FIL very confused in hospital

[hidinginthegarden]

My FIL is 79, spent most of November in hospital (out of control diabetes, leg ulcers and low blood pressure). When he came hime, he had days of being very confused - couldn't find his wife (who had died a long time ago), didn't know where he was etc.
Dr said it would just take him a while to re-establish his normality.

A few weeks at home getting eventually back to normal-ish, and he's back in a different hospital ( busier but more local to us) but is very very confused. He's phoning someone every day asking to call the police to get him out, that he needs money to pay the drug dealers who had kidnapped him, that he's about to be arrested. Call come at a range of time including regularly through the night. He's been there a week now. The nurses say he is confused but fine. He's in intravenous antibiotics.

Does anyone have any words of advice? Is this normal, does it get any better? Any tips for coping? Thanks.

Sounds like he has an infection hence the IV antibiotics. This can often cause confusion in older people who don't normally suffer from this. As the infection comes under control these symptoms should improve.

As the nurses aren't worried it is probably just the infection causing this. Did he have any similar symptoms before the infection?

When I was in hospital a few years back there was a lady in her sixties who was very confused and upset. I assumed she had dementia but it turned out she had a bad kidney infection. After a few days of IV antibiotics she was completely normal and lucid and we had some lovely chats

Yes as pp said it can be common for elderly people to get confused when they have an infection, and being in hospital can be very disorientating. Hopefully as the infection clears up so will the confusion.
It must be very distressing for him and all of you

hiding my dad was like this in hospital. A combination of infection, and being out of his normal environment and routines made him quite confused. Looking back now it is quite funny, but at the time the phone calls were very distressing. He would ring and tell us his car had been stolen, and he was being kept a prisoner. He invented stories about his fellow patients and was convinced he had been to a black tie event with them the night before. He had to have a DOLS, which upset me, but he kept trying to walk out. I knew it wasn’t dementia because it came on so quickly but it can be hard to convince the staff. As I said, it seems funny now, even to him, but I do empathise with you as it is really hard, and hope that things improve soon.

Has he been diagnosed with dementia OP? My gran was like this in the early stages of dementia when she had to into hospital after falling and breaking her hip. Every time someone went to visit she would think we were there to take her home and get very angry/upset when we explained she couldn't yet. If he's not normally confused though it probably is just down to the infection

Yes to infection causing sudden confusion, but the fact that it lingered on after his last discharge concerns me. I'm an OT - umpteen years in acute medicine, care of the elderly and neuro.

There is a chance he could have an early stage dementia - not evident in his own, familiar environment with his daily routines firmly in place, but decompensates completely in a new environment, with the added complication of infection.

Once he's confirmed completely free of infection, I'd ask for his GP to run a baseline cognitive assessment on him, or refer him for specialist assessment with an elderly mental health team. He'll have to consent to these, mind - if he refuses assessment or referral, there's nothing more you can do unfortunately.

I meant to add, her dementia went downhill really quickly while she was in hospital. She was practically fully functioning before (in fact she broke her hip when she fell while she was away for the weekend with a friend). After the operation she was never the same.

I'm not trying to alarm you OP. I'm referring to a PP who said dementia doesn't start quickly. In some cases it definitely can.

If he hasn't shown any signs of it before it's probably not dementia though.

It's quite common for older people with infections to get 'delirium' whilst in hospital.

Sometimes it highlights previously hidden confusion/dementia, sometimes it passes once they are well again.

Once FIL is out of hospital and if he is well enough to do so, it's worth having the conversations if you haven't already done so about getting powers of attorney, any advance decsions and wishes that he may have about his future care in place.

Has he had any social,services involvement previously?

And Elphaba's advice is spot on too.

I am not a medical person but is there any chance he is dehydrated?

My grandpa was like this in hospital and it turned out he had a UTI. He was a bit wandered anyway but was coming out with statements really like what you are saying. Men coming into the hospital during the night etc etc.
Once they got him the antibiotics for it he improved a lot. Another that helped a lot was seeing my daughter...there’s something about young children and old people....he was like a different person and it was like he totally knew what was going on all of a sudden. We only took her once he was a bit better though.
Hope he’s better soon

I would definitely be suspecting he has a delirium. It might be helpful for you to look at the signs and symptoms. It's very common for elderly patients in hospital to have one.
They will probably be assessing his mental health whilst he is in hospital and you can ask whether the medical professionals have any concerns or are planning on doing a CT scan which will show up any changes to his brain functioning that goes beyond the delirium.

Oh wow! Thank you all so much. I am actually crying that so many of you took the time to reply. We've felt so alone all of this.
We hoped a UTI was the cause but he's been on intravenous antibiotics for the best part of a week and it's not getting any better.
His sister and mother both had dementia and we are terrified he will get it too. Will see if we can get some formal assessment done - hopefully to rule it out!

Lots of advice - power of attorney is something we have talked about before.

He doesn't want to be in hospital at all, threatens to discharge himself regularly but really couldn't cope. There is an on going discussion about amputating his toes / leg and he's not mobile at all.

He has had social services do a care assessment and was getting 15 mins each day - just to put cream on his leg, put his sock on and make him a cuppa. I had organised more (an hour in the morning and half hour at night) before he got taken in again as social services weren't able to do an assessment before Christmas. We've also added a key safe and arranged a care line - but they didn't turn up to install it as arranged!!

I

I agree with previous posters - sounds like delirium. Hopefully it will improve quickly, but just wanted to let you know that it can sometimes take a while (weeks to a couple of months) to fully settle, even after the infection is gone. So if it's not quick, it can still be 'normal'.

Has he got some things to help orient him eg pictures of family, familiar items etc?

ElphabaTheGreen's post is spot on.

I've seen this too.

Very early stages of dementia don't make themselves obvious until the patient is taken somewhere very different to what they're used to.

Add a UTI or another infection and you have what you've described.

He needs to be tested for capacity, as he may not be competent for Power of Attorney procedures.

You may have to apply for a Deputyship under the Court of Protection, which is expensive and longwinded. Sorry.

Definitely sounds like delirium. Unfortunately with an elderly confused person in hospital they often assume dementia. Push them to see if it is delirium, there are things they can do to help it resolve more quickly.

If you want to get POA, he has to agree to it, and sign the documents. He may not be able to do so if he's already been diagnosed with dementia. We got our lawyer to come to PIL's home and he was satisfied they understood what they were signing. They had both just been diagnosed with dementia at that point and some lawyers might not have taken the same view. Having POA has been a godsend.

Some of the advice here around POAs is a bit off.

1. You don’t need lawyers for a POA. You can print forms off the OPG site.

1. You don’t need to test capacity. Just get someone known and trusted, we used a priest, to witness. (The website will give details of who can be used.)

But do it quickly, so be ready when he is next reasonably lucid. The Court of Protection process is lengthy and expensive.

Just sending - this all sounds very familiar. But for us, this was just a hospital-induced exacerbation of some dementia behaviours we'd already noticed over the preceding six months or so. But the consultant still said that while it was probably dementia because of what we'd noticed already, delirium can persist for up to six months.

So hang on in there - whatever it is, it sounds like sorting the POA would be a priority.

Thanks all. I've filled out the online application for POA and just need to print it out and get it signed - which I will do on Monday. How do they check it?
I've also spent some time today investigating nursing homes as, when we saw him today, it seemed highly unlikely that he would be able to manage independently any time soon!

Oh dear, OP. Sympathies I was looking into residential homes around this time last year for my DM. It was grim. I hope your DP/DH is OK through all this since I assume it's his dad.

With his poorly controlled diabetes plus the strong family history of dementia among first degree relatives, it would surprise me if there wasn't an underlying cognitive decline, sadly, that's just being brought to the surface by everything that's going on. It sounds like you're taking the right steps, difficult though they may be.

You're absolutely doing the right thing by looking at POA now before it's too late. My mum & aunt left it too late with my gran unfortunately and she wasn't competent enough to agree to it by the time they did. They had to go through a lengthy process to get guardianship through the court instead. Thankfully they have that now but it meant there was a much bigger delay getting her into a home that was suitable than we would have liked.

for you and your DP. It's a horrible illness