Funny turn - mum with dementia unresponsive blue lips and fingers temporarily

[Delphigirl]

Odd call from nursing home where she is in care as dementia. She was absent and unresponsive for some moments blue lips blue fingers, they put her in the recovery position phoned 999, then she came round and is now chatty and drinking tea. Paramedics on the way. Any idea what that might be? Some kind of embolism/cardiac event? Goodness knows what we will do if they suggest a stent or something, she is 89 and has little idea of what is going on. A massive heart attack would probably be a good way to go…

Sounds like a cardiac event or stroke. My mum had similar episodes, we dug our heels in and said no hospital admissions. One of the events saw her off in the end but even that was awful as it took her so long to pass. I’m sorry you and your mum are going through this, it leaves you destroyed.

Cardiac event of some sort or temporary breathing obstruction I should think.

Refusing a stent, if offered, wouldn't be unreasonable. My dad was brought back from a heart attack and said it would be his preferred way to go.

Thanks both. I didn’t send her to hospital - paramedic was excellent as was dr on 111. She had a quiet night. No doubt this is not a one off but let’s see what develops.

Aspiration of secretions perhaps causing temporary apnoea, which the recovery position allowed to drain so breathing restarted, is another possibility. In older people with dementia, it's common for the cough reflex to be very weak or missing, so the person can't manage their own airway very well if they do choke. Does she have a cold at the moment? Was she eating or drinking near to the event? She may need an aspiration risk review.

Thanks very much this sounds much more likely to me given what happened and the fact that she was as perky as anything today. She had just finished supper. I will ask for the aspiration risk review, thanks so much @roundaboutthehillsareshining

Glad she's none the worst for her episode. Choking in older people can be very scarey as you don't always know it's happening until they start going blue - they don't always have the strength or reflex to cough, and can lose their "buffer" very quickly, so don't flail about like a younger person who can't breathe would. I'd ask the staff to keep a close eye while she's eating and immediately afterwards, just in case.

Hopefully you have POA and can refuse any treatment beyond keeping her comfortable should she deteriorate? Some care homes are known for unnecessary treatments that prolong life just for the sake of it.

Yes we do. Her care home is fabulous, very respectful of our wishes.

I would say that bear in mind care homes have to provide a level of care and first aid for unexpected medical events. There was a care home who got dragged over the coals by the coroner and the CQC because they didn't provide first aid to a resident who was choking, understanding that the DNR in place meant they shouldn't provide first aid.

It was found that they should have attempted first aid up until the point that cardiac arrest occurred (so back slaps, abdominal thrust, suction, recovery position, airway support), as there was a clear initiating incident that had caused first aid to be required. This is despite the first aid for choking likely to be distressing for an elderly patient and to cause secondary injury (which the home argued).

So you can't request that a care home doesn't perform basic pre-arrest first aid or assessments (such as swallowing/feeding, falls risk, etc) that are required for them to provide safe care.

(sorry to derail)

Not a derailment at all, that’s very helpful. We would want them to provide such basic first aid so I don’t think there is any difference in their requirements and what we would want. We want her to be cared for, we just would not authorise resuscitation or surgery so things like hospital visits (which would really distress her) need a discussion about what it is likely to achieve. No point sending her there for an ecg if the hospital is unlikely to offer a stent and if they did we would not accept it, but if she fell and cut her leg so needed a stitch to aid healing we would certainly take her for that. All of these conversations are very useful to clarify our family’s thinking so thank you for your input.