Rapid decline or something else?

[DayDreamDelerium]

Hi, DF mid 70s has had declining memory for a few years & other symptoms such as hallucinations more recently. He's been asked at memory clinic & now in 6 week wait period for results consultation - I'm anticipating D with LB. At apt he was able to fully describe his symptoms & said he knew hallucinations weren't real.

He was admitted to hospital (first time) this week with sudden mobility loss & extreme confusion - his mobility & lucidity improved in ED with lots of liquids via drip & bringing temp down, but got very confused a few hours later to admitted to ward. Hes been in a permanent state of (what seems like) delerium since.

He will be assessed on mon by the non-emergency consultant "with a view to discharge" - although it feels like hospital environment is contributing to the issue theres no way he can be safe at home if the delerium continues. Anyone able to tell me their experience or advice? Will they really try and send him home if he can walk & eat but thinks he's living on a submarine etc??

Hospital induced delirium is common, and it's very hard to untangle that from underlying confusion. And sudden mobility loss plus raised temp is flashing a big red 'infection' light - UTIs are very common causes of increased confusion, and other infections can have similar effects.

So the first question is have they identified and treated the cause of hisninitial admission? And if that wasn't thoight to be a UTI, have they checked for one anyway?

Then you need to track down thebdichargebcoordinator. As an adult with social care needs, he should have been assigned one as soon as he was admitted. They will talk to you about options - one of which may be discharge home, but if you don't feel that would be safe or manageable you can reject it.

There should also be an option for intermediate care/discharge to assess. This is a few weeks of funded care - either visiting carers at home or in residential care - while they work out his new base level. It should also include close monitoring of his progress, physiotherapy, occupational therapy, and a home assessment to see if any adaptations are needed to the house.

Thanks NoBins, lots of test results came back clear but they either haven't had or lost his urine results. He has had a mild cold symptoms tho & they are giving him ABs anyway now.

I've experience of a younger person suffering 'ITU psychosis' but as you say its so hard to determine whats just environment and what might turn out to be his new baseline 😥 He doesn't seem to have any specific PoC, feels he's been put in a safe holding position for the weekend.

I would be asking 'could this be sepsis?'

My mum had a very similar rapid decline which turned out to be sepsis from a deep seated infection.

I would also be quite persistent in asking for iv fluids as this makes a big difference.

Not all antibiotics are equal, so they need to do a urine culture (not just a dip test) so they can give the right one for the specific type of bacterium (if positive). If they lost the first one they must redo it.

And yes, always consider sepsis.

Ask loudly so that more than one person can hear you.

Also, ask at the main reception in the hospital if there is an Admiral Nurse - they are funded by Dementia UK and are great advocates for patients with dementia. Because they have nursing knowledge, they tend not to be fobbed off with vagueness and will be a really helpful ally. Most hospitals have dementia specialist nurses, even if not under the Admiral banner. Ours was brilliant, even though we weren't sure what we needed from her. She listened to us and then managed to get more tests and physio organised for DM. Even though we'd already asked for that, it suddenly kicked in once the Admiral Nurse started advocating for us.

Thanks all, would sepsis show from blood tests? They've all come back clear along with saliva, swabs & ct scan. He's also much brighter(when we visit) & mobile again but just in a permanent state of delusion.

Trying for an Admiral nurse sounds like a great idea for both him & mum who is serially struggling. I just read the RBL have a link with them too, so might be able to get support via that route if not direct at hospital especially as military memories are surfacing frequently in his confusion.

I just wish I knew if getting him to a quieter environment would help (in a ward with similar/worse affected chaps so its quite noisy & alarming)

@ElizabethVonArnim the iv fluids made such a big difference in the Emergency dept, I'm not not sure they'll want to do more now he's mobile again as he keeps wandering, but will def ask.

Sepsis would show in the bloodwork, so at least that's one you can cross off the list.

Sometimes delirium can be triggered by an infection but then last for much longer after the infection has been treated. We were warned that mum's delirium could take six months to clear.

Gosh thats a long time😳
He's had a few really difficult days including needing the nurses to call for hospital security - awful for both him and them.
On the plus side he's started a different medication and soon after had 24 hours of normality, albeit followed by another dip into his alternate world. The nurse said this is quite common and usually stabilises over time. It was such a relief to have him back, really hoping for more of that today 🤞

Sounds really tough, but good that he seems to be more settled. Hope it continues on an upward pathway and you can begin to relax.