Delirium

[loopyloo87]

Hi, my mother went into hospital for a routine knee replacement 2 weeks ago however she contracted Pneumonia which apparently brought on delirium . We are at our wits end as she went into hospital with all her faculties and has been left spoon fed & incontinent she would be mortified if she understood what she's going through .
I have been in constant contact with the Dr's about the conditon & prognosis but very little is known about delirium . My mother had a ct scan last week which was normal apart from some scarring from a small stroke in 2010. The Pneumomia is clearing but she's still in a bad state of mind and was moved to the geriatric ward
Has anybody got or have any information on this condition please? I feel as though my mother has been taken away and wish that she'd never had the op

[OrlandaFuriosa]

Not an HCP but had elderly DM and DMIL.

Check she hasn't got a bladder infection. It brings on loopiness in the elderly. Truly. DM had appalling hallucinations much of the time and didn't know where or who she was, not sure that's delirium but in a similar area. Common issue and they may not have picked up if they are focusing on the pneumonia.

Check her temperature too. Spikes tipped DM. And extremes of blood pressure as well. She may need to take/ amend medication.

And some of the medication may have tipped her. Read all the small print of all her pills. You'd be surprised. One of them may do this, esp in conjunction with another. Get them to do an overall review of her medication, looking at how they react together.

Thinking of you.

[Skyllo30]

www.alzheimers.org.uk/info/20029/daily_living/370/delirium

This is a good explanation - it doesn't lead to Alzheimer's or other dementias but those with dementia are more prone to delirium.

Even when the underlying causes are treated, it can take a while for the delirium to resolve. The ward might have some more information. The geriatric ward will be the best place to manage it, delirium is a big "thing" right now so lots of wards have leaflets.

Wishing you and your mum a speedy recovery.

[Millybingbong]

I'm saying uti too. Have they checked for infection? My df found it very hard to shift and had a long road of illness in similar circs. But he got through it and became himself again.

[Out2pasture]

my experience with delirium (extensive) is that it can take up to 6 months to fully resolve. in the mean time support her with as much physio as possible. hopefully the hospital has a team approach and PT/OT social worker etc are working together. DO NOT TAKE HER HOME BEFORE HER TIME!! she should recover again with time and patience. but until that happens is high risk to fall again.do not dispose of her assets, do not sell the house, keep the siblings at bay....oh how my list goes on and on sorry

[Ankleswingers]

no advice just wanted to send my best wishes for a speedy recovery for your Mother.

[loopyloo87]

Thankyou all so much for your kind replies, the DR's have checked for infections and blood pressure is fine .. Her antibiotics finished last night I have to say that she isn't hallucinating as much now and i'm on the case to ensure that the physios get her out of bed on a daily basis
Its just so difficult for us as a family to see her like this bearing in mind she had her faculties going into hospital... I have been researching the condition and read that people with delirium die within the year :(

[Out2pasture]

It does have a high death rate, please don't dispare. Honestly expect a long slow recovery, but recovery is possible I've seen it many times.

[loopyloo87]

We are despairing and so wish that my mother had never had it done :(
Are you in the medical profession Out2pasture ? I'm just wondering when we will see an improvement if any however she hasn't been hallucinating for the last few days

[Out2pasture]

i'm retired nurse that specifically worked with long term conditions like delirium that required short term housing (assisted living or facility placement) until recovered. the improvements will be small and gradual and fingers crossed she does not have another event (usually a fall or repeat infection) that will set her back. encourage healthy nutrition and fluids, and the daily supervised mobilization. simple stimulating activities help as well sorting buttons playing bingo simple simple things. stay on top of the medical team, and make sure it is a team approach (physio and OT and social work and the dr's)

[loopyloo87]

Thankyou so much for all your advice you've been so helpful . My mums virus has cleared up but she's still confused today and can get quite aggressive which isn't her . It doesn't help that there's a lady in the same ward that's constantly shouting and creating problems with the staff . If this continues I might have a word with the ward manager

[OrlandaFuriosa]

It's going to take time: the antibiotics to clear pneumonia will have been quite fierce. And it's quite possible she's lacking sleep because if her neighbour. But I'm glad the virus has gone. Please go on sharing worries, keeping us in touch,

[loopyloo87]

Thankyou for your kind support . I went to see my mum today her new knee is working well and stitches were removed
However she is still confused and not eating very much I'm going to speak to her Dr maybe they can recommend a vitamin shake .. I complained about the disruptive lady opposite her but the nurse reassured me that she wouldn't assault another patient and there's a nurse in the ward at all times I should think so too . This particular woman keeps walking out and the nurses take her back to the ward she's convinced that they are keeping her against her will

[OrlandaFuriosa]

I ended up taking things in that she liked to eat. M&S mainly. But they wouldn't heat them up, health and safety rules. I thought it was more important to get stuff down her than what it was. Cake, ice cream on hot days, bananas, little sandwich selections. Creamy mousses. Cheesecakes. Also a bottle of squash and straws to help with dehydration.

We talked about my and her childhood stuff. It helped on the reorientation.

Hth

[loopyloo87]

How long did it take her to recover Orlandofuriosa ?

[loopyloo87]

I have asked for Ensure which is a vitamin shake and I've requested a meeting with her consultant I'm done with bed side talk we need a proper meeting . I feel so sad for my mum she went into hospital fine :(

[lougle]

There are some really simple things you can do to help your Mum. If you can make sure she has access to a clock with the date and time on it, so she can keep track of time as it passes, that will really help. Whenever you visit, remind her what day it is, what time it is, and tell her things about the season/outside world/news that will help her to orientate herself.

Make a photo board of pictures of her family that she can have by her bedside. It doesn't have to be flashy, just get some photos and stick them on a bit of card with a triangle of card at the back so she can see it. It will remind her of her reality.

Mobility is key, but it sounds like they're on that. Nutrition is vital, especially hydration. I agree to ensure she doesn't have a UTI. The other thing that can lead to confusion is constipation - it can make the most rational person extremely confused. Sleep is the other vital thing. Ear plugs and an eye mask can really help to give a good night's sleep in hospital.

[ShovingLeopard]

I am so sorry to hear this, we have had similar and it is devastating and heartbreaking.

Lougle makes excellent suggestions. We found talking about family, old times, lots of photos etc really helped. I know it's a bit tricky in the ward, but music/singing favourite songs can prompt memories.

On a medical note, have her blood sodium levels been checked?

[SlB09]

Sorry to hear this has happened. When you speak to the consultant try and keep in mind that although it may seem like the hospital has 'broken' her, it is a common complication, as is infection etc etc and more than likely couldn't have been prevented - its how things proceed now that matter.

So delerium unfortunatelty doesnt have a set timeframe but usually if due to infection it can resolve relatively quickly (within weeks) and the person has no memory of all the random things they may have said or done in this time, it may also intermittantly rear its head if the person gets an infection again in the future and is sometimes the first sign in the elderly.
Occassionally it does last but your mum sounds like shes improving which is a good sign.

Before jumping in with ensure drinks or other fortified items she should see a dietician to check this is neccesary and the ward should be keeping a record of her intake and weight on a regular basis which should trigger action if not adequate. Prior to this it really is better to try taking in food she likes like PP suggested, puddings etc. Supplemental drinks have their place but they are just that - supplements.

Great that shes seen physio and knee doing well, the staff should be making sure she mobilises to prevent pressure area damage and recording this regularly also.

Try not to despair, and dont google - you will pull from it all the bad things that arnt written in perspective or stats that arent in context. They will be doing everything they can in the background its just hard to get the overall picture when you get bits and bobs off whoever is on shift so your appointment with consultant hopefully will make more sense of everything.

Hoping for a speedy recovery.

[OrlandaFuriosa]

Sorry not to be back before now.

Difficult to say, in part because she was adept at hiding behind a veil of courtesy. And it came and went; as she got older you could see the gears slipping from time to time.

But generally it took at least a week after all infections had gone away, maybe double plus plus plus, before she was back to her normal self. We learned to let it take its time as pressure was unhelpful.

An easy format newspaper, Times, Independent, glossy mag, family photos from time to time, a local eg parish magazine or circular from RNLI, i.e. places/ things/people/charities she was interested in all helped. It was a bit like exercising a muscle after a break or sprain, reorienting her. Hospitalisation in any case often takes away the desire to know what's happening outside, so this was bringing in gentle stimulus. And when she got tired I just sat there quietly with her, not expecting very much. Seemed to work. I used to say things like" DSis has just rung, it was her 50th birthday yesterday, you remember what it was like when she was born and Mrs X came to see you." I didn't ask questions, that put too much pressure on: it was the reverse of target questions. Open questions were ok, as long as no decisions had to be made.

She found it distressing, so I tried to reassure her that this was normal for this stage of recovery, she would get better, we would always love her no matter what, and would not let her be incarcerated.

[OrlandaFuriosa]

I used to take in sewing, crochet or knitting to relieve the pressure on me: I found it creative and meant I could talk to her or not, it didn't matter; she had me there to talk to if she wanted but I had something to do if she didn't.

[loopyloo87]

Thankyou so much for your reassuring reply , my mother isn't improving atall on week 3 and is still incontinent and unable to feed herself
I just cant get my head around what this op has done to her 4 weeks ago she came to my house for dinner & was independant now she can't do anything for herself... I feel that DR's should warn patients about this happening when under going a general my mother should have been offered a local the odds are 50/50 of delirium & infection ..
We have a meeting with a senior consultant today so hoping to get some answers :(

[OrlandaFuriosa]

How has it gone?

[loopyloo87]

Not very well OrlandoFuriosa the consultant frtls that my mum is suffering from Delirium /dementia she has chronic Ischemic changes to her brain . She is free from infection at the moment but for every day at hospital it's a risk of another one which is concerning but she can't return home because of her state of confusion
We spoke to a occupational therapist who's going to start the ball rolling with an assessment of my parents home as there's no way my dad wants her to go into a nursing home .However my mum works need carers several times a day I don't know how my dad will cope the whole thing is a nightmare . We feel that the hospital have damaged my mum she went in with her faculties now she's in bed incontinent and can't walk or feed herself it's horrific
I mentioned physio to get her strong the dr said they will try but my mum is reluctant and finds instruction difficult
We feel this is the end of my mums independence all for a knee replacement that wasn't worth it 😢

[OrlandaFuriosa]

Oh no, I'm so sorry. That's dreadful. At the very least register your concerns with the patient liaison service, and talk to someone about what support she will be eligible for. Age concern have some excellent advice.

We had to put in carers because neither of us was near. Initially they came in just for getting up, going to bed, eventually it was 24 hour.

Is there a chance of retraining the brain? I still also recommend not only a second opinion but a third party doing a complete review of medication.

Also, we found that although not a nursing home, we got in effect a respite bed/ mid way between hospital and home bed at various stages, nearer home, more activity.

Poor poor you, your poor parents.

[loopyloo87]

Thankyou for your reply OrlandoFuriosa, did your loved one make a recovery? The consultant said they have tested for everything reversible the only meds my mine has now is her regular statins & blood pressure tablets which is what she was taking before the op ... Once brain tissues have been damaged its not reversible. I didn't sleep last night trying to absorb what has happened my mum put her trust in the Dr's & she will go home in a worse condition than going into hospital.
If we had known about delirium & how going under a general would effect an elderly person she wouldn't have had it done .
Yesterday we discussed getting her home which would require a hospital bed and 24 hour care its a complete nightmare it could take weeks to have their home assessed while my mum could get another infection in hospital .