My 81 yrs old mom with delirium

[tchan03]

Hi

I wonder if someone can share your experience.

My mother is 81 yrs . She does not speak English and not a social outging person. My dad just passed away last Aug after 2 yrs of battle with cancer . She was sad last Aug but in recent 2 months she was fine.

M mother suddenly felt lots of pain around stomach area on Jan 20th . Shes very sick and went to emergency and eventually Dr said she had gallbladder infection and had removal suregery performend on Jan 22nd.

After surgery, she was in ICU. she was with ventilator (breathing machine where the tubes are attached to her mouth ). After 24 hrs, attempted to take it off , but she could not breathe well by herself , so had to put the tubes on, that goes on for 4-5 days. I know whenver she got emotional,( She attempted to kick the nurses, she pulled off IV.) nurse would put more sedation medicine.

By Jan 27th she can take off the breathing tubes, but she was very weak . She kept thinking and tell me, why do i treat her like that ,why i take her to do all the tests ( ct scan, ultrasound etc test) for making money.

Dr ordered CT scan to look at her wounds (surgery area) . After CT scan, she got angry.
i think she got very emotional when it comes to tests. She attempted to commmit suicide by pulling phone lines around her neck etc.


Psychologist looked at her and suspected she has ICU delirium. My mother is getting physically but mentally just very down . A few days later, the Dr looked at her mentally said she is not cleared.

But in my mind, she is still very down. My mother is back home since Feb 4th

Its now Feb 8th. Today she still tells me : dont ever take her to tests just because i can make money that way.

I will schedule famiily Dr and mention this concern. But in meantime, what else can i do help her?
( over weekend i brought my kids to see her, she still has no smile )

Thanks
TC

 

[minnie mum]

I'm so sorry that your mother has been so very ill. Unfortunately, what you have described is very common in elderly patients with a serious illness or injury. And it can take a very long time before they are lucid. Unfortunately, some never bounce back completely. All you can do is be loving and supportive. Try to distract her with things she likes to do. Is there music that she likes to listen to? Does she read?

I know you live in Canada. Try to reassure and remind your mother that the tests aren't costing her anything. Maybe that will help a little.

 

[cabanafrau]

Your mother may have several issues going on, so a thorough exam and consult with her primary care physician is very important. It may very well be that some issues can be corrected with intervention and improve her quality of life. Be sure to have all of the emotional and mental issues ready to present to the doctor so a complete understanding can be reached in order to provide the best results of treatment. Best of luck to you and your mother.

 

[Christine]

My 76 year old uncle got "hospital psychosis" last summer also from being in the hospital for two weeks. Otherwise, he's very with it. Once he got home, he gradually got better. Hopefully, over time, your mother will improve but there's probably no way to change her mind about the hospital trying to make money off of her.

 

[Pea-n-Me]

Why did she need to be intubated? Was she/is she, a smoker? Or does she have COPD or other cardiopulmonary problems?

 

[Mark P.]

TC,
Please let me say that I'm sorry for what you and your family is experiencing. Our story's below, and in no way am I comparing to what we went through, and suggesting that the same may happen for you

We went through a similar ordeal, with my wife's 95 year old Grandmother, Grammy to us.
Grammy had dementia for years, and moved onto Alzheimer's. We gave her round the clock care, and she remained at her house, where she was comfortable.

Grammy also had Sundown Syndrome, and that brought a whole new set of issues. She insisted on going to bed at 5pm, then get out of bed at 7pm, and make coffee, thinking it was 7am. Just couldn't get through to her, so we'd go with it, as we didn't wish to make things worse.
She started to get a bit nasty here and there, which was totally out of character, which sadly can happen.

A year or so into the Alzheimer's, she fell and broker her hip.
Almost immediately, in the ER, her mental state dropped off the chart in a new level of confusion that we've yet seen. That can happen with a traumatic event we were told by her DR.'s, and generally the progression downward is permanent with her particular disease and injury. Sadly, they were right.
They repaired her hip, but her heart started to give out, she had a GI bleed and kidney trouble.
A week or so after the fall, we got her home with Hospice. I'll leave the story there, but she was home and we all took superb care of her.

Hang in there and do take care,
-Mark

 

[scrapquitler]

Make sure they check to see if she has a UTI. In the elderly, a urinary tract infection can cause dementia symptoms

 

[PlutoPony]

Make sure they check to see if she has a UTI. In the elderly, a urinary tract infection can cause dementia symptoms

THIS. And UTI's are quite common in the elderly
B-12 shortages, also common, can do strange things

Being hospitalized for a time does tend to "warp" a person's sense of self. Doctor's and nurses should be quite familiar with the phenomena
My advice would be to arrange sufficient care to get her out of the hospital as soon as she's stable - ASAP. Talk to the docs and/or social worker to put a plan together to get her out as quickly as possible. See if you can find a home health worker who speaks her language - that would be a huge help to making her feel more involved in her care.
Part of her concern about tests may be due to hospital personnel giving inadequate explanations of what and why they are doing things due to language barrier. Anything that can be done to help that could be good. It must be confusing to be in a hospital when you don't speak the language and don't really understand what's going on - I sympathize.

Best of luck!

 

[mrsv98]

Guys, check the date...zombie thread strikes again!

That being said, first thing always, check for a uti, super common and potentially devastating for the elderly.

 

[heath dog]

But it says it's from today?

 

[TipsyTraveler]

Guys, check the date...zombie thread strikes again!

That being said, first thing always, check for a uti, super common and potentially devastating for the elderly.

This thread is only 6 hours old.

 

[NewRVLady]

Guys, check the date...zombie thread strikes again!

That being said, first thing always, check for a uti, super common and potentially devastating for the elderly.

No it's a TODAY thread- you are seeing the date above which is in their Siggy

Sorry OP- I can remember my Mom insisting she didn't know me - she was on so many drugs in nursing home she got confused a lot

 

[mrsv98]

Dur...sorry, I can only plead that I went to the dentist and was loopy

 

[indimom]

This is pretty common with older patients who are under a lot of stress during illness/injury/surgery. And it can take some time to resolve.

I agree with others though, UTIs are a common cause of "behavior/mood changes" in the elderly (and since she was in ICU, I'm assuming she may have had a catheter at some point - a common cause of UTI), so be sure to have that checked out.

I also agree with another poster who recommended an interpreter to help with the language barrier for any future appointments. It can be difficult to explain the need for certain tests without any barriers. With her husband's lengthy and recent illness, she may have some prior issues/concerns regarding medical care that are making her even more stressed, things she isn't really saying out loud. She went through a pretty intense medical crisis and that can be very scary. She may have some memory from those days in the ICU, being sedated, medicated, possibly restrained to keep her from pulling out her iv and other tubes, and that could be frightening as well

I work on a surgical floor, and patients do go through a LOT of tests at times, many of which are just to confirm that all is well, and their recovery is progressing. Many, many patients become frustrated with the number of tests/scans/blood draws and the cost that they know goes along with them. So, it doesn't really surprise me that she feels like she's simply be "gouged" "for the money." I hear this quite a bit on my job, and it's difficult to convince patients that the tests are necessary to monitor their progress/catch any complications.

As far as her mood shift: I would continue visiting regularly, and try to arrange for others to visit also. Clergy? Neighbors? Other members of the family. Work on getting her involved in whatever regular activities she participated in prior to her illness, and give her some time. When she makes these comments, talk to her about her medical concerns, try to pin them down, and help her create a plan that is acceptable to her, so she feels more in control of health/medical situations in the future.

Good Luck!

 

[Pea-n-Me]

OK I'll take a stab at - it in addition to what's been said, and without my questions being answered above or having a medical history in front of me.

One would not expect a prolonged intubation for routine gallbladder surgery. So there was likely a process going on in her lungs that caused a disruption in the oxygen exchange and her C02 (carbon dioxide) levels were high. This can happen with people who have chronic lung diseases like COPD, acute lung problems like pneumonia, or even cardiopulmonary problems like congestive heart failure that results in fluid build up in the lungs. If that were the case, it's possible her lung processes are not completely back to normal yet, and her C02 levels could still be a little elevated. If her lung processes recover, and her air exchange improves, then hopefully she will gradually clear.

I noticed you said she was "fine" before this happened, but it is possible she had a little dementia prior to this? It can begin very subtlety, and sometimes families don't even realize their loved ones have it, but in retrospect, understand that some of the "personality quirks" they've been displaying could be early signs of dementia. That combined with acute delerium in the hospital could be quite a hit to an elderly person.

But beyond that, as indimom explained, having an episode of ICU delerium can be quite disturbing for anyone, even people much younger. This phenomenon has been the subject of intense study and we are now learning that people can be left with anxiety, depression, and even PTSD, from their experiences in the hospital when they are intubated and confused. (And believe me, caregivers in the ICU recognize this and many steps are undertaken that you probably weren't even aware of to prevent this and work with it. It is not possible to eliminate entirely in many people.)

http://well.blogs.nytimes.com/2013/07/22/nightmares-after-the-i-c-u/?_r=0

Follow up with this may prove difficult right now where she is angry and distrustful, but make sure you discuss your concerns with her primary care doc, who can coordinate her necessary referrals. Consider a gerontological assessment in the long term, especially if this continues, to see where she's at and perhaps undertake measures to help her as she ages. Good luck.

 

[Wishing on a star]

Tchan, who is there with her, as her aid and interpreter thru all of this.
Others have given much better personal and medical advice!!!
But, it just strikes me that if mis-trust and personal issues are a factor, at all... is there some neutral objective person that she might 'trust' and be more agreeable and cooperative with?

And, also one more thing. All the treatment and drugs, and their side effects, can seem to be worse than the condition.
When my mother was older and hospitalized, we noticed that something was off... they just brushed us off... normal side effects, etc...
Turns out my sister noticed very specifically that when they gave her one certain med/drug, there was an immediate noticeable effect.
Some people react differently to some drugs and treatments than the normal standard.

Also, just know that you are NOT the only one with an elderly parent who is mis-trustful, and just simply does not want, or can not handle, further hospitalization and invasive testing, etc. Both my mother and my MIL were that way.
This is very common.
My MIL was more comfortable in hospice without all of the heavy drugs, treatments, testing, etc.

I am so sorry that you are going thru this.
I am sending well wishes and hugs.

 

[littleblackegg]

When someone is delirious or has dementia, one of the best things we can do for them is called a "no fail intervention." Essentially, research shows that people who are having a difficult time with reality testing do much better with a non-challenging environment. Delirium comes from medications, detox from alcohol or drugs, and many different physical conditions. It can be reversible. I am very sorry you are going through this. Since approaching her with a lot of logic or technical talk will likely upset and frustrate her, I think you'll find focusing on comfort and reassurance will yield the best results. I wish you well.

 

[roseaster]

This is actually a fairly common occurrence in the elderly. We call it "ICU psychosis." There are, probably, several issues at play.

First is the illness itself. Seniors systems are delicate. Even small illnesses, such as urinary tract infection or mild dehydration can throw their system off. This, often, manifests itself as confusion.

Second, the environment. The ICU is loud and busy. The lights are on 24/7 and people are coning in and out of your room 24/7. It messes with people's wake/sleep cycle, which in the elderly can, again, cause confusion.

Third, medication. If your MIL is on pain medicine, the elderly often become confused with strong pain medicines such as morphine. My own grandmother hallucinated on morphine. If they are giving her anxiety medicine, such as ativan, that can cause confusion in the elderly, too.

Fourth, your MIL has a language barrier. So efforts to keep her oriented to time and place won't work because the nurses are probably unable to communicate with her and keep her informed of the date and time and explain to her what is going on.

This usually reverses itself as the patient improves and moves on to a regular floor with a more standardized schedule, and as her condition improves and the medications are reduced.

Likely after discharge your MIL will be moved to a rehab facility. Seniors lose a lot of ground, so to speak, when they are hospitalized and often need physical therapy. It might be a good idea, at that point, to have her evaluated by a psychiatrist. You said that she is fairly recently widowed and is not very social. She may be depressed, which can mimic the early stages of dementia (and vice/versa)