Changed grandmother due to hospitalisation

[Lululemonade38]

Hi all, this has been playing on my mind a lot and I'm very confused.
My grandmother is in her 90s and fell about 6 weeks ago and has been in hospital since. Prior to this she appeared to be her 'normal' self, as in we had no concerns apart from the obvious declined in mobility expected with her age.
Due to Covid restrictions we were not allowed to visit, however as my parents became persistent in asking, the hospital managed to allow this, so in total my grandmother has seen her family twice in 6 weeks.
She has recently been moved to another hospital and I was allowed to visit, however I think she is a changed person. Initially she came across I can only describe it as almost hyper and very animated, and then her mood lulled a bit. She then asked me if I was her daughter and some of her sentences where quite jumbled and I couldn't understand what she was saying.
Since the fall she's had various scans and blood tests and they said she had an infection which they treated with antibiotics. Aside from that they are assuming she has dementia or she's become very confused as a result of this infection.
I'm very confused as I thought dementia needed some sort of official diagnosis or testing? Also can it happen so quickly? Also can an infection cause dementia? Is there any hope in her getting back to her old self? Sorry for so many questions but this is all new to us as a family and we're not sure where to go from here? Is this the beginning of the end :(

Has she got a UTI?

@BritInUS1

Has she got a UTI?

Just what I was thinking.

It's important to ask them to check her urine even if she's been on antibiotics however Delirium is very common in the elderly admitted to hospital and you can read more here www.rcn.org.uk/clinical-topics/older-people/delirium. Gran did get better but it was a good few months although she was never quite the same.

This is what happens when people are hospitalised for weeks with next to no socialisation. I volunteer for a charity where many of our clients (and their families) have seen this happen.

Excluding an underlying issue (UTI or side effects of medication), many get better almost overnight once home. Sadly some do not, for instance if there was already some cognitive decline, isolation has exacerbated this and the change is permanent.

Care home staff have sadly reported the same with their residents.

Sorry for such a negative post, I hope your grandmother does make a good improvement (and good on you for advocating for her).

I'm in no way blaming families for this. The problem is hospitals failing to balance the need to manage covid against the holistic needs of patients.

@BritInUS1

Has she got a UTI?

No, they said she had a stomach infection.

Thanks for all your replies. I was so shocked how quickly she changed.

An infection of any kind can cause quite dramatic changes in the short term which correct themselves as it clears. A friend's mum goes really hyper and almost manic with any infection, then goes right back to normal in between - and has no memory of being so hyper, either.
But any fall, illness, or just the hospitalisation itself can also speed up other cnditions such as dementia or cognitive decline as well as making older people more fragile.

A simple infection can cause havoc on elderly people and it can take them a long time to recover. A lot never fully recover and after each infection can deteriorate.
Have a look into delirium. It can last a while after an infection.

Has she been on oxygen?

My gran had this while in hospital, seemed to have gone completely crazy, seeing things thay werent there, thinking my uncle was her deceased husband etc. Turns out it was because she had been coping on 'normal' oxygen levels much lower than normal due to copd and reduced lung capacity, so when she had the full amount of oxygen, it left her temporarily loopy until they found the equilibrium for her body.

It sounds like delirium. Ask the ward staff if they have considered this. A family member was assumed to have (very siudden) dementia until we inisted on an assessment from a psychiatrist. He didn't have dementia, just delirium but it took nearly 3 months to persuade the hospital of this, by which time the changes were permanent.

If she was fine six weeks ago it’s very unlikely to be dementia so suddenly. More likely the staff have assumed she’s got dementia and not looked further.

I know you said she’s in for a stomach infection, but have they specifically tested for a UTI? It really can have very similar symptoms to dementia behaviourally.

@Candleabra

If she was fine six weeks ago it’s very unlikely to be dementia so suddenly. More likely the staff have assumed she’s got dementia and not looked further.

I know you said she’s in for a stomach infection, but have they specifically tested for a UTI? It really can have very similar symptoms to dementia behaviourally.

According to my mum they tested her urine when she was first admitted and it was fine, but Ill advise her to ask for her to get tested again, thanks.

No, she hasn't been on oxygen

@Cookerhood

It sounds like delirium. Ask the ward staff if they have considered this. A family member was assumed to have (very siudden) dementia until we inisted on an assessment from a psychiatrist. He didn't have dementia, just delirium but it took nearly 3 months to persuade the hospital of this, by which time the changes were permanent.

This is the first Ive heard of this so thanks, Ill look into it. Once she's released she will be an outpatient for the memory clinic. Im not sure what that entails exactly. Would delirium be picked up there?

This is a really good short video about delirium. It's really common when older people get an infection and can last for several months and can be mistaken for dementia. It might help you so you know what questions to ask the healthcare team looking after her. There should also be a delirium follow up if she has it or has had it.

Delirium is very common in elderly people, especially if they are admitted to hospital. It can be caused by a range of things, including infection of any kind, constipation, medication, dehydration . The list is huge. It causes a sudden onset of confusion. It is more common if there is underlying dementia, but can happen in people with normal cognitive function. People recover - but it can take up to 6 months for a full recovery, and the confusion can continue for a while after the underlying cause has been resolved. For this reason the memory clinic may not be able to make an immediate decision about whether it’s dementia or delirium.
If there is underlying dementia the episode of delirium may cause cognitive function to deteriorate further .
www.alzheimers.org.uk/get-support/daily-living/delirium

I'm a nurse and I've seen mentally competent older patients appear completely delirious and incomprehensible when they have a UTI, so despite the initial testing of urine when she was admitted I'd ask that they test this again. The antibiotics shes been given for her stomach may not have been the correct ones to also treat a UTI. Some hospitals are also notorious for not ensuring patients get enough fluids which would exacerbate or even cause such a problem. Aside from that and if it's all clear it could be as a pp posted, a natural but fast decline of any existing mental decline that might not have been so obvious before. Hopefully once she's discharged and in a familiar environment she will start to pick up.

Hi Op
It could be Delirium post infection.
It could also be Dementia.
I worked in Elderly Care and the number of people admitted post fall/ infection with Dementia where the relatives said she/ he had been fine previously was really high.
People adapt gradually and family often fill in the deficits without really noticing or are in a type of denial.
Also elderly people manage much better in their own environment and can become confused in a hospital environment really easily.
Day/ night, their normal routine, visitors are all absent or muddled.
If its Delirium she may qualify for an interim stay in a NH to see if this resolves.
There types of Delirium
Hyper-agitated
Hypo-sleepy ,withdrawn
Or a mix of both.
I would push very hard for a diagnosis, ask for a brain scan and comprehensive discharge planning.

Any kind of infection ( and a million other things) can cause delirium. It doesn’t have to be due to a UTI.
The diagnosis would be delirium in this instance. Whether or not there is underlying dementia won’t be clear for some time .
I am a retired consultant who worked in a memory clinic .
A brain scan can’t differentiate between delirium and dementia but can be useful to look at any underlying problems
Discharge planning is very important I agree

Sorry brain scan to exclude so that other things can be ruled out.

Hey, firstly, I want to say how sorry I am that you're going through this.
Exactly the same happened with my Nan, except she did have early onset dementia before being hospitalised, but was still coherent, she just forgot things and did silly things like lock herself out / microwave her purse.
She became incomprehensible when she was admitted for a UTI, she was hospitalised for about 3 weeks.
In her case, she never really recovered, she was with us for another 2 years but not mentally.
Appreciate that's not a happy story, just honest from my perspective.

I hope everything goes well and she makes a full recovery

Thank you all for your responses and also sharing your personal experiences, it's been an eye opener. She actually ticks most of the boxes which can cause delirium and at one point they were concerned with her drowsiness as she was sleeping on and off throughout the day, which sounds similar to hypo delirium.
I obviously can't rule out dementia sadly and I know there's a strong chance she may not be the same again considering her age.
I feel like the longer she's in there, the worse she will get.