Communication barriers and challenges in informed consent in prehospital emergency medical services: A case report of an elderly patient with hearing impairment and dementia

Abstract

Background Older adults frequently require emergency medical services (EMS), and coexisting cognitive and sensory impairments can hinder history taking and informed consent in the prehospital environment. This case illustrates compounded communication failure caused by profound hearing loss without sign-language proficiency and dementia. Case presentation A woman born in 1939 was reported from a local market to 112 EMS with nausea and vomiting. Verbal communication could not be established; assessment identified complete hearing impairment, no sign-language knowledge and dementia. Relatives were contacted but could not attend, and medication history was unavailable. Vital signs were stable (BP 120/80 mmHg, pulse 72/min, SpO 2 98%, capillary glucose 208 mg/dL). Procedures were demonstrated using devices and gestures. Although she showed apparent non-verbal assent through head movements, this was not considered equivalent to informed consent; absent preparatory communication before fingerstick glucose testing triggered startle, fear and agitation, and subsequent procedures were interrupted. Pen-and-paper communication was only partially effective because of reading and comprehension difficulties. Hospital transport was recommended and consented to in writing. During transport, IV access and repeat glucose measurement were completed; ECG could not be obtained because of communication and consent barriers. The patient remained hemodynamically stable but agitated. Decision-making capacity was approached as task-specific and functional, but her ability to understand, weigh and communicate decisions could not be reliably verified. Conclusions Profound hearing loss combined with dementia can make prehospital consent and assessment ethically and operationally fragile, delaying care and limiting diagnostics. Structured communication aids and decision-support approaches for capacity and consent are needed.