My mum is 93. She's always been a strong, determined person. She’s had 5 hip, both knees and a shoulder replacement, cancer of the colon and macular holes in both eyes (registered part sighted). After a nasty fall 18 months ago she fractured her neck, so could no longer care for herself. After six weeks experience of home carers, she made the decision a care home would be better for her.
Early January this year her right leg spontaneously fractured around the pin of her hip replacement. It was operated on but broke again 2 weeks later. Another big op. She was recuperating well, for six weeks walking bit more each day with zimmer frame and help from carers.
Early March, in space of few days, she slept nearly all the time, was unable to talk for more than a few minutes, became confused and started to hallucinate. GP insisted it was lack of sleep caused by nocturia. He decided that, although she wore incontinence pants at night, carers and family encouraged her not to worry about it, just ‘let it go’ in the night, by him telling her to, she would. I had my doubts, which I expressed, because mum had been up nightly 2-3 times for years which increased to 6-9 times for several months prior to breaking her leg. However, we were told by staff she was using pants and sleeping much better at night.
But her mental & physical capacity continued to decline and by mid-April she lost all mobility.
Early May, after lots of pushing to GP's, they finally agreed to do culture of urine & mum was diagnosed with UTI, admitted to hospital for 8 days, with 4 days of antibiotics by drip. During her admission the hallucinations got far worse, which we expected as she'd had it a badly when in hospital with broken neck and touch of it when her leg first broke.
Of the 5 GP’s from mum’s surgery that have seen her, only one has agreed with me about delirium. Sadly he’s a trainee, actual GP he was with would not acknowledge we could be right. Hospital literally just don’t answer when I’ve asked if it’s delirium from UTI. As a side issue, one morning while in hospital with UTI, she had a funny turn. In the middle of saying hello to visitors and myself, her head flopped over to the left, her eyes glazed over and she was non-responsive for several minutes. When she came to, she carried on as if nothing had happened. I suspected mild TIA and reported it to the ward registrar 10 minutes later, who said as he didn’t see it happen, he couldn’t comment and there are no tests that can be done to diagnose TIA.
Late May mum had chest pain. She was taken to hospital, diagnosed with fluid on chest, sent home after 2 days with frusemide, 3 days antibiotics as showing signs of UTI, and GP advised to refer to palliative care team. GP I spoke to refused to do referral, said we had to move mum to a nursing home for palliative care.
At the end of May mum was unwell, oxygen levels low, very confused. Ambulance team came out – excellent care – they conversed with on-call GP and care home manager. On-call GP was furious at attitude of mum’s GP and said he would contact the surgery about referral and tell them, in his opinion, mum should be on long term, low dose antibiotics for UTI. Hey-ho, following day antibiotics prescribed and GP I saw the following week did referral.
Last week yet another GP saw mum and stopped the antibiotics. No explanation other than mum had been on them for a few months. Mum had a blood test the previous week and her potassium levels low. He made no mention of this.
Mum was unwell Friday last week so care home called district nurse to come. I told them about potassium level and they are of opinion it needs checking and they will speak to GP about it.
At the moment mum is much more alert, can have a conversation provided it's kept simple, she’s got her words back on the whole. She can even operate the TV. Bit muddled still, mixture of real thoughts & memories, just in wrong order here & there. Some strange thoughts but there are logical reasons why & mum accepts it when I say they are dreams. (e.g. she told me carer took her to sleep in the mortuary last night, a dream after finding out a friend had passed away).
Physically she has lost hardly any ability to twiddle her ankles and pull her legs up towards her while in bed. If sitting in chair she can raise both legs out straight. It core strength she’s lost. She can now pull herself forwards a bit – couldn’t do that at all 3 weeks ago.
This, to me, says delirium that is slowly starting to show signs of clearing.
Tomorrow Iam taking mum for a hospital check-up on her leg. This should involve x-ray so clutching at straws, it will prove there isn’t a mechanical reason for her immobility.
We can’t get a diagnosis yet - memory clinic say she must be like this for 6 months, not had any antibiotics for at least 2 weeks prior to blood tests and not got UTI before referral will be triaged.
So I guess we just have to wait and see how she is on a daily basis and hope no more UTI’s. So stressful and I can’t help but feel an early urine sample could have prevented so much of what my mum’s going through.
Early January this year her right leg spontaneously fractured around the pin of her hip replacement. It was operated on but broke again 2 weeks later. Another big op. She was recuperating well, for six weeks walking bit more each day with zimmer frame and help from carers.
Early March, in space of few days, she slept nearly all the time, was unable to talk for more than a few minutes, became confused and started to hallucinate. GP insisted it was lack of sleep caused by nocturia. He decided that, although she wore incontinence pants at night, carers and family encouraged her not to worry about it, just ‘let it go’ in the night, by him telling her to, she would. I had my doubts, which I expressed, because mum had been up nightly 2-3 times for years which increased to 6-9 times for several months prior to breaking her leg. However, we were told by staff she was using pants and sleeping much better at night.
But her mental & physical capacity continued to decline and by mid-April she lost all mobility.
Early May, after lots of pushing to GP's, they finally agreed to do culture of urine & mum was diagnosed with UTI, admitted to hospital for 8 days, with 4 days of antibiotics by drip. During her admission the hallucinations got far worse, which we expected as she'd had it a badly when in hospital with broken neck and touch of it when her leg first broke.
Of the 5 GP’s from mum’s surgery that have seen her, only one has agreed with me about delirium. Sadly he’s a trainee, actual GP he was with would not acknowledge we could be right. Hospital literally just don’t answer when I’ve asked if it’s delirium from UTI. As a side issue, one morning while in hospital with UTI, she had a funny turn. In the middle of saying hello to visitors and myself, her head flopped over to the left, her eyes glazed over and she was non-responsive for several minutes. When she came to, she carried on as if nothing had happened. I suspected mild TIA and reported it to the ward registrar 10 minutes later, who said as he didn’t see it happen, he couldn’t comment and there are no tests that can be done to diagnose TIA.
Late May mum had chest pain. She was taken to hospital, diagnosed with fluid on chest, sent home after 2 days with frusemide, 3 days antibiotics as showing signs of UTI, and GP advised to refer to palliative care team. GP I spoke to refused to do referral, said we had to move mum to a nursing home for palliative care.
At the end of May mum was unwell, oxygen levels low, very confused. Ambulance team came out – excellent care – they conversed with on-call GP and care home manager. On-call GP was furious at attitude of mum’s GP and said he would contact the surgery about referral and tell them, in his opinion, mum should be on long term, low dose antibiotics for UTI. Hey-ho, following day antibiotics prescribed and GP I saw the following week did referral.
Last week yet another GP saw mum and stopped the antibiotics. No explanation other than mum had been on them for a few months. Mum had a blood test the previous week and her potassium levels low. He made no mention of this.
Mum was unwell Friday last week so care home called district nurse to come. I told them about potassium level and they are of opinion it needs checking and they will speak to GP about it.
At the moment mum is much more alert, can have a conversation provided it's kept simple, she’s got her words back on the whole. She can even operate the TV. Bit muddled still, mixture of real thoughts & memories, just in wrong order here & there. Some strange thoughts but there are logical reasons why & mum accepts it when I say they are dreams. (e.g. she told me carer took her to sleep in the mortuary last night, a dream after finding out a friend had passed away).
Physically she has lost hardly any ability to twiddle her ankles and pull her legs up towards her while in bed. If sitting in chair she can raise both legs out straight. It core strength she’s lost. She can now pull herself forwards a bit – couldn’t do that at all 3 weeks ago.
This, to me, says delirium that is slowly starting to show signs of clearing.
Tomorrow Iam taking mum for a hospital check-up on her leg. This should involve x-ray so clutching at straws, it will prove there isn’t a mechanical reason for her immobility.
We can’t get a diagnosis yet - memory clinic say she must be like this for 6 months, not had any antibiotics for at least 2 weeks prior to blood tests and not got UTI before referral will be triaged.
So I guess we just have to wait and see how she is on a daily basis and hope no more UTI’s. So stressful and I can’t help but feel an early urine sample could have prevented so much of what my mum’s going through.
