pressure sore, a blister or broken skin; see wound care at home for older adults and pressure ulcers: stages and care.
• Pain that is severe, new or not controlled by the usual plan.
• Bleeding: nosebleeds that keep returning, blood in urine or stools, unusual bruising, particularly on blood thinners; see atrial fibrillation and blood thinners.
• Eye, ear or mouth problems: sudden vision change, eye pain or redness, sudden hearing loss, severe toothache or facial swelling; see hearing loss home care guide and cataract and glaucoma home care.
• Medicine problems: vomiting that prevents taking essential medicines, a missed or doubled dose of an important medicine, a new rash or side effect after a medicine; see giving medicines safely at home.
• A significant change in mood, withdrawal, refusal of care, hallucinations or suspicion that is new.
• Black or very hard stools, no bowel movement for several days with pain or vomiting.
• Catheter or tube problems: blockage, no drainage, leaking, fever, redness; see catheter care basics for families.

Level 3: Book a visit soon

Book a visit for gradual weight loss, falling appetite or tiredness over weeks (see how to help an older adult with unintentional weight loss); slowly increasing forgetfulness (see mild cognitive impairment guide); gradual hearing or vision decline; low mood or loss of interest lasting more than two weeks; poor sleep, constipation or mild bladder problems; worsening stiffness or mobility; a changing lump, skin change or mole; mild stable ankle swelling; and for reviews of medicines, vaccinations and routine checks.

Why older adults look different

"No fever" or "no pain" does not mean "nothing". In later life, infections may cause confusion, falls or loss of appetite rather than fever or cough; heart attacks may have no chest pain; dehydration develops quickly and causes dizziness and confusion; some medicines mask or cause symptoms; pain is under-reported, especially in dementia, and may show as restlessness or refusal; and several conditions interact, so one flaring can look like another. Sudden change from the person's normal is the most important signal, so know the baseline: usual alertness, appetite, walking, sleep and mood.

Prepare so you can act fast

Ask the doctor for a written list of "call 112", "call today" and "mention at next visit" signs for your parent's conditions, with their baseline readings (usual blood pressure, sugar, oxygen level, weight), and keep it on the wall. Keep a thermometer and a blood pressure monitor, and a glucometer or oximeter if advised; learn to use them, and remember that oximeters have limits; see pulse oximeter guide and how often to check vitals. Keep a care diary to spot trends (see care diary and handover notes) and numbers handy for the family doctor, an after-hours line, a nearby hospital and 112 (see emergency contact card and medical summary). Brief attendants on the list, and make it safe for anyone to raise a worry; see training a new attendant: the first week and home doctor visits for the elderly.

How to describe the problem

When you call a doctor or the emergency number, say briefly who the person is (age, main conditions, medicines, especially blood thinners, insulin and heart medicines), what the problem is and how it differs from usual, when it started and how it has changed, and how bad it is: temperature, blood pressure, pulse, oxygen, sugar, breathing, alertness, pain, food, fluids, urine and stools. Mention any fall, new medicine, recent illness or hospital stay, any allergies and your parent's wishes about hospital care. Write down what the doctor advises, the time and the name, and ask: "What should I watch for, and when should I call back or go to hospital?"

Trust your instincts

Carers who know a person well often sense that something is wrong before any number changes. "He is just not right" is a valid reason to call. If the first response does not match what you see, ask again or seek another opinion.

For your own wellbeing

Making these decisions alone is tiring. Share the responsibility, and be kind to yourself if a call turns out to be minor; see caregiver burnout signs and prevention. For mental health support, a national tele-mental-health helpline (Tele-MANAS, 14416) has been announced; check the current number and service.

When to ask a professional

Ask your parent's doctor for a personalised warning-signs list and an after-hours plan. A nurse can teach you to take readings and observe. A pharmacist can advise on medicine concerns. For senior citizens' information and support, Elderline 14567 is a helpline; check current availability, and note that it is not an ambulance. In an emergency, call 112.