Advice please for sudden change in mum

Discussion in 'Middle - later stages of dementia' started by fidget, Apr 5, 2015.

  1. fidget

    fidget Registered User

    Mar 31, 2008
    4
    Hello
    My mum recently moved to a new care home when her previous home closed. She was diagnosed with a urine infection in her first week in the new home. She has had urine infections in the past. She had a 3 day course of antibiotics and seemed fine and tested clear for infection.

    She had settled in well in the new home but 3 days ago when my brother visited her he found her slumped in a chair with her head down all the time and very very sleepy and confused. I think someone at the care home said that she had not slept well overnight.

    She is still the same today, 3 days later.

    Normally mum is very chatty and quite lively for her 92 years. Whilst she does get confused there are times when she has a 'normal' conversation. She really enjoys taking part in activities and chatting to other residents. This is such a dramatic change

    The new care home staff are suggesting it may just be a progression of the disease. They have tried to get another urine sample but have not been able to do so yet.

    Could anyone tell me please
    If it turns out that she doesn't have another urine infection can dementia progress in such a dramatic way overnight or could there be another cause for the change?
    with thanks
    Kate
     
  2. #2 DazeInOurLives, Apr 5, 2015
    Last edited: Apr 5, 2015
    Hi Kate,

    It is not impossible that it is a sudden progression of her disease, but this is more usual in vascular dementia than in alzheimer's disease and I'd look for other causes first.

    It is not at all unreasonable to suspect a urine infection; perhaps the antibiotics didn't full clear it and it has returned. At 92 this could quickly overwhelm her in the way you describe. Elderly people often she little sign of infection other than confusion and drowsiness.

    The GP could restart her antibiotics or prescribe a different one without getting a urine sample, just based on her history and current condition. Given the dramatic change, I'd not wait until after the bank holiday though to speak to a GP.

    Good luck

    Daze
     
  3. PeggySmith

    PeggySmith Registered User

    Apr 16, 2012
    1,683
    BANES
    Hi fidget,
    My MIL (86 at the time) was much the same just before Christmas before last, I visited her along with a friend of hers and she was slumped in a wheelchair, very unresponsive but with no sign of infection. She wasn't very good or "with it" over Christmas but picked up after a couple of weeks. Nobody ever quite understood what had happened although, as she has vascular dementia, I suspected a TIA.

    I hope someone comes along soon with more information for you.
     
  4. Beate

    Beate Registered User

    May 21, 2014
    11,746
    Female
    London
    A three day course of antibiotics might not have been enough - we have never been given less than seven days.
     
  5. lin1

    lin1 Registered User

    Jan 14, 2010
    9,320
    Female
    East Kent
    I suspect that that uti didn't wasn't cured with such a short course of Anti biotics, here they tend to give a five day course. With my mum though we found that not only did she need a seven day course of ABs she often needed a second course of a different AB.

    you say they haven't been able to get a urine sample this time, I assume this is because of incontinence rather than mum suffering retention ( not passing urine) which must be dealt with urgently.

    Their are special pads that can be used for urine sampling for those who are incontinent, the GP, nurse at the home if it is a nursing home should knowu about them an be able to arrange .

    Our GP's sometimes treated my mum for UTI's without getting a sample, mind you this was only because of repeated confirmed UTIs

    If it turns out their is no infection, I would check mums medication and dosage are correct, before suspecting a deteriation in Dementia. I am a bit out of date now so the names may have changed,the forms about about a persons medications and the dosage used to be called M A R S sheet .

    I hope you see a big improvement in your Mum soon.

    Please let us know how you and mum gets on.

    PS. Have just remembered. A week after finishing ABs for a urine infection, it is a good idea to get another sample tested just to ensure their is no lingering infection.
     
  6. lin1

    lin1 Registered User

    Jan 14, 2010
    9,320
    Female
    East Kent
    Hi again Fidget. Have just realised you are new here.
    Welcome to TP. I hope you find it as helpful and supportive as I have.
     
  7. fidget

    fidget Registered User

    Mar 31, 2008
    4
    Advice please sudden change in mum

    Hi All
    Many thanks for advice . My brother has asked the care home manager to call the Gp. I rang the home and spoke to someone else who told me that first course of antibiotics had not cleared the original infection and she had a second course. Also that they managed to get a urine sample yesterday and it tested negative.
    I guess if dipstick urine tests are totally reliable then we are looking for some other cause and will have to wait for results of blood tests. I will check that meds are up to date on Mar sheet.
    thanks kate
     
  8. Hi again Kate,

    Urine dipsticks are not always accurate; they are expensive and an old or contaminated batch may well be unreliable. I hope that they do give the additional antibiotics as a UTI is still a likely cause.

    Other reasons for your Mum's sudden deterioration are numerous of course, but could be a chest infection, dehydration, a slight stroke, thyroid or low blood pressure problems, severe constipation, a reaction to a recent increase or change in her medication (other than the antibiotics) or even profoundly disturbed night's sleep.

    People with any dementia need very good quality sleep to function as best they can. In my Mum's case, a bad night's sleep can have her look dramatically unwell the next day, when she needs to sleep for hours and then has another bad night and so forth. Once her night-time sleep is restored she can bounce right back and her alzheimer's can appear to have improved by several months. It sounds like it is more than this in your Mum's case though, but it may be a contributing factor.

    Your Mum is so elderly that it can take very little to tip her over into a very poorly state; if she is no better tomorrow back on the antibiotics, I'd request a GP visit to review her.

    With warmest wishes,

    Daze
     
  9. fidget

    fidget Registered User

    Mar 31, 2008
    4
    Advice please sudden change in mum

    Hi Daze
    Thanks again for all your advice. GP saw mum on Monday and gave her a thorough check over and found no sign of any illness including infection. The last urine test taken at the home on Sunday was negative. GP took bloods which she was going to discuss with my brother on Wednesday, but they were delayed. Given your advice my brother was going to ask the GP to re test her urine.

    However, we found out today that the home tested her urine again yesterday and she does have a UTI !!!. She is now on a stronger antibiotic. We are keeping our fingers crossed that it is just the infection that is causing the drastic change in her behaviour.

    Thank you so much again to you and others on the forum who offered advice and support it has been invaluable. I'll let you know the outcome.
    Kate
     
  10. fidget

    fidget Registered User

    Mar 31, 2008
    4
    Advice please sudden change in mum

    Hello Daze
    Update on mum

    Had hoped to say mum was much better but after some improvement she has got worse again.

    Transpires she was put on the same antibiotic (trimethoprim ) but a seven day course.
    All her blood tests came back okay.

    She was improving a bit, no longer slumped in chair all time and sometimes walking about. Then deteriorated again. Urine test showed she still had an infection so has now been put on amoxycillan. Sample has been sent to the lab.

    I was wondering, does this mean that they may be able to identify which antibiotic will be most effective if there is no improvement on the amoxycillan?

    Kate
     
  11. #11 DazeInOurLives, Apr 18, 2015
    Last edited: Apr 18, 2015
    Hi Kate,

    it depends whether they sent her urine sample to the lab for culture or not. If the care home just dip-sticked it for protein, pH and white cells then they are still guessing which kind of bacteria is in there. In many areas the majority of infections are resistant to trimethoprim. Did she deteriorate again after the trimethoprim ended or whist it was still going?

    Nitrofurantoin is a common alternative, but maybe the amoxicillin will do the trick. She may need a long course to clear it properly. The penicillins are also more effective if taken on an empty stomach at least two hours after food and an hour before food. Few people adhere to that as it is a royal pain, but it makes the treatment more effective.

    Good luck.

    Daze
     
  12. I just spotted that you mentioned that a sample was sent to the lab. As long as the person sending it made a note that she was on antibiotics (and which ones) then it will hopefully give some helpful information.

    If it is inconclusive, or she needs a subsequent sample taking, bear in mind that many elderly people need help to provide an uncontaminated sample of urine. It really needs to be caught into a sterile bowl or pot mid stream, immediately following a wash with saline solution (or water without soap) from front to back. The sample should never be poured into a pot from a commode. An early morning sample is best and it needs to be stored correctly and sent to the lab as soon as possible. There are so many ways that the sampling or processing can go wrong, not least in a care home or with a person with dementia.

    Her reaction or otherwise to the treatment will be the real test...I do hope she is on the right antibiotics and is on them long enough to really clear it this time. Many care homes just don't provide enough fluids, which can cause or perpetuate the problem, so it might be worth asking if your Mum can have an extra cuppa a couple of times a day in-between the usual times to see if that help her.

    With warmest wishes,

    Daze
     
  13. Soobee

    Soobee Registered User

    Aug 22, 2009
    2,734
    South
    I was also going to add a bit more about dehydration. It is so easy for an elderly person to get dehydrated without us realising that is the case.

    Please ask the home to give more fluids and keep a fluid diary with her care plan. Then you can see just how much in the way of liquid is going in. It's really important to keep fluids up when you have a UTI whatever age you are.

    Different care homes do things differently and it may be that your mum was offered adequate liquids before but not since being at this new place.
     
  14. griff

    griff Registered User

    Mar 17, 2010
    74
    north london
    massive decline

    Hi guys , not posted in a while but feel so worried and could do with done advice.
    mum has been in CH for 5 years , she recently was diagnosed with a pressure sore ( although this is so odd as she was fully mobile before this sore was found!
    mum wax also diagnosed with UTI and has now had 2 sets of antibiotics , the last one being 3 days supply which she has now finished!
    She has suddenly decline rapidly , sleeping all the time , mobility gone , shuffles along only with help ! I just don't know what to think !!! Has the alzheimers progressed so quickly ? Or is it something else ???? Her blood pressure etc all fine ???? Anybody out there experienced this ????? What should I do ???? X
     
  15. lin1

    lin1 Registered User

    Jan 14, 2010
    9,320
    Female
    East Kent
    Hello Griff.
    Sorry to hear about your mum.
    I'd get another urine sample checked asap. such a short course of antibiotics doesn't seem right to me.
    My mum often needed two 7 day courses to clear her UTIs .

    I am also wondering if pain can be making your mum worse, pressure sores are very painful , my mum improved once we got the pain from Arthritis under control.
     
  16. Miche47uk

    Miche47uk Registered User

    Apr 3, 2015
    5
    Surrey
    recurrent UTI's

    Hi there,

    My mum has quite literally had years of the symptoms of UTI's on top of vascular dementia which can simply put send her to a different planet...her behaviour totally changes with a UTI and I can spot one at 100 miles away! At the endof the day everyone is different and the 'norm' is a course of trimethoprim for 3 days which in Mum usually did nothing. You can be resistant to an antibiotic so unless cultured in a lab you may be pushing a pill doing nothing!

    Actually, and on reflection, UTI's due to a lack of bodily hygiene before she went into a home and indeed in 2 out of the 3 homes, caused Mum to have infections again, which absolutely causes havoc. My Mum doesn't have a bladder that empties fully so hence she is more prone.

    Dip stick tests are not enough but my end and I touch wood here, a low dose of Cefalexin is keeping them at bay, and now out of a care home facility and knowing she is clean and her pads changed regularly I am hoping that it keeps them at bay. Don't ever underestimate the impact of UTI's on the elderly, they can, in fact, be fatal.

    M xx
     

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