Chest Infection symptoms or worsening dementia?

[retiredcopper]

90yr old mum-in-law is usually fit as a fiddle except for her dementia & arthritic knees. She started with back pain 4 weeks ago when pushing herself up out of bed, her chair & the toilet - when sitting or lying down she was fine. GP diagnosed her as having a chest infection because he heard crackling at the base of the lung where she had the pain & she took 10 days of antibiotics & painkillers. She appeared to be getting back to her normal self & then on Sunday I couldn't get her out of bed without her screaming in pain. She was pale, sweaty & very drowsy so the Emergency doc was called & he prescribed more antibiotics. She went for a chest x ray the next day & got worse over the last few days - so much so that she has been refusing to get out of bed or her chair & when we manage to help her up she screams the house down. She refuses food & fluids sometimes too.

It culminated this morning in my having to call a carer out to help me get her off the toilet (it had taken me an hour to get her up & on the toilet) - she is a dead weight with no energy in her legs to hold her up. We put her back in bed & the GP came out & admitted her to hospital where she will have tests & x rays (the earlier chest x ray hadn't shown anything due to her not breathing in enough at the time & they are now wondering if she has somehow cracked a rib).

She is normally quiet & easy to get on with - the only time she has previously shown aggression & refused to get up, eat etc is when she has felt unwell, so I'm wondering how much her screaming etc is due to pain or how much is due to her dementia worsening because of her feeling unwell & frustrated. The only time she doesn't shout, scream etc is when she is left in her chair or in bed & I wonder if she is frightened to move because she associates it with pain? Especially as she screamed when the ambulance crew & the admitting nurses moved her but she didn't even flinch when the admitting doctor sat her up to check her back!

Has anyone had experience of this please?

 

[SWMBO1950]

"they are now wondering if she has somehow cracked a rib".

On reading your post I was wondering if maybe mum had had a fall? I cracked a rib this year (slipped in the bath and wacked my chest on side of the bath) - blooming painful it was too. She may have forgotten what she did and maybe her dementia stops her from being able to correctly say where it hurts. Xray does not always show up a cracked rib if that is the problem and in my case I just went with it until it healed but I am fairly healthy and able to do this.

I hope you get something sorted soon. best wishes

90yr old mum-in-law is usually fit as a fiddle except for her dementia & arthritic knees. She started with back pain 4 weeks ago when pushing herself up out of bed, her chair & the toilet - when sitting or lying down she was fine. GP diagnosed her as having a chest infection because he heard crackling at the base of the lung where she had the pain & she took 10 days of antibiotics & painkillers. She appeared to be getting back to her normal self & then on Sunday I couldn't get her out of bed without her screaming in pain. She was pale, sweaty & very drowsy so the Emergency doc was called & he prescribed more antibiotics. She went for a chest x ray the next day & got worse over the last few days - so much so that she has been refusing to get out of bed or her chair & when we manage to help her up she screams the house down. She refuses food & fluids sometimes too.

It culminated this morning in my having to call a carer out to help me get her off the toilet (it had taken me an hour to get her up & on the toilet) - she is a dead weight with no energy in her legs to hold her up. We put her back in bed & the GP came out & admitted her to hospital where she will have tests & x rays (the earlier chest x ray hadn't shown anything due to her not breathing in enough at the time & they are now wondering if she has somehow cracked a rib).

She is normally quiet & easy to get on with - the only time she has previously shown aggression & refused to get up, eat etc is when she has felt unwell, so I'm wondering how much her screaming etc is due to pain or how much is due to her dementia worsening because of her feeling unwell & frustrated. The only time she doesn't shout, scream etc is when she is left in her chair or in bed & I wonder if she is frightened to move because she associates it with pain? Especially as she screamed when the ambulance crew & the admitting nurses moved her but she didn't even flinch when the admitting doctor sat her up to check her back!

Has anyone had experience of this please?

 

[lin1]

Hello
I am sorry to hear about your MIL

I hope they find the cause of her distress soon and that she recovers quickly
Though I am no medic to me It does sound as though your MIL is in pain when she is moved.

Another worry for you is to make sure each ward MIL is on are fully aware she has dementia, some hospitals have schemes where a special sign is placed above the bed, with a this is me folder.

Please let us know how MIL gets on

 

[retiredcopper]

We did wonder if she had had a fall when she first started complaining of the pain, however we found it very unlikely as she had no bruising or marks on her body consistent with a fall (she bruises at the slightest knock) and if she fell she wouldn't be able to get herself up due to the arthritis in her knees - either me or the carers would have found her on the floor.

The ward are fully aware of her dementia - the admitting doctor asked her lots of memory questions & the only ones she could answer were her name, where she lived & her date of birth.

Fortunately she has a good Mental Health Nurse who has cared for her since diagnosis 4 years ago & knows what her general health & character is like. She has just rung me in reply to my message & she is of the opinion that the screaming & aggressive refusal to move etc is in the main due to her pain rather than her dementia & she is hopeful that things will improve once the cause of the pain is found & treated. Hopefully the hospital will start the tests etc today & we will know more and her MH nurse agrees that MIL shouldn't be discharged home without full care in place - ideally she should be moved to a kickbed if treatment is successful & then she can be assessed from there (she lives alone in her bungalow with carers & myself going in 3 times a day).

Unfortunately I am on my own dealing with MIL's health at the moment. She is a widow & my husband is her only child. We have no children but hubby has two from his first marriage - one lives in Australia & the other lives 250 miles away with children of her own & a full time job in education. On top of that hubby is currently working on a ship in the middle of the Atlantic & can't get home until early December so any decisions have to be mine at the moment, hence my contacting her MH nurse & asking all you good people for advice (I have POA for MIL).

Thank you all for your help so far & I will let you know how MIL gets on.

Angie

 

[Wenrob]

Hi there,

I can only comment on my experience with my mom.

I couldn't get her out of bed and she cried out in pain when trying to move her , she was admitted to hospital with a suspected hip fracture her X-Ray was clear , after blood tests she was found to have very low sodium levels , once this had been brought up to normal level via a drip she was fine.

I'm not sure how this caused pain however but maybe it was her body saying something
was wrong , I hope they find out what is wrong with your mother in law quickly.

Kind regards

Wenrob xx

 

[Helen33]

Good morning Angie,

First of all I would like to say I am so sorry that there is this change in your MIL and i do hope the cause is found and treated as soon as possible. On reading your thread, my initial thoughts were that it might be physical rather than an aspect of dementia because the screaming is selective. By selective, I mean she only screams at attempts to move her. This is most likely because she experiences pain. The screams and the level of pain might not tally but MIL may not be able to tell you or others in words that she hurts and how much it hurts.

I will wish you peace and strength as you deal with this especially as you are alone whilst this is happening.

Love

 

[retiredcopper]

Thankyou Helen & Wenrob for your kind words & advice. MIL seemed a little more lucid yesterday & the painkillers they are giving her allowed the physio & a nurse to get her out of bed & into the chair with less pain & agitation than usual. She is waiting to have x rays & we are waiting for results of her blood & urine tests - I was interested in your comment about sodium levels Wenrob - I was unaware of the problems that can cause.

The physio told me that, once they had established what was causing MIL's pain & treatment given, when she is medically better she will be transferred to a kick bed at another hospital (closer to her home) where she will have rehabilitation in the hope it restores her mobility to the level it was before her illness.

I will be with her again at lunchtime to help her eat as she is still not eating or drinking of her own volition but when I give her the plate/dish of food she is now eating a little more before refusing to finish it. I'm just praying that she doesn't start getting upset about not being at home as she was a little yesterday. Unfortunately a lady in the next bed has a transistor radio that is tuned to a sports channel & is quite loud. Loud noises distress MIL & I'm hoping it doesn't set off her agitation. We will see what today brings......

Angie

 

[retiredcopper]

Got to the hospital at noon yesterday to find MIL asleep in bed. Apparently she had refused to get out of the chair & into bed the night before & they couldn't move her until 5am so she had had little sleep. The sister told me that, as she was now obviously suffering from 'Day/Night' syndrome that they would do a CT scan to see how far the dementia had progressed. We are still waiting for the x rays to be done & the results of the tests to come back. Sister said that MIL would be with them for a while & therefore she would be moved from the assessment ward to a ward for the elderly.

MIL woke up an hour later & was in a happy mood. She kept saying she was comfy in her bed & she ate & drank everything I gave her. However she was more confused than usual as she said 'I like it here, they sell lots of lovely things here' and she asked me how long I had worked there, even though she knew who I was. I feel more reassured that she is in the best place & being cared for but I'm sure now that her mental state has declined even further. I feel so sorry for my husband as I know that he will be very upset to see the decline in his mum in the month he has been working away.

 

[retiredcopper]

Well MIL hasn't been out of bed for 3 days now & is getting less communicative. She only eats when I feed her & then refuses it after a few mouthfuls. Because she has been in bed so long she is now starting with a pressure sore on her bottom & heel so they are getting an air mattress for her.

Meanwhile all the test & xray results have come back & the Sister says they show nothing conclusive. Because she no longer needs acute medical care the Discharge Team are going to contact me about sending MIL to a 'kick bed' for rehabilitation. Has anyone had experience of this please & what it actually entails?

Because MIL had carers coming in 3 times a day prior to her hospital admission I now fear they will eventually try & discharge her back to her own home with a little more care provided. This won't be good enough - in 5 weeks she has gone from being semi-mobile & able to feed herself to being bedridden & having to be fed (as if she's given up). The thought of her being on her own for hours in between visits (and during the night when she is wide awake) fills me with dread. A care home is something we may now have to consider but can we delay her discharge (from the kick bed) until a suitable home is found or would they try to discharge her to her own home for the time being?

Angie