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 used to get tiny little bits if things, think feeding a toddler. Tiny bits if cake, a few nice snack things like cheesy biscuits, the sort if mini snacks you'd provide at a drinks do. And ice cream, in tubs, or water ices to suck. Also Ribena, but def lemon barley water because it's got carbs as well. And get her drinking through a straw because you drink more that way ( who knew? Not me). I didn't care about the junk/ non junk argument because if she couldn't or wouldn't eat shepherds pie but would eat a bit of Victoria sponge with eggs, fat in it, then at least she was eating something. Water biscuits with pate or spreads on them, salmon, pate, chicken pate, marmite.. taste. She hated bovril so that was a no no in terms of spread or drink, but try that. She liked milky coffee, so a bit of that got dairy into her. Puddings, esp if I provided cream, but they wouldn't heat up proper ( i.e. eggy ) custard, but she didn't like custard anyway. She liked digestives and chocolate digestives, in small bits.

I had to be there for meals. At the worst point, at home, she had our dog on the bed and tried to give him all her biscuits. I got round that one by telling her it was bad for the dog's discipline: she had to eat first every time, befire she gave him something, as otherwise he'd think he was top dog.

I made sure that if I was there she and I went, with wheel chair to begin with, then zimmer, on little perambulations in the hospital. We also did her exercises together, me doing them too, saying oooh this one is a bit testing, can you do it? and explaining what had to be done. Obv she couldn't remember. She was resistant a lot of the time.

We interspersed this with discussions of her childhood and early adulthood, things she liked like flowers and paintings, and she mostly came back, save when tired or under the weather when the gears would slip. She got distressed and we had to comfort a lot.

Thankyou both for your advice its greatly appreciated and ideas of food.. We have been in touch with the patient liason team a few times and have another meeting scheduled for one day this week with the occupational therapists and social services about care when she gets discharged.
I am going to ask them to check her urine again its very true in the sense they should be checking it regularly.. The dietition has started to put snacky bits in the fridge for my mum labelled things like yogurts , custards etc she's also on ensure & protocol supplements..
I'm not happy with the physio and I'm always on at them in fact I asked why she can't do bed exercises ? I will be bringing this up at the meeting as well as I am worried about muscle wasting and it can't be good for overall health .. My mum sounds like yours OrlandoFuriosa it really is like persuading a toddler its so sad :( I'm holding it together for my dads sake he needs our support

I got them to do a lot of soup. She didn't really like it when normal, but in hospital it slipped down easily, calories, some protein etc, liquid. I also did the ". Morning, Ma, I've just bought myself a coffee so here's one for you too. " 45 mins later " oh good, they're bringing round the coffee, I wonder if they'll be nice and give me one as well as you?" I ended up stuffed with coffee but it was worth it. For the hospital one I did the, " well, the coffee isn't v nice, so I brought you a biscuit to go with it and make it special". She didn't really take to hobnobs or things that took a lot of munching like flapjacks, even if I wanted her to ( oats, fibre) hence digestives.

Good luck, it's really hard. Look after yourself.

My mum refuses everything no matter how much we use persuasion
Today I told her that I'd had a chat with her GP who she likes and I said "he wants you to start eating all your meals mum so you can go home it seemed to work she ate her breakfast but I don't know if it will continued to work your ideas sound good ..
My mum is out of it I put a napkin under her chin and she tried to eat it she's also hallucinating cigarettes she is a smoker it's such a hard situation

It's quite likely because she hates being incontinent/ fears incontinence and going to the loo. So humiliating and distressing. So you just have to say to her you're going to take her there regularly. That way it's fine to eat and drink.

And the way we got round that, though never easy, was to try the following:

You did it for me when I couldn't, so now it's payback time when it's hard for you. [ But when you've eaten and got well, it will improve. And then you won't need me/ nurses anymore]

You'd do it for me, wouldn't you, if I needed you to? Well then.. repeat..[..]

It happens to everyone at some stage.. [...]

Let's go for a little walk....Oh good, we are just by the loo. Why don't we take the opportunity, as George V said..

You know how people have to be taught to walk and talk again? They also have to learn loos again. Well, you've made huge strides on the walking and talking, this is another thing you're going to conquer. Bet you do: bet a bottle of champagne on it,,,( made her giggle as she hated champagne and I don't).

(A bit like toddler training, with bits of humour. )

Reassure her, reassure her, reassure her.

A tiny bit of humour helps.

Reminding her how she was and is a stunner helps. Extra beautiful hand cream, getting her hair done, new bedwear, new scent...reading out her get well cards to her, even if she's confused as to who she is, the reassurance that she's a person is important.

If she was /is religious, get a chaplain to come along.. there'll be an RC/CoE/Protestant minister/rabbi almost certainly, if you're in a city there will be an imam or equivalent, and in Thomas's/Guys they have a Buddhist one as well. There's prob an atheist/agnostic/humanist counsellor too if I but knew.. they can be very comforting.

Hope helpful.

All of the above is excellent advice. The only thing I'd say about drinking, is that straws can actually be really hard work. As the diameter of the opening goes down, the force of suction required to bring the fluid to the mouth goes up exponentially. So a straw make the force of suction much stronger, and a weak patient just won't manage the sustained sucking required. A beaker with a lid and 3 holes in the outlet combines safety and controlled flow, but allows easy access to the drink.

If the physios are reluctant to get your Mum walking, ask if they can use a MotoMed (motorised exercise pedals) with her. It's a machine that they wheel to the end of the bed, then her feet are put into pedals, and her legs pedal, like riding a bike, for several minutes. It's great exercise for patients who can't mobilise for whatever reason. Also ask about passive exercises, and for OT to provide some resources for mental stimulation.

Lougle, I wish I'd known about that! Wow. And the in bed exercises: I had to make them up !

Ps, my ma made mistakes like the napkin one...

Thankyou so much Lougle , you've all given me such good advice & ideas on trying to get my mum to some sort of normality ... I've got a meeting with the OT this morning so will be asking a list of questions about my mums care & future I will also mention the Motomed it sounds perfect if they can get hold of one its all so easy to let the elderly fade away in bed but I'm trying me best not to let it happen .. Six weeks ago my mum had a better quality of life apart from a bad knee everything has been taken fro her its on my mind night & day

Hi , there's not much improvement with my mum but she's able to follow instruction at times this seems to be in the morning after she's had a good sleep
The OT's are now talking care homes which sounds so final , but my dad wants her home they basically said it'll take two people to manage her to bed etc and he's on his own so what happens in between . I just don't know what to do for the best

Very common pattern, regains some marbles when not tired. Loses them when tired. Gets tired very easily.

If not in a care home, he should see what the options are for getting her help to get up, get to bed. Bear in mind that social services domicilliary services are under such pressure that they often spend no more than 10-15 mins over visit, when you actually want more so the person can have a shower, wash hair or whatever. He also needs to ensure that your home is ready for her with bed, hoists, etc. And you need respite care for him because it is shattering.

We were fortunate, we were able to pay for private... just as well because they only ever came in the morning to assess her needs when she was lucid and decided that she didn't need help. ( rage, if they'd seen after lunch the pic was rather ( understatement) Different.

But we were also fortunate because there was a home where she could go if necessary. She hated it but we used it from time to time. What we did with FIL was: he lived at home during the week, MIL got helpers in, and at weekends he went to care, we made sure he ate etc, that was a good way round, gave MIL the rest she needed but he was at home for most of the time. And lots of people go home at weekends so they had spare beds.

I don't know if any if that might be a possibility?

It's horribly distressing but you need to focus on the good bits and on managing the bad, for your own sanity. You sound like a great daughter.

My mum still isn't eating well and has lost more weight , her overall condition is the same . The docs asked us if we would agree to an NG tube but she would need mittens to prevent her pulling it out
It's such a big decision especially wearing the mittens it might stress her out

But if it gets her strength up, that's good. I agree, awful, but what's plans b and c? Worth looking at all the options unemotionally, if you can.

Thinking of you.

I would say yes, tbh. If she is malnourished, that can contribute to delirium in and of itself. Your Mum can't make rational decisions to eat if she's so malnourished that her brain can't process hunger cues and she hasn't got the energy to chew and swallow. As she becomes less dehydrated, more nourished and has more energy, they can reduce the tube fees in stages, so that she gets more hunger cues, then discontinue it altogether once she's eating sufficiently.

no harm in trying. you can request the doctor includes in the notes not to reinsert the tube under duress.
sadly sometimes dr.'s orders give the nurses the impression they need to have this tube in place 24/7 and the clients with dementia can resist so much that it's too hard on them.

Thankyou for your replies , its so difficult and to top it off my dad was with my mum all afternoon as the Dr said it would be an idea for someone to be with her when they do it . However he left at 7pm last night and they were still faffing about looking for mittens , the best time for them to do it is in the morning after shes had a good sleep I feel if its at night she's going to be very confused and stressed. I was so irate last night and phoned the hospital requesting that its not to be done until one of us is with her as she's going to be very upset with the mittens as at the moment she uses her hands fidgeting with the sheets . Its so distressing to see my poor mum in this condition I'm going to the hospital this morning as they are also giving her a lot of laxatives she had the runs yesterday bearing in mind she isn't eating.

It's horrid, isn't it. But they will be concerned to get her strength back up and see her on the mend. Hope it goes well.

It's horrendous , I was so irate yesterday my mum ate two weetabix for me this morning but refused lunch .. My sister informed me that the nurses tried to get her out of bed to be weighed but she couldn't weight bear on her legs it's so upsetting we feel that the muscles are in her body are wasting away as she's more or less bed bound .. She was confortable this morning but screams when the nurses try and change her it's so distressing .. We feel that she's lost the will to live now

Sorry I wasn't irate with my mum but with the Drs

Mini weetabix or the big ones?

How about ( yuk) chocolate weetabix?

And reinforced soup, iyswim..

I'm so sorry this is taking so long. positive thoughts next week is better. continue to do your best.

The normal weetabix with warm whole milk she seemed to enjoy it . We feel that she's deteriorating and has lost quality of life she's mortified when make nurses change her I think she's embarassesd as she screams and cries .. The Drs that do the rounds in the morning can't answer my questions and suggested that I email her consultant which we are doing today we would like another meeting as we feel my mum is coming towards the end of her life .As I said yesterday she's in bed all the time now and can't stand the physios feel it's too dangerous to walk her with the zimmer because of her state of mind . I so wish she had not had the knee replacement it's not worth anything now . Thankyou both for all your support and guidance you've both been so helpful

Just to say the same thing has happened to my dad who is 93. He lived with us but was totally lucid and Independent. He contracted pneumonia in July and has been in a state of confusion ever since. The same happened with the physio. Because he couldn't follow instructions they gave up. He too is now unable to walk and incontinent and doesn't like drinking because of this. He is now in a nursing home and although well cared for seems to have given up and has been refusing medication the last week. Dr has now withdrawn medication and he is just on pain patches and totally out of it. My job for tomorrow is to find out why. Sorry I haven't got anything positive to add but thank you all as i am also trying to understand why this has happened and it's comforting to know I'm not alone also.

Two weetabix is great, with warm milk, well done. After that, a healthy soup, tea, hot chocolate, is good.

Has she got bed sores? The screaming could be both shame and a sore behind if she's not moving much, she'd need a ripple mattress or turning. MA's skin became v sensitive, we used to slather her in lovely smelly cold cream.

Well done for emailing consultant.

My mum is still losing weight though , I think they might be fitting the ng today OrlandoFuriosa, I'm so worried how she'll react especially with the mittens I couldn't sleep well last night thinking about all she's been through .. As far as I know she doesn't have bed sores but I think she gets embarrassed when the nurses change her especially as she's now doubly incontinent .Hopefully the consultant will get back to us soon with answers for my poor mums future .