Delirium - advice please

[gutrotweins]

Hi
Potted history: dm fractured wrist on 3rd November and contracted a UTI in the following week. After major hallucinations and a course of antibiotics, we hoped she was better, but she was hospitalised on the Monday (12th Nov) with severe confusion (speech - no hallucinations). No UTI found, but low electrolytes. Since the A+E/MAU transit, she's been on an elderly ward for 3 weeks.

In the 3 weeks, all physiological tests have been negative (apart from 2 more UTIs which have been treated immediately).

They were talking about discharge to home a couple of weeks ago (even though we were originally told she would go to rehab due to broken bone). However, in the interim, she has become increasingly delirious - paranoid, obstreperous, deluded, hallucinating. She was seen by the MH team, who prescribed 2 weeks low dose haloperidol last Friday.

The haloperidol seemed to work over the weekend, but the delusions are back in force this week. She thinks she's well and is always ready to go home when I visit . (Reading between the lines, I think the doctors are telling her there's nothing wrong with her, without saying that there's something wrong with her thoughts, so she thinks she's completely fit.)

Dm lives with us, and I am not worried about dealing with her physical well-being, as we have carers ready and waiting. However, I am very worried about the delirium, as I feel that it's not getting any better. I have no idea how we'd deal with her in this state, particularly as she seems to be most unsettled at night.

Has anyone got experience of this?
Are people generally discharged when delirious, or do they discharge after a few days without a delirious incident?
Are there support services that I could contact if I have a problem with her when she's at home?
In other people's experience, do people improve once they getting their home environment?

I know this is rambling, but I would really appreciate some advice.

Thank you.

hi there
sorry to hear this

I wonder if you'd be better flagging this up on the "general" thread for caring for elderly parents - people might have some experience there.

the carers you have planned, does it include night time care?

Sorry to hear this, it’s so worrying.
Firstly- is it proven (is laboratory tested UTI’s) and has it been treated and retested to show it was clear? Has she been tested for other infections/medical conditions (eg chest infection, neurological conditions) that could be causing the continuing confusion?
On one occasion when my DM was in hospital and confused I had to challenge them on this. I was being told her confusion was a UTI, but her tests were clear and she had not been given AB’s to treat this (non existent UTI) - turned out to be a low grade pneumonia.
However another time, when she was in hospital for a fracture following a fall, she was very confused and I really began to fear for her mental health, but I took her home (they had wanted to do more tests for an unrelated condition they found pre-op), she was back to normal lucidity within a couple of days of getting back home. Her lovely GP, who knew her better than the hospital staff IYSWIM, explained it as a kind of PTS reaction to the fall/surgery/hospital stay. She quickly realised she had been ‘a bit mad’ as she put it.
I did have the advantage of being senior HCP though, and no shame at using this to get people to listen to me when I needed to advocate on behalf of my DM. There were times when I wondered how people without this knowledge managed.
I hope your DM is better soon .

Fadedred you've set my mind at rest a bit - thanks. I was reading about hospital delirium, and TBH, I can also understand how psychologically and physically frail people can get confused by 'shouters' on the ward!

Everything has been tested and re-tested, and treated when necessary. The only thing that's vaguely worrying is her fairly low BP (97/57). Today, she was totally lucid, so I'm hoping she maintains this stability over the weekend so that she can be discharged early next week. (36 hours ago, she was screaming 'FIRE, FIRE' and accusing the nurses of kicking her to death.) The change from day-to-day is unbelievable.

When the GP is informed of discharge and change of meds, will they be obliged to get in touch with us to ask how she's coping? (Our GPs have over 10,000 patients on their books, many >70)

Can I ask for visits from a community nurse, or is that beyond their remit?

Dh and I often take the dog for a walk together day-to-day. I don't even know if she'll be able to be left by herself. (A granny-sitter may be possible for our longer absences during the day.)

Obviously we'll see how she gets on at home... but it's that need for a lifeline - someone to phone if it all goes tits-up! Just for peace of mind.

Gutrotweins, I doubt the GP will contact you, but you can let them know your DM is home and ask for a home visit assessment for her blood pressure and a needs assessment for her ongoing care.
You will probably have to be somewhat assertive! Polite but assertive.
Has she been seen by a OT for assessment prior to discharge?
Has she got an alarm button? You can get falls monitoring equipment at home, if she is agreeable.
Age Concern can advise, also the Elderly Parents thread on MN is a good source of advice and support.

Thanks for all your help Faded. I will need to use your advice regarding GP surgery in a few weeks, but...

...had a bit of a result today. They are admitting her into a care home for 6 weeks for assessment and rehab, because they feel that she needs 24 hour care at the moment. I'm really, really relieved.

That’s a relief for you and your DM, Gutrotweins. I don’t think many people in this position are made aware of the six week rehab placement for older people, probably because so few places are available, but certainly gives you some breathing space and a better idea of how to plan for the future outside of the stressful place that acute hospital wards are. Hope it all goes well.

gutrot, that's good news.

btw what's the age for the 6 weeks in a care home or is medical criteria for that?