Delirium

[loopyloo87]

Hi, my mother went into hospital for a routine knee replacement 2 weeks ago however she contracted Pneumonia which apparently brought on delirium . We are at our wits end as she went into hospital with all her faculties and has been left spoon fed & incontinent she would be mortified if she understood what she's going through .
I have been in constant contact with the Dr's about the conditon & prognosis but very little is known about delirium . My mother had a ct scan last week which was normal apart from some scarring from a small stroke in 2010. The Pneumomia is clearing but she's still in a bad state of mind and was moved to the geriatric ward
Has anybody got or have any information on this condition please? I feel as though my mother has been taken away and wish that she'd never had the op

I'm sorry to hear about your mum. I know it's no comfort, but the same thing happened to my dad 2 years ago in his late 80s then. He was admitted for a chest infection (first time in hospital in his life) and he suffered delirium due to an imbalance of blood fluids (not due to negligence) because he'd refused to see a dr until the chest infection was quite established and he has kidney failure too. He didn't have a GA.

The worst effects lasted about 6 months- once he was home he would hallucinate, swearing he could see and hear things outside etc.

He has been assessed by the memory clinic and has suffered brain damage. His behaviour is like that of someone with dementia, in that he has no short term memory and cannot understand simple finances. or manage his own medication.

It is very trying for my mum who cares for him.

I don't know if you can 'blame' the GA your mum had- you know better than me what happened. She may get better slowly to a point.

I think if you can get your mum home it might help. They don't get much stimulation in hospital. You need to contact SS or her GP does to arrange care at home if your father could cope. Obviously the incontinence is a real issue. Does she have any opinion on where she wants to be? My father was in hospital for about a week. He is mobile (just) and mainly continent but does have some accidents. It IS possible your mum could recover to a degree. It's early days. Mine has lost the ability to read except newspaper headlines- before, he read 6 books a week and listened to Radio 4 and 3 all day. Now he can't follow anything because his memory is so bad- literally in one ear and out the other. Don't give up hope- you've not said how old she is but my father is in his 90s. If she is younger you may see some improvement.

Once again sorry not to get back sooner..

She never returned to being 100% what she had been but I'd say 80% much of the time until towards the end of her life. If she got tired, hadn't slept well, was ill, then things slipped, but she was hallucinating less.

Home was definitely better. She was reassured and slowly started to recognise people and take an interest again. We were able to address her fears, feed her on stuff she liked, get people to come in to see her (max 10 mins to begin with). Blood pressure came down.

We too were told hospital bed, problem was that it didn't fit! So we said sod that and had a normal bed downstairs until we thought she was well enough to go upstairs. We put in a stair lift that she refused to use... She had a commode in her rooms, even when she was well enough to get to the loo. She had to have a wheelchair from time to time. And simmers. We put surrounds round loos and places to hold on to. And removed rugs and put chairs to sit down on. I rang every day and sent cards twice or three times a week ( I lived a couple of hundred miles away) so she had something to touch, that she could ask people to read to her or show them.

And we checked the medication, there was one set that sent her completely into hallucination. We pressed for it to be reduced or replaced. It made a difference. The GP was understanding in a way the hospital doctors weren't.

*zimmers!

Thankyou all for your informative helpful replies .My mum is 82 PollyPerky. OrlandoFuriosa you've been great .
To date my mum is still confused with occasional hallucinations but the Dr's have said she's medically fit but because of her confusion can't go home ..We are so angry & feel that she wasn't fit for the op she's also now incontinent which she wasn't previously . I'm sorry if I tend to repeat myself but my head is all over the place my mum has gone . I'm also annoyed that physio don't try and persuade her to get out of bed she's now quite happy staying there all day which can't be good for overall health especially with her new knee which could cease up . Occupational health will need to assess my parents house but a hospital bed won't fit I was told she will need it for various reasons including the pressure relief mattress . This is all life changing for the sake of a simple op 😞

I have a feeling that if it's an electronically operated ripple mattress that's may be right but we had provided for us some sort of mattress cover which was pretty good. And if she can be got to mobilise, she won't need it so much.

they said she had probably had several strokes and also she fell, cut her head open in hospital ( their fault) and her general state of health was pretty poor , her ability to understand her state of health or anything was limited though her opinions were forceful, and there was no way she could go home without care.

Thinking of you, pm me if you want but as you see I don't always pick up straight away.

It's odd how they won't discharge your mum due to hallucinations whereas my dad- much older- was discharged WITH hallucinations which carried on for months at home. He used to bang on the windows to scare 'people in the garden' when of course there weren't any.

I don't think they can keep anyone in hospital against their will.

Why don't you contact your GP to ask for support and what could be provided at home? My parents' health authority has now adopted a practice of as much care in the home as possible and I thought this was a national policy- to provide care at home rather than have the elderly clogging up the beds in hospital?

You could also talk to charities like Age UK and Alzheimers for advice.

Your mum ought to be getting on-ward physio and being made to get out of bed. her muscles and mobility will decline rapidly with bed-rest.

Have you spoken to her GP to talk about all of this?

So sorry you are going through this, no advice to offer really,
I am just very surprised that the hospital thought it was suitable to operate on an 82 year old
I was told that in some cases they wont operate on someone over 70
I hope you get some satisfactory answers

I am just very surprised that the hospital thought it was suitable to operate on an 82 year old. I was told that in some cases they wont operate on someone over 70

Good grief no! Operations on those aged 80+ are very common. The Queen mum had her hip done when she was about 102!

I really don't know what to think at the moment but I feel that Dr's should assess an elderly persons faculties before any form of anesethetic as my mum was fine & independant beforehand ..
To date my mum is still incontinent and confused however she seems to be lucid in the morning when I visit but seems to drift off again its been 4 weeks since her op .I just don't know what I can do next .
The hospital are now onto the occupational therapists about getting her home she will need 24 hour care , the carers work up until 10pm then we would have to pay the rest , I'm really worried about this as my parents don't have any savings atall I'm guessing their property would be taken into account {angry}

six months loopy it will take about six months not weeks. the progress will be very very slow as long as she doesn't have a major set back.

I think you need to focus on the fact it was the chest infection - pneumonia- that caused this not the anaesthetic.

Everyone has a pre-op assessment and there was no way your mum would have had a GA if they'd been worried she'd not cope.

Comparing her with my father, I don't think she will need 24 hr care. She would have to wear incontinence underwear at night if she is unable to use a commode, for example. she ought to have home physio for some time and aids to help her mobility. These will be provided.

Don't give up hope- it's very early days. Good luck.

Thankyou out2pasture & Pollyperky, The occupational therapist has said she'll need 24 hour care , I'm hoping that things change .
Pollyperky you've got a good point about the Pneumonia & Anaesthetic she's totally incontinent at the moment she wan't prior to the op . I'm hoping to have another meeting with the Senior Consultant and Occupational therapists next week I think the sooner she's out of hospital the better.

push for them (and they will!!!!) to hold her bed and allow her day passes home, I've even seen our local hospital HOLD a bed for the weekend if someone is trialing a discharge with support.

If she's okish in the morning, great. She'll be getting tired by 4, so that's when the gear shifts will occur. But good news.

That sounds unsympathetic - I'm not, just that I had to learn to try to hold every bit of improvement.

Talk to PALs about the provision, then contact age concern who are helpful.

How are things?

Hi, my mum isn't well at all she's refusing most food & fluids and has lost 2 stone , we are at our wits end she's still suffering with delirium with no improvement , altough she does recognise faces ... The Dr has now suggested a feeding tube through her nose which I'm a bit worried about its a catch 22 the feeding tube could trigger an infection the likely hood is she will pull it out as well so the Dr mentioned mittens I think this would drive my poor mum over the edge there's no way that she would understand it was in her best interest...They also feel that because she is so weak & not co Operative that walking isn't a good idea so she's more or less bed bound with the occasional sitting in the chair . OrlandaFuriosa I just so sorry for her if only we had known about the risks there is no way she would be where she is now :(

I'm so sorry.

I’m sorry to hear this as well.
Will she eat more for family? Can you bring in small sampling of her favourite food? Ice cream?
There is a medication called Megace that improves appetite.
Nasal tube feeding would be hard to witness. Positive thoughts next week is better.

Nasal feeding may help. Being malnourished and dehydrated (and most likely constipated as a result) will worsen delirium. I'm so sorry your Mum isn't improving.

They need to get her out of bed! Muscle loss in the elderly is HUGE with just a short time of bed rest. You need to insist she has some more support because it sounds as if they are happy for her to languish because it makes life easier for them.

From what you have said, the chest infection was because she was in hospital and nothing to do with the actual knee operation. Don't keep blaming yourself for 'allowing' the operation. Any hospitalisation for older people has risks, whether it's MRSA or infections.

Can you take some food in for her? small things she might like? They will have to get fluids in to her via a drip, if nothing else.

Hope she improves.

Thankyou all for your kind replies , we took my mum out in a wheel chair yesterday the sun was shining & it was perfect I think she enjoyed the fresh air bless her... PollyPerky you are right about the muscle loss I@m constantly on at the physios but they feel that with her state of mind she could fall so they tend to get her out of bed and to a chair.. I'm not happy as she's so weak . Out2pasture I mentioned Megace to the dietician today but she didn't really say much but thankyou for your suggestion I will mention it again it seems that every day is different staff at the hospital .. My mum is only on her usual meds which is statins & blood pressure tablets could these effect her confusion ? I managed to get her to eat her breakfast this morning its really difficult so patience is required all the time .We are trying everything to try and persuade her to eat my dad is taking her some of her fav cheese cake today.. How do I go about third opinion on meds?

The BP tabs and statins should not affect her delirium. what does affect it is her fluid levels and they also need to check her for UTIs even if she has no symptoms because these can cause delirium type symptoms. They ought to check her urine often to see it's clear especially if she is not drinking much.

I can't believe they are not helping with her mobility. It's catch-22. if they don't get her moving she will lose more strength and muscles to the point where she can never be mobile again. why aren't they supporting her as she walks around the ward a little? I understand she can't do this on her own but she ought to have help.

Is there no way she can come home, have OT and physio at home? They don't seem to be doing much for her.