Fractured hip and delirium - help!

[Impossiblestandards]

DM is in her 80’s and fractured her hip a couple of days ago, fine mentally before, is now in hospital waiting for surgery on a lot of morphine and suffering delirium. How can I support her? She just wants to come home, doesn’t know why she can’t walk, phones multiple times an hour asking for me to get her, thinks she’s at a station/restaurant/cafe not a hospital and everyone is horrible to her when I’ve visited and know they’ve discussed treatment and have been really nice. I feel awful but have stopped answering the phone as she can’t remember what we just discussed and is really angry and aggressive thinking I’ve abandoned her. Has anyone come out the other side of something like this? Any advice? I love DM so much but have no idea what will help, she is so confused and just thinks we are all against her.

Has she got a UTI? This commonly results in delirium for elderly hospital patients. She'll need antibiotics if so. Check the ward have tested for this.
There isn't really a good way of dealing with it. While she's in this state you have to try and say non committal but reassuring things. Tell her that she's not quite ready for home yet but it shouldn't be long, that sort of thing.

And don't bother telling her you've already talked about something. She doesn't remember and she wouldn't be saying it again if she did. Accept that you'll be having repeated conversation for a while. Keep everything soothing, don't bother disputing anything. It won't help. Lots of 'I'll have to check on that' fence sitting.

I thought it sounds like a UTI too.

Thank you, I’ve been doing that a lot today but just can’t do it over 10 times an hour 😔 no UTI, possibly some dehydration but she was quite lucid yesterday evening and completely out of it today.

History of UTI but has also been on antibiotics recently for something else which only finished a couple of days ago so I think it’s unlikely.

There's very little you can do, unfortunately. Do make sure the ward staff are all aware this is a temporary state, not her baseline - they do tend to just write it off as dementia rather than doing further tests if you're not insistent.

It could be a UTI, so make sure they check for that - with a urine culture not just a dip test. But it's very likely it's simply a combination of the pain, the meds, and the unfamiliar environment. None of which are within your power to change for now.

When you visit you can try taking in 'grounding' items such as photos, or watching a familiar TV programme or listening to a radio programme that she follows regularly.

It is very common in older people in hospital, and the best treatment is usually being discharged.

Thank you, I guess I’m just looking for reassurance I’m not being horrible not responding for a few hours but I’m completely exhausted physically and emotionally and I feel v selfish even writing that as I’m obviously in a better state than DM. I’ve told the hospital this is v unusual and definitely not baseline and will do the same tomorrow as well.

My relative had this after being put on high dose of steroids, they returned to their normal state once they stopped taking them.

I don’t know how long she’s got to wait for the operation but morphine delirium is not unusual sadly, I hope the dr’ s are reviewing her regularly. You are really not being horrible by looking after yourself, with any luck she won’t remember this period of time and I really hope the operation happens asap.

Hi - that sounds incredibly stressful. I can empathise as my 82 yr old mum broke her hip in January and suffered acute delirium after the op. In her case it was a combination of morphine plus a PE (blood clot on the lung.) She did recover.
I'm a retired psychiatrist and long time ago in a previous post I worked in hospital liaison psychiatry - our team was often called to medical/ surgical wards to assess folk who were delirious. Once we'd assessed that their issue wasn't psychiatric but medical ie acute delirium/ confusional state our advice to the medical teams was always to investigate for any underlying causes - which could be multiple and get them treated.
Re your mum - I'd be asking to speak to the treating doctors to check they are investigating for all possible causes and not just assuming it's due to morphine alone ( eg infection/ PE/ other drugs). Then address the cause - review morphine dose/ treat any infection/ UTI etc.
Ask if there is an old age medical team who could get involved. Orthopaedic surgical teams aren't always geared up to assess and manage delirium. She may need something like diazepam to help calm her agitation. We also used to prescribe low dose antipsychotics in severe cases but I don't know if that's done these days. Hopefully someone with more up to date medical knowledge than me might respond here.
She might be best in a side room with lights on at night, reduced distractions. Hope you can get her assessed and treated. I'm afraid it can apparently take weeks for some people to return to their baseline level, depending on the cause. Good luck and I hope her op goes well.

Thank you, hopefully the op should be tomorrow so I’ve got everything crossed when she’s off the morphine she won’t remember and will start returning to normal but I feel awful in the meantime. Almost feels like a bad dream, this time last week she was fine other than usual aches and pains and one fall and it feels like a catastrophe change.

I’ve just come out of an episode like this with my DM. DM’s delerium was also not UTI related, I think it was the shock and chaos of being in hospital, and being in pain. It’s strange and sad seeing them like that.
Very useful advice on this thread already, nothing major to add other than sending you solidarity and reassurance that , once she was home,my DM has regained full capacity.
Really glad to hear that you are making boundaries for yourself, in terms of how often you answer her calls. I know it can feel hard to do that, but you really do need to pace yourself.
Agree firmly with previous poster who advised to be clear with staff that this is not her normal - i definitely experienced that staff write it off as dementia.
Also be wary of appropriate discharge planning. I had to really be insistent about mums discharge - they were ready to send her home (she lives alone) when she was still fully delerious - literally thinking people were flying in the sky outside. After a lot of negotiation she was discharged temporarily to a care home, where she slowly regained capacity and eventually returned home after a few weeks.
I hope your DM makes a full recovery, and that you are supported while this is going on. Take care of yourself as well!

We had exactly this with mine at Christmas, the ward staff were very reassuring and said it is completely normal from the shock, pain relief etc. They did a memory test on her which she passed and they were in agreement that it was not dementia, I have POA and they lots of discussions with me (she did not have capacity to consent to surgery). Also because she could describe in detail, corroborated by my dad, exactly how her fall happened and how she initially got to hospital, it was as soon as she was given pain relief her memory went funny and she was completely confused as to what was going on. She improved steadily and was back to normal within I'd say 2 weeks, we just had to go with it and keep repeating ourselves. She has made a very good physical recovery too.

A couple more thoughts - while my mum was going thru similar I did more reading about delirium and was reminded that a common feature can be that it fluctuates over time - one moment a person can be totally lucid then an few hours later completely confused - so staff who don't know the person can miss that they are still delirious. Also there are two types - the more obvious florid type - with confusion/ disorientation/ paranoia/ hallucinations/ mood changes and agitation but also a quieter hypoactive type eg sedation, becoming withdrawn, talking less, going off food/ drink. People can have a combination of the two phases. So as someone mentioned above - if when it comes to discharge home - if you feel your mum isn't back to her usual self I'd emphasise your concerns to the staff. Signs of ongoing delirium can be subtle to people that don't know the person.

Thank you to everyone who commented and really helped on this thread. I’m relieved to say that after the hip replacement and coming off morphine DM is mentally back to her old self. She was a bit confused the first day or two after coming off it but is now completely back to normal. She remembers some of the hallucinations and they were completely real to her at the time but she understands it was just the meds. Still a lot of rehabilitation to do with her hip but I’m feeling a lot more positive. Just wanted to post the update in case anyone else finds themselves in the same situation and wonders how it worked out.

Thanks for the update @Impossiblestandards glad she's got through that part, hope the physical rehab goes well.