Hospital stay - delirium or dementia(14 Posts)
My mum was in hospital for 4 nights after a heart attack & successful angioplasty about 4 months ago. By the last night she was delusional, accusing the nurses of poisoning her, trying to phone the police and get out the ward.
As she had no issues before she went in I was pretty worried about this but the doctors assured me she'd be much better once she was home. They never mentioned delirium but as she wasn't 'right' at home we looked into it and assumed that's what we were dealing with.
4 months on and while the paranoia stuff stopped within a few weeks she's still not the same woman as she was before. Memory and finding words is an issue, struggling with some simple tasks, assuming every bit of tech she has is 'broken' (normally unplugged or out of battery). She is still living alone, managing shopping, cooking etc though.
This was worrying us enough that on Monday I arranged to speak to her GP behind her back about getting it investigated, but before I have had chance, she had a fall Monday afternoon and is currently waiting for surgery. I told anyone and everyone in the hosp about how badly she was affected last time, so they were aware and could hopefully help her feel better this time but within 24 hours she's rambling on the phone about the nurses stealing her money.
Now terrified she's going to be even worse than she was, at least she was still reasonably independent. Last visit it was like talking to a child with no attention span, it's horrific to see her like that, hoping it was down to being tired/stressed/on morphine, but the pessimist in me is presuming the worst.
Is there any chance this could all still be just delirium? I know they say it can last months but I'm assuming it's wishful thinking that she could come back from this with help?
Some people have delirium which passes, but it can also be the case that someone with early dementia that isn't noticable will have a massive downturn when they have a general anaesthetic or major health incident and though it might get better, they never return to the point they were. And I'm afraid you can't tell necessarily which is which.
Has she been checked for a UTI? That is often a cause of confusion and easy to get in hospital
I’d be pushing for a full investigation for infections. Urine, chest are common culprits. Can be long standing and cause this.
She was clear for UTI last time, not sure what they've tested for this time - the hospital have been terrible at telling us anything. She had surgery this morning, was apparently pretty risky due to recent heart attack yet didn't tell us she was going down, we rang constantly in the afternoon asking if she was back etc, no one knew anything and we were left for 7 hours wondering where she was, how she was, and tbh if she'd even made it through the op until she phoned us herself to ask 'am I alive?'
I am a mental health liaison nurse, what you are describing is sadly not unheard off after a heart attack and angioplasty. Her circulatory system will have been interrupted during the heart attack leading to potential loss of adequate blood supply to the brain. A CT brain scan may show up areas of ischaemia. Delirium persisting for four months has a poor prognosis for mental recovery and after 4-6 months a diagnosis of dementia may be considered. I would request a memory clinic review. I am frequently frustrated by Cardiologists not having more open discussions with families about this type of scenario. If all treatable causes of delirium have been excluded the likelihood is that the delirium has now become a chronic problem. I hope I am not seeming too harsh and blunt.
Not blunt at all, it's what we're expecting I think. Just hard because no one has even questioned her behavior at all, they just seem to have stuck all the old 'crazy' ladies in a bay together and left them to it. I've been telling everyone this is not normal for her, & she has no diagnosis of dementia etc but they're not concerned. The OTs are sorting her discharge packages etc and have said they'll get the psychiatrist in but I don't think they're bothering with memory clinic assessment, said the GP will sort it when she's home.
I know it's so common to react like this but it's frustrating to see her knowing that this is all doing some level of further damage, and everyone just shrugs and says it's normal. Whereas everything online seems to suggest delirium should be considered as serious and minimised as much as possible. But not sure what we can do to help it?
Delirium is a serious medical problem and not normal. Most hospitals have access to a mental health liaison service who would see your Mum, you could ask about this. The best chance of recovery is at home in familiar surroundings but you have tried this. The ward OT could do a cognitive assessment if no mental health team available or if she is over 65 ask for a care of the elderly review . They should have checked her blood for what is known as a 'dementia blood screen' which looks at potentially treatable causes of confusion such as B12 deficiency, in reality this rarely shows anything. All her medication should be reviewed and ideally a brain scan.The fact that she has word finding difficulties is a strong indicator of vascular problems in the brain. People with her medical history can have ' mild cognitive impairment secondary to cerebral vascular disease' but are able to correct themselves with adaptions such as writing things down and have insight. Dementia is generally diagnosed with a 4-6 month history of memory and functional loss attributed to no other cause. Hope this is helpful.
In addition to the excellent advice above, have they kept on top of hydration? I am prone to rapid dehydration owing to a chronic condition and become confused, ramble, loose words/time and have difficulty with focus, balance, fine motor skills and the like. It usually takes a few bags of iv fluids to return me to normal, and local Trust policy is to always iv hydrate in tandem with morphine.
I am by no means suggesting this as a cause/reason, but it may be worth checking on to get a full picture.
Hi, we had a similar situation with my mum. She has two hospital stays, both for delirium/infection. The delirium did pass, but she was slightly worse mentally. Nothing you could point your finger at and state dementia, but definitely more needy/childlike, and definitely struggled with life a bit more.
She then fell and broke her hip, had a replacement, (aged 83), and really embraced her dementia colours, to the extend of staying in hospital for 4 weeks instead of 3 days, then moving to a rehabilitation centre, and eventually a residential care home. After the surgery, it was almost as if she fell off a cliff mentally.
When you're dealing with this situation, it's like playing a game, only nobody tells you the rules. I'd suggest that you get as much done at the hospital as you can, because once you go home, with a care package, you're pretty much left to it. Our council suggested a care package of 4 x 15 min visits per day, despite being told that she needed 24 hour care. Thankfully, we had medical intervention. We were also told that the best recovery was at home, in familiar surroundings, but, she wasn't changing her clothes, eating properly etc.
Check out the Alzheimers Society website, they have great advice, and a really good forum, where you can ask as many questions as you wish.
My last point would be to get your Power of Attorney sorted out, particulary for Health and Welfare. We didn't have that, and the social worker tried to send her home on her own, knowing that there was a hole in the kitchen floor, and that the house was damp. I'll never forgive her.
I wish you luck. xx
Thanks guys, the OT apparently took bloods so wonder if this was for checking b12 etc. We're not going to let them even suggest discharge without at least some form of psych evaluation but the OT did seem like she'd grasped the situation and was going to sort this so fingers crossed someone is on our side so to speak. Package-wise she's going to need as much as possible purely from the physical side (arm has to be completely immobile for weeks) so she will have support, but whether it's the right support will remain to be seen I guess.
Hydration is probably a factor, she's having her cuppa when they're offered etc but never been one for water, we're trying to encourage when we're there. She's not eating much either, partly lack of appetite and partly because she's only got one working arm and not seen anyone offer any help with cutting food up or anything.
May have missed the boat on POA, had been looking into it and thinking about how to broach the subject, but she doesn't have the capacity to sign it now. Hopefully if we get some improvement we can get it sorted.
OP I am so sorry that you and your DM are going through this
My DF was admitted into hospital at the end of last year after a fall, which was due to complications of his terminal cancer. For the previous year he had been having problems with his memory and like your DM having problems with tech, especially new technology like tablet and mobile phone. We had him tested for dementia and he managed to pass all the cognitive tests, and we were told it was just old age (he was in his 80s). I also wondered whether it was down to many years of chemo. Most of the time though he could cope with everyday things, lived at home with DM, driving etc.
When he went into hospital it was like someone had flipped a switch, his mental capacity just seemed to fall off a cliff. But the hospital team just didn't seem to notice, they were just concerned with his mobility and were keen to send him home with a walking frame and everything would be fine. After about 10 days in hospital we finally managed to convince them that his mental capacity was deteriorating rapidly. They made him do the cognitive tests and he failed every one
However, they were still keen to send him home and I was told I would be amazed how much he would pick up once he was home and he could go to memory clinic. DF died a few days later due to his cancer.
The thing I found really surprising was how unconcerned the medical team were about his mental capacity, and the rest of the men in his ward were the same. It was so sad. I wish I had stood up more for my DF, I know the outcome would have been the same but his last few days might have been more comfortable. The only person who really spoke to me and DM was the OT nurse. OP do what you can to get help for your DM. We were told every day that my DF wasn't eating/drinking but no-one was helping him
We left it too late to get POA for my DF. Your DM will have to have better mental capacity to sign one, and she will need someone else to sign that she knows what she is signing. But if you do have a window when her mental capacity is better get it done then, she just needs to know what it is when signing. My DF had a couple of days when he understood things and was keen to sign POA but by the time we got the forms ready and a neighbour willing to certify the form, he was back in his mental fog.
I hope things improve for you and your DM.
I have been facing a very similar situation regarding getting the medics and nursing staff to understand the extent of my mothers impairment , compared to how she was before. Concerns brushed off with " she's doing fine".
Result - discharged with inadequate care, needing prompting for everything and very confused. Back into hospital after apparently injuring herself getting back into bed in night.
She has now been in a rehab place and has improved, so suspect the confusion/ delirium was related to her pneumonia. Her memory continues to deteriorate at an alarming rate though . That started about six months ago, getting more repetitive and forgetful. Has been referred to the Memory Clinic.
They seem to treat everyone from a universal base line whereas my mother was exceptionally active at 87, doing own shopping, going out to church and for lunch with friends, reading a broadsheet every day _- and like you say, it was as if she had fallen off a cliff after hospital admission ( without any surgery) .
You have my sympathy. It's all very shit.
When he went into hospital it was like someone had flipped a switch, his mental capacity just seemed to fall off a cliff. But the hospital team just didn't seem to notice had similar with MIL after she went into hospital aged 75. I felt as though the staff just looked at her and saw an old lady whereas prior to going in she's been super-independent - she'd just driven back from a holiday in Cornwall, she was a retired physio and ran a club for stroke victims in the town where she lived. I also really echo what has been said about POA - we've just set this up for my mum who is 81 and still in fantastic form. It's a difficult thing to broach when it's not needed, we hope we will never need it, but if we do then it's there. to the OP and anyone who is going through this.
Thanks for your messages, helps to know you're not alone doesn't it.
She's still in, still delirious. Had a really good morning Saturday, seemed like she was really improved. But then a few hours later and she's back to wandering the ward, panicking and getting anxious over stupid stuff. Have to say it's getting hard to be patient and sympathetic when you're getting yet another call about the same old rubbish! (No you're not trapped, no they're not moving you anywhere, no they've not stolen your phone - you're talking to us on it right now... etc etc )
At least the discharge team seem to be taking it seriously though, they've requested 4 x daily visits, but also sending her home with 24 hour support for at least a day or three, to see how the confusion resolves. But still no idea of how long this will take, hopefully soon!
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