How long to wait to see if UTI confusion improves?

[tobyj]

Short history: FIL has dementia which has been steadily worsening, but MIL has been managing to look after him at home, with some carers coming in and a bit of residential respite. In the last couple of weeks, the confusion has grown suddenly much worse, and GP diagnosed a UTI and prescribed antibiotics. So far, after a week or so, they don't seem to be making much improvement in the confusion.

The hope is that the UTI will resolve, and he'll return to his baseline. But from what I've read on here and elsewhere, it could take days, weeks or never for that to happen. Question is, how long do you wait before making any permanent decisions? MIL is struggling to cope on the previous level of care, given the increased confusion. Past experience suggests that a change of environment (eg bringing different carers in or sending FIL in for a temporary stay in the care home) are likely to make the confusion worse in the short term, particularly given his current state, and may reduce the chances of his confusion improving as he recovers from the UTI.

It may be that this is the turning point and that permanent residential care is now the only option. But equally it's hard to feel confident that that's the right decision on the basis of a possibly temporary decline that could improve in a relatively short time. But how long do you struggle through and wait to see if the 'recovery' happens?

Any similar experiences?

I’d expect to see an improvement when the antibiotics have finished, presuming they have got rid of the infection.

My experience with my dad was if something happen that made his dementia worse that he would improve a bit but never back to where he was. The important thing at this stage is your MIL's welbeing -and it may take time to sort out extra help or residential so i would move on it now - if you find the right care home they can do much for people with dementia and your MIL can visit frequencly

Thanks. MIL doesn't like the idea of more care at home, so we're looking into residential care homes. Sadly, the lovely one he's gone to before for respite will only take residents with early dementia, and he's past that stage now, so it's not a long term option.

Oh that is a shame but it would be worse for him to move more than once -my dads care home was brilliant but he did need the advanced dementia suppory. Dementia uk have a brillant helpline with specialist nurses and were great with my mum at this stage - for finance in england the local age uk were brilliant. Its a tough time

So sorry, its a tough place to be. My dad had continuous UTIs in his last months. I'm afraid they can be repeated and resistant to meds.

Was there proof it was a UTI? Antibiotics often get given in a downturn in hopes it is a UTI.

Even if it is a UTI, people with dementia often don't recover back to where they were before. Unfortunately only time will give you the answer.

Your poor MIL. We went through this whole thing with my Dad. One period of rapidly increasing confusion was attributed to a UTI but even after the antibiotics things didn't get better. Dementia is like a roller coaster, they seem to plateau for weeks or months before a sudden dip.

All you can do is give your MIL the support she needs. Residential care is probably the answer going forward but it's a huge decision - not so much for the person who has dementia as they are going to be confused and upset whatever happens, but more so for the rest of the family.

With vascular dementia you can go down in steps quite suddenly I believe.
I would start planning for a move now. Today is likely to be the best he will ever be.

I think my DM has had at least 3-4 courses of antibiotics for “UTI” since September, despite the home not getting any useable urine samples, before she was even seen by the mental health team who finally prescribed her with medication. As a previous poster said, it’s like they start off hoping it’s just a UTI and completely ignore it might be a deterioration in the actual disease they already have. Pointless courses of antibiotics which she will now be more resistant to.

If it is a uti, on urine culture, and appropriately treated it may still take 2-3 weeks for the confusion to improve, though as previously said often will take a bit of a step down with each episode like this.
It's important to make sure they are drinking enough, as often delirious old people don't drink and that will make their confusion worse

Thanks all. Fil has Lewy Body Dementia, which I understand can have sharp declines. I'm not sure about the UTI - MIL said the GP seemed sure, but then the antibiotics were prescribed immediately, so who knows. We're spending the weekend there so will hopefully get a good understanding of the situation, and an opportunity to talk properly with MIL about future plans and what support she needs. So sad to think this might now be his 'best'. What a horrible disease.

Look up about delirium - a person can have delirium on top of dementia which can come on suddenly. Do you know if FIL is constipated as this can also cause delirium as well as lots of other things. I would push for a f2f appointment with GP if possible so they could at least rule it out. Or it may indeed be a sharp decline in his abilities. I'm sorry you're going through this

Elderly people often need antibiotics specific to their infection so if these are not working he may need different ones