Any suggestions for root cause of symptoms

[whatohwhattodo]

My mum is in hospital and has been for several weeks. She went in originally as she was becoming very immobile and my dad could not even get her to the toilet.

She now seems to have a whole mix of stuff going on but the hospital don’t seem to think there is anything in particular wrong.

Difficulty swallowing
Trouble picking up or coordinating herself to hold small items
Has some good days but then bad days
Says she feels ‘slow’ on the bad days
Can understand what you say but cannot seem to get an answer out to reply
Forgetful
Drowsy
No interest in reading a book / watching TV to pass the time
cannot comply with physio - says she cannot make her legs move

Hospital just suggesting she needs physio but our gut feel is it’s more than that and could be neurological.

No ideas Op, but I do agree with your assessment. How old is your DM? Does she have other identified issues - heart, dementia etc?

Push for an MRI if you can. Although if she has an alternative diagnosis , you may struggle to get traction on that.

Is there any sign of infection which could be causing mild delirium? Could she have had a TIA? Ask for MRI. Some elderlies just don't do well in hospital and can become disoriented, confused and demotivated. She may pick up once she is back on familiar territory.

I agree it sounds neurological. It does not sound like 'just needs physio'.

What tests has she had OP? Blood tests, head scan?

How quickly did the symptoms come on, had it been gradually over a long time, or sudden and recent? How old is she?

Has anyone checked for a UTI which can cause confusion in the elderly?

Thanks for all the comments.
she is 81
She has been in and out since January- shoulder replacement and in for a month, then had a fall Easter weekend and in until first week in June then went in first week in August.

she had pneumonia / chest infections in the April admission and this one - eventually cleared up with antibiotics. also collapsed lung in this admission caused by mucus.
she has existing copd and a bit of a lung missing
she is probably a bit depressed but now on anti depressents
before the second admission she had become very confused at home - hence the fall but reading symptoms for pneumonia in the elderly it all fit.
i don’t think it’s a uti - it’s not confusion as such I don’t think more a flatness - to some extent I feel like she has given up and just had enough.

My sister is under a neurologist which is why I think that’s hitting home with her - she just said it relates to how she feels. She went two days ago and she was really alert and with it. And then today just gone backwards again.

it doesn’t help that today she found the hospital had put food down and left her sleeping - they are meant to be monitoring what she eats and helping her eat it. They also hadn’t made sure she took medications.

@Justbecauseyoucandoesntmeanyoushould problem is she cannot come home - she is completely immobile. Needs a hoist to move. You cannot put a hoist in a 400 year old cottage. My dad is 82 and cannot do it anymore.

The anti-depressants could be causing her symptoms - they should be used with caution in the elderly. Look up the side effects of the one she is on.

Oh and other symptoms - incontinece - needing to wee multiple times an hour sometimes.

also several episodes of constipation - week at a time

As the symptoms come and go - alert one day, down the next - it does not sound as if it is related to her medication.

OP your mum has had so many physical issues I wonder if cognitive issues have have been missed, as the focus has been on her physical problems. I mention that because my mother had dementia and one day could be alert and chatty, and the next very down and uncommunicative. The 'flatness' you describe is common with dementia.

Hospital it is a very negative environment for the elderly, particularly if they have issues which mean they cannot feed and hydrate themselves reliably. Whatever they say she won't get assistance, when my mother was in for a hip operation they dumped food and drink on her tray then complained she ignored it. She only ate and drank if I was there to help and encourage her.

It sounds unfeasible for her to return home, hospital is not helping and is probably causing her to deteriorate further. Moving her into a care home would ensure she is comfortable, and helped to eat and drink, they will have a hoist so she can be moved from bed to chair. You could set up a short stay of a month and see how it works out. If she has the money to fund it, it will be easy to arrange; if she can’t fund it, it will be more hassle but could still be possible. The manager of the care home would assess her to ensure they can meet her needs.

That sounds like my Mum! She was in hospital until last week. Can’t walk but was walking fine 3 months ago. Doesn’t eat. Didn’t drink water either and ended up being diagnosed with dementia which miraculously righted itself once she had some fluids.

@catofglorymy sister managed to speak to doctors on their rounds today. Yes it seems they were so focused on physical they ignored everything else that went were saying. He did some cognitive tests at the bedside and provisional diagnosis is dementia - needs a ct scan to confirm.

@whatohwhattodo It is good to hear that you seem to be getting towards a diagnosis now, although I'm sorry it's sounds like it is dementia.

The one piece of good news is that she should be able to leave the hospital for a more comfortable and supportive environment in a care home.

I was going to say cognitive decline or dementia.

These situations can have a fairly typical trajectory after a fall and a bone break at that age. Infections and cognitive decline.

I almost think the body runs out of steam to recover from such a significant trauma and the rest of the symptoms start coming out like a bit of a landslide. We had a break followed by the lung collapse, pneumonia and a number of bouts of sepsis. In our case the hospital were absolutely exceptional though and caught things early. It was a very difficult time so I completely empathise with your situation.

Sometimes in hospitals because they see it day in and day out with elderly patients they get desensitised to it but when it is your loved one it is so different.

Thanks @catofglory@Handsomesoapdish. Yes I would rather we know. I have been saying for several months that it just seems as if she had given up. She didn’t have any fight in her. The previous admission she was very focused on getting home - this one she didn’t seem bothered. Just resigned to being there.

Needs a hoist to move. You cannot put a hoist in a 400 year old cottage.

it doesn’t have to be fixed to the roof. MIL had a freestanding one like an engine hoist.

Sorry you’re going through this, I hope they can give you some answers.

Dementia investigation sounds a very good idea, but with the weeing multiple times an hour I'd also make sure they do a UTI test (culture, not just dip).

Constipation can also cause confusion, in a similar way to a UTI, so they need to see if they can sort that.

And it's also worth thinking about Parkinson's - can cause constipation, is often misdiagnosed as depression, and would explain the 'can't get her legs to move'.