Elderly Parent Having a Seizure? What to Do and When to Call 911

When an elderly parent has a seizure, stay with them, keep them away from hard edges and stairs, and roll them onto their side if they aren't awake. Note the clock time it started. Don't hold them down and don't put anything in their mouth. Call 911 if it lasts longer than 5 minutes, if it's their first seizure, if another one follows, or if they're hurt, struggle to breathe or don't wake up.

This is general information to take to your parent's doctor, not medical advice. Their doctor's written plan always comes first.

Seizure first aid: stay, safe, side

The Epilepsy Foundation teaches seizure first aid as three words on its first aid poster (this copy is hosted by Indiana's education department). Lehigh Valley Health Network and the South Carolina Department of Public Health summarize the same steps:

1. Stay. Stay with your parent until they're awake and alert. Stay calm, start timing, and check for a medical ID if you can do it safely.
2. Safe. Guide them away from anything that could hurt them: the stove, the stairs, the corner of the coffee table.
3. Side. If they aren't awake and aware, turn them onto their side with the mouth toward the floor so the airway stays clear. Loosen anything tight around the neck and put something small and soft under the head.

For the whole-body kind of seizure that causes falling and jerking, MedlinePlus adds: help them to the floor in a safe spot, clear away furniture and anything sharp, and cushion the head. The CDC also says to take off their glasses. As they come around, LVHN's summary says to reassure them they're safe and tell them what happened.

What not to do

From MedlinePlus, the National Library of Medicine's consumer site, and the Foundation's poster:

• Don't hold them down or try to stop the movements.
• Don't put anything in their mouth. Not a spoon, not your fingers. LVHN's summary retires the old myth: a person can't swallow their tongue.
• Don't give water, food or pills by mouth until they're fully alert.
• Don't start CPR during the seizure. MedlinePlus says to start it only if the seizure has clearly stopped and they aren't breathing or have no pulse.
• Don't move them unless they're in danger where they are.

When to call 911

Between them, MedlinePlus and the Foundation's poster list these reasons to call 911:

• The seizure lasts longer than 5 minutes. (MedlinePlus's seizures page says more than 2 to 5 minutes; its epilepsy home care page says 5 minutes or longer.)
• Another seizure follows soon after the first.
• The person has trouble breathing or doesn't wake up afterward.
• They were injured during the seizure.
• It happened in water.
• It's their first seizure.
• They have diabetes.
• They're pregnant.

MedlinePlus also lists three more: they don't return to their normal behavior afterward, the seizure is different from their usual ones, or they have no medical ID.

Two of those matter more with an older parent. A first seizure at 75 is a 911 call by these rules, even if it stopped and your parent insists they feel fine. And "doesn't return to normal" is hard to judge if your parent already has memory problems, which is why the binder page below starts with their baseline.

A seizure can also be a sign of something else. Rush University Medical Center's neurologists note that a convulsion can signal a stroke or a bleed in the brain, and they say to always call 911 if you see someone convulsing. You don't have to sort out which. If you notice a drooping face, one-sided weakness or garbled speech, run through the checks in our guide to stroke signs in an elderly parent and tell the dispatcher what you saw.

If your parent has known epilepsy and a seizure action plan, their doctor may spell out exactly what counts as an emergency for them. Follow it. Without a written plan, use the list above, and if you're unsure, call.

What to time and what to notice

The most useful thing you can do during a seizure is look at a clock. MedlinePlus tells caregivers to note when it starts and how long it lasts.

Five minutes feels like twenty when it's your mother on the kitchen floor. Say the start time out loud or start the stopwatch on your phone. If someone else is there, one person times and the other does the first aid. Plain words beat medical ones:

Rush's older-adult epilepsy specialist suggests a phone video of episodes so the doctor can see what you saw. Film only if someone else is handling the first aid, or once your parent is on their side and safe.

The recovery period

MedlinePlus says seizure symptoms may stop after a few seconds or minutes or go on for up to 15 minutes, rarely longer, and some end in a spell of confusion. Rush calls the time after a seizure the post-ictal period and says it tends to last longer in older adults than in younger people, many hours or even days, with confusion and often no memory of it later. Stay with your parent through it.

Write down how long it takes them to come back to themselves. The paramedics and the doctor will both ask.

What to tell 911

Dispatchers are trained to ask specific questions. Calvert County, Maryland's 911 guidance lists four: the address, what the emergency is, your name and the number you're calling from, often followed by questions about the medical problem. Don't hang up until the dispatcher is finished, and on a cell phone be ready to describe your location in detail.

A clear first sentence saves time:

Then be ready to answer:

• First seizure ever, or known epilepsy?
• Is it still going, and how long has it lasted?
• Breathing, color, any injury
• Diabetes, past stroke, dementia, blood thinners
• Whether a rescue medicine was given, and at what time
• Whether there's a POLST or DNR. Have it in hand when the crew walks in; our POLST form guide explains how those orders work.

Hand the crew medicines and allergies in writing; a medication list built for the ER beats reciting it from memory.

Why seizures in older adults can look different

In older adults a seizure is often quieter than the fall-and-shake people picture. Rush lists five patterns to watch for:

• Repetitive lip smacking, hand movements or brief jerks, like picking at a collar or rubbing fingers together, often lasting less than a minute
• Confusion, memory loss or trouble finding words that comes and goes
• Being "off": withdrawn or flat for a while, then back to normal
• Frequent falls or "blanking out" spells with no dizziness, palpitations or shortness of breath to explain them
• Convulsions, the kind everyone recognizes

MedlinePlus adds that some seizures cause only staring spells, which can go unnoticed, and its epilepsy page says seizures are more common in young children and in people 65 and older.

So a parent who zones out mid-sentence, loses ten minutes of the afternoon, or keeps falling for no clear reason may be told it's just age or dementia. Sometimes it is. But Rush warns that epilepsy can be mistaken for Alzheimer's because the memory loss and confusion overlap, and that uncontrolled seizures are a treatable cause of dementia. Their advice is low-tech: keep a diary of anything out of the ordinary, however small, note whether episodes are getting more frequent, and bring it to a primary care doctor, geriatrician or neurologist. The table above doubles as that diary.

Confusion that comes on over hours and stays has other causes to rule out fast; see our guide to sudden confusion in an elderly parent.

New seizures after a stroke or with dementia

A 2016 review in Neuropsychiatric Disease and Treatment (Liu and colleagues) calls stroke and other blood vessel disease of the brain the most important risk factor for new-onset epilepsy in older people, at 30 to 50 percent of identified causes. It puts neurodegenerative diseases such as Alzheimer's at roughly 10 to 20 percent, and notes that seizures can be hard to spot in people with dementia because of their other behavior changes.

So after a stroke, or with dementia, a new staring spell or unexplained fall belongs in a call to the doctor, not the "another bad day" pile. If the dementia diagnosis is recent, add "ask about seizures" to the list from our first 30 days guide.

The seizure action plan

A seizure action plan is a short document that tells anyone nearby what a seizure looks like for this person and exactly what to do. The Epilepsy Foundation of Minnesota, for one, publishes a printable adult seizure action plan that asks for:

• Emergency contact, treating doctor and significant medical history
• Each seizure type with its usual length, frequency and description
• Triggers or warning signs, and what they're like after a seizure
• A blank for "a seizure emergency for this person is defined as"
• The emergency steps to take: call 911, notify the emergency contact, notify the doctor, give emergency medicine
• Daily and emergency medicines with dose, time and how each is given
• Whether they have a vagus nerve stimulator, and its magnet instructions

It has a line for the doctor's signature, so bring a blank copy to the next visit and fill in the medical parts together. Then give copies to siblings, the neighbor with a key, a home aide, the adult day program.

If the doctor prescribed a rescue medicine

MedlinePlus says caregivers should know whether a rescue medicine has been prescribed and how to give it, and the South Carolina health department notes it can be given if a health professional prescribed it.

If your parent has one, write down exactly what the doctor's plan says: when to give it, how to give it, whether a second dose is ever allowed, and when to call 911 afterward. Copy the wording from the plan or the pharmacy label, never from memory. Note where it's kept, and check the expiration date whenever you test the smoke detectors.

Medicines: timing, missed doses and interactions

MedlinePlus's home safety page says to take seizure medicine exactly as prescribed, refill before it runs out, never stop it without talking to the doctor even if the seizures have stopped, and ask the provider what to do about missed doses.

For a parent who takes eight other things, interactions are the quieter risk. MedlinePlus's questions for the doctor include whether antibiotics, pain relievers, vitamins, herbal remedies and alcohol are OK with seizure medicines. Rush notes that taking more than the recommended dose of certain antibiotics, painkillers, mental health medicines and sleep medicines can raise seizure risk.

So whenever a new prescription or drugstore product comes home, ask the pharmacist to check it against the seizure medicine. If doses were missed or a refill ran late, call the doctor or pharmacist rather than adjusting anything yourself.

Safety at home

MedlinePlus's home safety advice, applied to a parent's house:

• Showers, not baths. It advises showering only, because of the drowning risk in a tub. A shower chair and grab bars help with ordinary falls too.
• Kitchen. Turn pot handles toward the back of the stove and serve food at the stove instead of carrying full pots across the room.
• Medical ID. Wear a medical alert bracelet. The Foundation's first aid steps include checking for one.
• Sleep, stress and alcohol. It calls lack of sleep one of the most common seizure triggers, suggests avoiding too much stress, and says not to drink alcohol while taking seizure medicines.

Rush wants repeated falls evaluated, especially ones with no dizziness or other warning; our guide for when an elderly parent keeps falling covers the assessment to ask for.

A seizure page for the binder

All of this fits on a single page in your parent's binder, right behind the emergency sheet:

• Diagnosis and roughly when seizures started (or "no known seizure disorder")
• What their usual seizure looks like, how long it lasts, and what they're like afterward
• Their normal baseline: "knows the date, walks with a cane, does the crossword"
• The doctor's definition of a seizure emergency for them, copied from the action plan
• Rescue medicine, if prescribed: when and how, in the doctor's exact words, and where it's kept
• Daily seizure medicines and the times they're taken
• Neurologist and primary care names, with after-hours numbers
• Known triggers
• Other conditions that change the picture: diabetes, past stroke, dementia, blood thinners
• Where the POLST or DNR is, if one exists
• A blank seizure log on the back: date, start time, length, what it looked like, recovery time

Tuck the action plan behind it, and put the seizure details on your parent's emergency information sheet for paramedics, since that's the page a crew reads first.

Frequently asked questions

How long can a seizure last before it's an emergency?

The Epilepsy Foundation and the CDC say longer than 5 minutes; MedlinePlus's seizures page says more than 2 to 5. Also call for a first seizure, repeated seizures, trouble breathing, injury, or if your parent doesn't wake up or return to normal.

What do seizures look like in older adults?

Often not like shaking. Rush University Medical Center describes confusion or memory gaps that come and go, trouble finding words, picking at clothes, and unexplained falls or blanking-out spells. MedlinePlus adds staring spells.

What should I do after the seizure ends?

Stay until your parent is fully awake, keep them on their side while drowsy, give nothing by mouth until they're alert, and write down the length and recovery time. MedlinePlus advises reporting every seizure to their doctor.

Getting the plan written down

You can build this page yourself with this guide, a blank action plan and one visit to the doctor. Or Emergency Binder Now can do the organizing from about 25 minutes of guided questions, producing a printable binder with your parent's conditions, medicines, doctors and contacts, a one-page sheet for paramedics and the ER, and a list of what's still missing. See a sample binder before you decide.

General information, not medical advice. Your parent's doctor sets their seizure action plan and any rescue medicine instructions; their pharmacist can check new medicines against current ones.