Confused elderly mum in hospital

[Allfurcoatandnoknickers]

Mum (92) was taken into hospital nearly two weeks ago with pneumonia. She has had this several times, and each time has miraculously made a recovery. Her cough has really improved, her temperature is back to normal, her sats are up and down and they are trying to wean her off oxygen and want to discharge her with a resumption of her care package next Monday. They are trying to get her sats stable, but it could be that they discharge her with oxygen.
She has worried me - each time I go and see her (I last went on Tuesday), she seems a little more confused. Today, she was struggling to remember my name, but didn't seem agitated, aggressive etc., The nurses said she had eaten a little, and had been having a little bit of banter with them.
She normally can have some confusion when she is at home, but is worse in the morning, when she has just woken up or is tired. I've mentioned my concern to the nurse, who said she would speak to the Drs. When she first was admitted, she managed to count backwards from 20, knew the dates of WWII (the Dr who saw her got it wrong!!), etc and that was in the throes of a high temperature.

Just wondered whether this is a common problem with the elderly in hospital?

All patients can get a bit confused in hospital, disturbed routine, noise at night, medication, illness, age. Guess she has had a dementia screen? Speak to the doctor and therapists, has she been referred to social workers. Don't let them send her home until you feel sure she is safe to be there. Don't let them just restart care package without the staff fully assessing that it will still be enough. Sometimes the care company will want to re assess a client berforte they go home just to make sure they are able to manage, especially if she goes home on oxygen.

Have a look at dilerium it's an acute onset confusion and the hospital I work at has had really good outcomes from simple measures such as having a large visible clock etc...

Delirium

Thanks for your replies. As I say, I've mentioned it to the nurse today as I was quite concerned and she was going to talk to the Drs. I'll see if I can ring them again before the shift change. There are no clocks, no TVs nothing to provide any stimulation, and only three people in one room so apart from the comings and goings of the staff not much going on. I am worried about her care as we sacked the last lot of appalling carers and they have to carry on until 5th November when the new, hopefully much better carers are in place. I am very concerned about their ability to look after mum, and have mentioned this several times to the hospital, but we can't do anything until the new ones are in place.

I can't stress enough how important it is that your mum is properly assessed before she goes home. If the carers can't manage she runs the risk of becoming unwell at home and going back into hospital. The hospital must have a discharge team who you can speak to. Ask the manager of the care agency to come and see your mum in hospital. If they try and send her home and you still have concerns then speak to PALS. Do you have power of attorney for your mum.

Yes I do. I’m going to the hospital tomorrow and will be asking to speak to them. I’ve also asked the carers to call me in the morning.

Good luck. Put your foot down if you need to. There's also the option of interim beds if mum doesn't need a hospital bed but not ready to go home yet. Has the funding been sorted out for her care, that's always an 'issue'.

She was already having 4x double handed Care calls a day. Two days before she was taken ill I ‘sacked’ the carers as they were shambolic, and we’re in the process of changing to new ones, so not great timing. The new ones start the first week of November. The social worker has re drafted the Care plan (might need another one now)...

Has she been assessed for a UTI? It is a very common cause of sudden onset confusion in the elderly, and often doesn't present with the more usual symptoms (pain or burning sensation) in this age group.

Does she have water easily reachable by her bed? If she's not drinking enough (and to be honest, hospital staff don't have the time to monitor or assist with everyone's fluid intake), it could affect her susceptibility to infection.

Hope she recovers soon, op.

Yes you should ask for care plan review. Have they done a chc checklist, is the oxygen new, if so that all needs sorting out and carers need to know how to look after it properly.

It's very common. If she already has periods of being confused at home, then her brain is highly vulnerable. Having a severe pneumonia is a common cause of delirium which is most probably what she has - it fluctuates and can take many weeks to resolve.

If she already had 4x double upcalls a day, and has had more than one previous admission this year then she was very frail to start with before this pneumonia.

You should be prepared for a long haul and she may not necessarily get back to where she was at the beginning.

Quick update. Went to visit Mum today. She’s had another X-ray which shows pneumonia clearing well, no temp and bloods show her oxygen levels a bit too low and Carbon Dioxide a little too high. The Dr was going to see if the nurses could get a sample (she wears incontinence pads). I’m going in every day to keep on top of things. I sat with her today and she seemed initially very slow tired and confused (I’d woken her up), but looked at some photos, chatted and even chuckled at some stupid YouTube videos of dogs doing silly things!

Wishing mum a quick recovery, look after yourself. Good job she is not being pushed to go home.

Thanks. It’s re good that I was able to speak to a Dr today- and even better that he actually listened to me! Feel more positive today just knowing that they’re doing tests etc and not pushing for discharge.

yep, they are pretty good at trying to get people out, at least she is in hospital, can stay there and they can continue trying to find out what's going on.

Latest is that they’re sending her home with a small amount oxygen. This will be a permanent thing according to the Dr. Just trying to sort this out now so will be later in the week.