Hospital lied! Wwyd?

Have they simply assumed that it is post operative delirium, and do they consider that the underlying cause of the delirium is being treated or managed? Delirium absolutely should be mentioned in a discharge letter, as it is very serious, can cause irreversible mental and physical decline, and can recur post discharge. If they have documented (badly!) your concerns about cognitive symptoms and they haven’t followed up looking into delirium then that may well be something to complain about.

I would try and overlook that and focus on what care plan they have made for her upon discharge.

This, in spades.

Not having P of As can, and very often does, cause endless massive headaches.

it would be very unusual to diagnose dementia while someone has acute medical problems that can interfere with cognition and it can take some time (weeks/months) to recover from an acute event. Post-operative cognitive dysfunction may also be relevant and can also last for months or occasionally accelerate an underlying dementia process. It does take time to work out what's going on and to what extent it's recoverable and it's quite likely that the hospital team aren't in the best position to make a diagnosis

Exactly all of this.

it would be very unusual to diagnose dementia while someone has acute medical problems that can interfere with cognition and it can take some time (weeks/months) to recover from an acute event. Post-operative cognitive dysfunction may also be relevant and can also last for months or occasionally accelerate an underlying dementia process. It does take time to work out what's going on and to what extent it's recoverable and it's quite likely that the hospital team aren't in the best position to make a diagnosis. It sounds like you have had a conversation with the team about cognitive impairment/dementia so while the wording may be clumsy, it is important that that is reflected in the discharge letter so the GP knows a bit about the concerns, who's aware of the concerns and how much of an eye they need to keep on things. (Discharge summaries are often written by someone who's not been directly involved in a patient's care so they have to piece together what's gone on from the written notes. Where mistakes creep in it isn't usually an intentional thing/misrepresentation - it's someone doing the best they can with what's available and if the patient hasn't yet actually been discharged they may well be amenable to amending the note. Apparently hospital management believe the average discharge summary should take 3-5 mins to write - if someone's been in hospital for weeks/months then it's not surprising things get muddled!).

Re. POA, the donor has to have capacity to make the decision and if they're delusional and disorientated that may preclude them making that decision at the moment (PoA is not something you get, it's something they give).

My other favourite rant: EVERYONE should get POAs in place. I mean, on behalf of relatives but also for themselves. Even if you’re not old or ill or whatever. Nobody knows what’s around the corner. And having a spouse or family is not enough as they wouldn’t be able to make decisions on your behalf if you lost capacity.

OP in my experience you will be taken more seriously if you have POA. In most cases the healthcare professionals are just glad there is someone there who is legally allowed to make decisions. If it’s not too late, I promise you it will make things immeasurably easier in future if you have POA for your relative. I dread to think how much more complicated things would be for me if I didn’t have it in place for my relative.

Do they have a chronic UTI and/or are they dehydrated? Quite common for lots of the elderly in hospital and incorrectly presents as dementia. It’s not always picked up (hard to understand why tbh as should be standard stuff). There’s always a dramatic difference if treated properly if they have one or both of these as underlying factors.

Going forwards, do you have PoA for Health & Welfare? They have to take you seriously then.

If you think there's dementia there, the route is usually a GP test, followed by a referral to memory clinic and a CT or MRI scan to see what's going on. I'm not sure it makes a huge difference though, apart from making it less difficult to access certain things. It's best to get PoAs in place before this though, if you haven't already.

Does your parent get Attendance Allowance? It does sound like they qualify.

Really my DM was tested in hospital, not dementia, just delusional

But she is convinced they had her on a dementia ward, even though the hospital doesn't have a dedicated dementia ward (just elderly people)

We tried to manage with carers coming in 4 times a day (this was paid for by NHS) but they were completely useless. You couldn't rely on them coming at any particular time and they would stay for as short a time as possible. This meant we had to be there, and then they said because we were there, they didn't need to be. She went into a home a few months later.

I didn't think my mum's delusions were dementia, tbh, as they were incredibly severe at times yet she could go for hours without a problem. It was as though she was dreaming and believing the dream. Nothing was ever noticed by staff, either, which I think wouldn't be the case with dementia. Or maybe they just weren't taking any notice of anything she said.

My mum is in her 90s and fell, breaking her hip. She had part of it replaced under an epidural. She was doolally for weeks, frankly! Even months later when she was back at home, she was never sure which room was which, or where anything was. In hospital, she had serious delusions which made us wonder about dementia but then some research showed delusions are really common after hip operations in elderly women. It's very distressing for the patient and for the family.

Part of the reason they hesitate to make a memory assessment in hospital is that elderly people can often develop delirium during hospital stays. Delirium presents very much like dementia, but can resolve over time. It may be that conditions improve in the home environment over a few weeks.

If not, then the GP does need to refer for a memory assessment by a consultant psychologist/psychiatrist. Ideally followed up with a scan to identify the type. But I understand that it can be a battle to get to that point.

Ah ok, if you don't feel that your mother has dementia say so loud and clear, to your mother and to her medical team, and do complain.

But do you disagree with anything the hospital has written? If they are stating that you said something you never said and do not believe to be true, by all means complain. But if you would just prefer it to come from them and felt that they agreed with what you were saying, I would leave it and move forward from where you are.

Are you sure they don’t have a UTI, this happened to my grandad

Agree with this. GP refused to do memory tests or refer MIL to clinic because MIL had not asked for the test. Well duh!

But those test results may/ would have implied further action needed so they chose to ignore .

Sorry you are going through this. I found the hospital social care team much more helpful.

I have lost count of the number of hospital discharge letters I have seen for my parents.

They always contain errors. Unless it is something dangerous like a medication related thing, then we don’t say anything.

We have actually wondered if some letters are written the way they are to justify whatever it is the hospital wants to happen next.

in one case, they said I live with my mother - which I don’t, I was living two hours away at the time - but it would’ve been considered a risky discharge otherwise. But when we told them, they didn’t care.

(It didn’t matter because at that point I was arranging to put her in a private care home for respite).

But in general, all the myriad of people involved in my parents treatment have been aware that a hospital discharge letter is just completely wrong.

I don’t know how many layers of bureaucracy it satisfies, but it certainly indicates how many things need to be chopped out of the NHS.

Sorry that’s not relevant to you.

I hope everything goes well for you both.