Sudden worsened dementia after fall- experiences

[Newmummy46]

Hi,
My father, when I last saw him in early December was in pretty good health. Starting to get a bit forgetful but fine living alone and physically fit. Aged 93.

He had a nasty fall a week ago, with a big bang to the head. Taken to A&E by ambulance, scanned- all fine. Needed stitches in his head. No broken bones.

But since then he has been very forgetful, keeps repeating the same question, doesn’t really know where he is. Unable to remember what you told him 5 mins ago. He can remember who visited him yesterday but asked me 10 times when he was going home. Seemed surprised each time I said Thursday. No recollection of the fall. Still remembers friends and family etc.

Anyone with experience of this- is this likely to be the new normal or a blip and might we see a bit of an improvement to how he was just before the fall?

I think he needs another medical assessment ASAP. He could have a slow bleed.

Agree, his doctors need to know he’s had a sudden and serious drop in his cognitive abilities following this fall. He could well have been just about managing at home in a familiar environment and this fall and admission has tipped him over the line into not managing. Or it could be a symptom of something else that needs investigating.

Is he still in hospital? has he been assessed for whether he’s safe to return home? It sounds like if he returned home now without any help or support this would be an unsafe discharge and you need to say this clearly to ensure he gets the attention he needs.

It can be very debilitating to fall, and I'm sure that with my mum each fall did induce a decline.
There was then usually a slight improvement or plateauing in decline before the next crisis. I think it's to do with the fact that once someone is very elderly, even if they seem to be doing pretty well, everything is actually in the balance. So a fall (and perhaps the cause of the fall, eg had there been TIA, or some other form of very minor stroke, or parkinsons, or a UTI??), even when quite minor, can have a massive impact.
It also causes stress (the shock + the awfulness of being in hospital) which can really impact on cognitive ability. Then there's the lack of hydration and good quality food and sleep whilst in hospital, which doesn't help.
My mum did tend to bounce back eventually but each time never quite got back to pre-fall ability, especially once she'd hit 85.
Sorry that it's difficult and hopefully he will improve once he's back in his familiar home environment (though obviously the hospital will have to make sure it's a safe discharge).

Your poor dad. My mum's the same age and it's such a worry.

Do you know why he fell?
And you know this level of memory loss is new since the fall?

As PP say above, I would definitely contact the GP or if you can bear it even take him to the A&E that scanned him before, I suspect they might want to rescan.

Yy to the above. Being in hospital in itself is very taxing on the brain - unfamiliar setting, broken sleep, lots of activity and questions.
Do hope that he recovers soon, and that you find help managing this journey with him.

We had this with MIL. They gave her a scan and it turned out she'd had a small bleed on the brain. The doctors suspected that it happened before the fall, and it was that which caused the fall in the first place.

Thanks all so much for the messages.

Tripped over on a pedestrianised street for no apparent reason.

He had family staying the day before his fall and they reported back that he was on great form.

He has left hospital. The doctor assessed and said he wouldn’ t be safe to discharge home but didn’t give any more info about prognosis. He has been discharged to a care home for 8 days while we think about steps going forward. We had hoped to see more of an improvement by now. He seems v keen to get back home so we’re hoping he finds that more settling and can stay there with the right support. Just need to make a call on what that support will be.

Really appreciate everyone sharing their experiences.

My gut instinct was he was just about coping at home, this has thrown all his routines out of whack and worried him, and he’s now not so good at hiding it. Unfortunately, from all your experiences, it sounds like we’re unlikely to see a material improvement, which while v sad, it’s nice to be able to manage my expectations and appreciate that he’s reached a great age in great health.

Glad he’s safe at the moment and hope you find the right long term solution.

You often find that people have gradually developed coping strategies in response to very slowly declining physicaland mental abilities. A fall or other illness can knock the strategies out of kilter and really show up a lot of issues that weren't obvious before. I've lost count of the number of friends and family who have only how frail/ cognitively impaired a relative is when their spouse does or is ill.

When my MIL had a stroke and was in hospital for several weeks my FIL, left alone at home, went suddenly downhill in terms of cognitive ability - similar to the things you mention about forgetting stuff and asking the same question again and again. Obviously he hadn't had a fall or any other medical emergency himself, ie there was no physical reason for this, so I assume it was due to the stress and disruption to his routines resulting from MIL's situation. He did improve over time (although not back to the previous level).

Assuming hospital ran bloods and checked for UTI ?

Being in a familiar environment (i.e. their own home) can mask the loss of memory due to dementia. They may appear to be doing fine, but in reality, it's muscle-memory rather than their brain keeping things ticking over.

Similar situation, though not with an accident. We'd been taking my mother on holiday (holiday cottages/homes etc not hotels) with us for 10 years after her husband died. Yes, she was getting more and more forgetful but it seemed minor to us. She was fine on holidays, just went along with what we were doing, coped OK with a different bedroom, different "home" etc. but just needed to be constantly reminded where things were, i.e. knife drawer, etc. Always straight back into normality once back home. Last year we took her for just a 4 night stay just an hour from home and she was an absolute nightmare - prowling around all night, couldn't sleep, constantly asking if it was our house, asking why we'd sold her own house, going out and wondering down the road, etc. We cut the holiday short just to get her back home and into her own home again, but she really struggled - couldn't do things she'd managed perfectly well to do for the past decade, i.e. didn't know how to use her own oven, etc.

Even the slightest thing can tip them over and break the routine, and often it was only the routine that kept them going! Then it really highlights they're a lot worse than they seemed.

This is interesting you ask since he said he thought he might have a UTI the day before he fell. But then when I spoke to him the morning of his fall he said he felt better. Can I ask why you ask? Is there a link?

There is a link between UTIs and increased confusion in the elderly.
Infection can cause delirium.

UTI's can cause confusion in elderly patients. They can be very serious too (especially so in men) so see if you can ask the care home to get him to do a sample.
Did he have concussion?
I think I'd take him to be looked at op

@Newmummy46
There is a huge link
UTI's can be a really common cause of falls and sudden deterioration in cognitive function in older people

Someone else has mentioned delirium, that was my thought too. Google it and see if it fits.