Am I right to call 111?

[JamieFrasersSassenach]

DM has definitely got cognitive decline.
This week it has got markedly worse.

Today she has been telling me things have happened that I know have not.

Examples are that her heating isn't working - it's 23 in her house.

She says people have been coming in and out of her house all week - British Gas Homecare came twice to put new batteries in her hive thermostat and then to show her how to set her boiler temperature - their records say she was confused.

I live an hours drive away from her, I came over this morning to check everything for her - all good, spent about 2.5 hours with her.

I got home at lunchtime, by 3.30 she had phoned me 3 times to say her heating was not working and she was freezing (her hive account which I have access to was showing the house temperature to be 23) and then that none of her 3 TVs were working.

I came back - everything working fine, DM wearing a vest top because she is so warm.

She then said she phoned me because there were electrical wires all over the floor and she did not know where to put them.

She said I had left the wires there when I was stripping down electrical equipment this morning.

There were no electrical wires and I had not had any electrical equipment out this morning.

I called 111 and spoke to them about her confusion. I am waiting for a call back.

Is there anyone else I could contact for help this evening?

I can't stay here with her and simply cannot keep driving over, or to be honest cope with constant phone calls. I'm thinking maybe she has a uti and this is making her a bit delusional.

Anyone have experience of similar - ideas of what I should do to get DM some help tonight/tomorrow?

I have PoA set up so if she is deemed in the future to lack capacity I can act on her behalf.

Cinnamon Trust can help with animal care whilst the owner is in hospital, or local rescue centres may be able to help - I'm thinking foster care for the cat, rather than someone visiting the home. Volunteers will be experienced at fostering animals.

There are charities for pets that might be able to help, this is one, someone local to me has a dog from cinnamon trust https://cinnamon.org.uk/

This is another that may help, although I don’t know anyone that has used this one https://themayhew.org/how-we-help/in-our-home/pet-refuge/

She’d be just as unknown to DM if DM had hired her. Perhaps you could lock a few internal doors.

If there is a neighbour to help out I definitely think that’d be best for the cat for the next week or so, hopefully by Wednesday/Thursday you’ll have a bit more idea how things are going and can rethink cattery or a vacation at your house!

OP the cat will sleep so I think leave him where he is with a visitor feeding.

I agree. Neighbour to begin with until you have take to think and take stock.
Don't be rushed into anything.

I'd either do this or take the cat to your house, OP.

If neighbour not keen, have a look on amazon - there’s loads of automatic cat food and water dispensers. Would at least mean you've not got to go every day.

I'm more worried about him not having any company - I can leave lots of food and water down for him. It's just hard with an hour each way to add in time to spend with him too.

I work as a dementia specialist nurse and I very much agree with @RunnerDown that this sounds like delirium brought on by UTI.

DM could have dementia too of course, or some degree of MCI, it's not uncommon. And people who have either are often more prone to episodes of delirium and don't always return to baseline in the way someone with no cognitive impairment would.

The hospital would be unlikely to diagnose dementia while delirium is present as they need to know what her normal functioning is like to make an accurate diagnosis, so you may want to look at a referral to memory services once this is sorted. The scan will be helpful depending on the type of scan done.

Hospitals treat lots of delirium, they will be well used to it. They may have a specialist delirium nurse if you want to speak to someone and will certainly have a delirium policy. They will look at options for getting some antibiotics into your DM, IV would be great but they might need to consider something to help her be calmer before doing so, no point if she is just going to pull IVs out. It would usually be treated under the mental capacity act without the need for being sectioned under the mental health act.

Discharge planning is important but again, you need to know how she will actually be at the point of discharge before a plan can be put in place. There will usually be a discharge coordinator and a hospital social work team who can discuss a plan of care for discharge, along with occupational therapy if needed but its important to remember that once the delirium is treated DM might well regain capacity and then what support she wants at home is fundamentally up to her.

From personal experience my DGM (90) has had numerous episodes of delirium, in which she feels she has been kidnapped, taken to all sorts of places, is agitated and confused. With treatment she has always recovered well and although she also has vascular dementia this has just continued to progress very slowly over the last 10 years. Professionally, I see delirium all the time - it has many causes (infections, constipation, dehydration, medication changes, pain, change in environment are some common ones) and the first question I always ask someone when they tell me about a change in someone's presentation is "do they suddenly seem more confused than usual?" because that is the "Think delirium" clue. With some types of dementia people are more prone to bigger changes at once / fluctuations but even in those dementias you'd always rule out reversible causes for changes first.

Cats are self sufficient survivors, Not a needy Labrador!
He will be fine looking after himself for a few days at a time, you’ll hopefully know more this week and can make a plan. A two hour trip is an extra burden you could do without at the moment I’m sure. Hope she’s improved overnight.

So last night was apparently even worse with her shouting and swearing and trying to hurt people, and she managed to break a locker on the ward.

But she has been more settled today and agreed to IV antibiotics which she was having this afternoon.

I did not visit today because I seem to agitate her and did not want to spoil her settled-ness.

The nurse I spoke to said that they had called the mental health team out and were waiting for them to come and assess her.

I have everything crossed that the antibiotics will make a difference 🤞🤞

DMs neighbours have agreed to look after her cat so that has reduced my stress somewhat as well.

Once again thank you all for your help and support 🙏🏻

Oh you poor thing, how ever so worrying for you. Sounds awful for your poor mum too. Here's hoping 24hrs on the abs make all the difference.

Actually, OP, cruel as it sounds, enjoy no night time phone calls when you can.

At least the neighbourooking after the cat means there is someone to see if there's a leak or other problem there. One less thing to stress over.

I agree with this. It can be really hard to hand over the responsibility mentally but you must really try to without guilt. You don’t have the same resources to provide what a hospital ward clearly can. The ability for the staff to go home and have a break is a massive part of that.

How is she now OP? Has she settled down with the antibiotics? I hope things are a bit quieter.

We are not really any further along - she is still refusing the antibiotics and has been moved to a side room now.

She assaulted the security guard so now has 2 security guards.

I haven't been to see her today - it's just too overwhelming for me to be honest and I feel like every time I go she wants to 'tell' on every else on the ward in the hope that I will avenge her, which seems to exacerbate everything.

They are still waiting for the mental health team to visit.

So we go around in the same circles.

She did have some lorazepam yesterday but I don't think it was enough because she was still throwing water over the guards.

She did have some lorazepam yesterday but I don't think it was enough because she was still throwing water over the guards

As a nurse, I've often seen doctors seriously underestimate the dosage of tranquillisers required to sedate some elderly patients.

It just sounds awful, @JamieFrasersSassenach . Not just for you - but also for your mum, and all the staff in the hospital. She is clearly not happy and seems very distressed, whatever the reason for that distress, and they are not pulling their finger out to make the changes needed to deal with it. Today is Friday - I would in your position make a massive fuss today because in my experience of having an elderly parent in hospital this time last year, bugger all decisions are made on the weekend.

Oh love. I think you’re right to keep your visits minimal, for your dm and yourself. Will she talk to you over the phone? I do wonder whether she’d benefit from a phone call (not visit) from her friend. It’s a tough call between trying to comfort her and protecting her dignity though.

keep in mind that there will be a resolution to this. It might not be what you or your dm actually wants but there will be one. In the meantime she’s in the place that she needs to be because you both need access to the kinds of professions you need on board to access help. Your dm wouldn’t be better in a world you could be caring for her full time, you’d be the focus of her resistance and hostility.

I honestly wouldn't push for anything to happen today. OP can't demand that her mother's prescription is increased, and it doesn't seem like there's anything else to be done.

Pushing for something to happen next week makes more sense, imo. Ask for a meeting with the Ward Sister and the hospital's Adult Mental Health person, and the hospital's Social Worker. Nothing will happen without a meeting that you attend, OP.

OP's mother is, basically, in the safest place at the moment. Hopefully they can get the antibiotics into her - can they not grind them up into her food, or something? As the pills and IV clearly didn't work.

Does she still have the UTI?

How’s things OP?