elderly mother unwell, any ideas what this could be

[AInightingale]

My mother is 88 and has always enjoyed good health despite having what is now moderate dementia. For the past six weeks or so, she has been v tired, sleeping until woken, then falling asleep again in the daytime, quite pale, sick on waking a few times, light headed occasionally, just not herself. She has pernicious anaemia and quarterly injections but blood/urine tests have shown nothing. Do these symptoms ring any bells with anyone? Trying to get through to GP is the usual nightmare.

Hi OP Im sorry I have no idea what this could be but for something that has gone on for so long I would really insist to the GP that she is seen. I know how hard it is to get seen by a GP (I look after my mum too) but I would speak to the receptionist and insist. Good luck

Is she remembering to drink properly?

I suffered with very bad dehydration recently and had dizzyness, sickness, so tired, feeling generally shite. Didn't actually feel thirsty either.

My DGM and MIL with dementia just will not drink unless reminded. Both have ended up needing fluid drips at different times and were presenting as 'generally unwell' beforehand.

We've also had to get things put on place to stop DGM making herself ill, given the chance she has a habit of keeping food far too long and eating things that have potentially gone off.
She's made herself sick a few times doing that. Also taking the wrong medication at the wrong dose because she can't remember what it is / if she's taken it already.

Is her b12 currently OK? Because that makes you dizzy etc too.

Thanks.

You know I did suspect the B12 because she is almost yellowish-pale, but the bloods came back okay.

She is in a care facility where they do make sure she eats and drinks properly, it's very warm but not enough to cause dehydration I don't think.

I've asked them to do a carbon monoxide check just in case but I doubt it's that. I will go to the GP in person on Monday and insist that she's seen by someone, they do seem to have a bit more flexibility where someone is v old/young/vulnerable. Hope so anyway. Really don't want to have to take her to A&E when she is so out of sorts. God the NHS!

She definitely got her last B12?

It was late, but she got it recently. They are classic low B12 symptoms aren't they?

Pale doesn't suggest CO, and that should be quite unlikely in a care home unless her window is right next to the boiler outlet or something (although no harm in checking).

Doesn't the care home have a visiting GP?

Could be anything, op, low blood sugar, illness...She needs an urgent apt with GP, time to kick up a fuss

It's not a 'care home' proper, just assisted. They have a district nurse which is handy but she does need to see a doctor ASAP.

Ask if her recent blood tests included a full blood count which would show iron deficiency anaemia. The symptoms and the yellowy-pale would tie in with that

If it's 'own flat/bedsit' type assisted living I may need to revise my CO probability estimate. Does she have her own boiler, gas hob, gas fire or similar?

I've been reading up on delirium recently due to my SMs very sudden onset of the hyper type. There is also hypo which can include drowsiness, sluggishness etc. Apparently it can be tricky to diagnose and separate out from existing dementia and can have no definitive cause or can be indicative of infection, low sodium etc. Might be worth just having a look to see if it resonates x

In any case very best wishes to you and your Mum and I hope you get a positive resolution soon xxxx

There is gas heating underfloor, no boilers inside the flats, or gas hob or fire. Nearly sure there is a CO alarm on the ceiling though. But you are right, CO poisoning usually means very flushed in the face rather than pale, I believe.

Could be anything really at that age …. if absolutely no sign of infection and she’s looking yellow could be her liver function is off, perhaps kidney function, fluid balance; pernicious anaemia can also go hand in hand with other auto-immune conditions like Addisons disease. Is she an any other medication or has had any changes to her meds? The best thing is a thorough GP check up as we can only speculate!

It does mean flushed - and gas-powered undefloor heating won't be carrying actual gas around. Gas is used to heat water, which then circulates in sealed pipes.

A lot of common causes of paleness - anaemia, infections, blood loss - should be picked up in blood tests. But it depends what they actually tested for.

Hypothyroidism? That can present with a yellowish pale hue to the skin, and tiredness.

Might also be worth looking at cardiac function. Any swelling of the ankles?

I work on a dementia unit and a lot of residents sleep a lot. Even if they do get up, they will fall asleep in the chair. Of course. She may be ill. Behaviour often changes and then changed again.

I'm sorry your mum feels ill. Dementia does have physical symptoms too. Common for UTI's to cause problems, and infections. Keep trying for nurse/ gp appointment.

Kidney and LFTs would definitely be a good idea. I wouldn't say any kind of delirium because she's v coherent when you talk to her, and no UTIs afaik.

@AInightingale

That's a reassuring sign x

Really hope you get to the bottom of it soon as delirium is a bastard.

All the very best x

my mum has this and she was a terrible colour she is on medication now and is a lot better she also had similar symptoms to the op mum.

How much do they monitor fluid intake? Most people in care facilities don't drink enough imo, so I wouldn't rule that out. When did she have her urine tested? Often a UTI presents as being generally unwell for a while first before delirium etc. If she's incontinent a UTI is more likely, but then you say it's been tested for...

@lavenderandlemon very true

Get some jellies, fruit, ice lollies, mini fridge with cold drinks, or jelly drops

https://www.jellydrops.com/

She's 88 and her body is shutting down she will have lots of niggles
Keep her fluids up and comfortable