Medicine and Memory

[MrsMoose]

My father in law's dementia is getting progressively worse. He lives in sheltered accommodation and a carer comes in, in the morning. There is a very good warden who keeps an eye on residents

He has been prescribed antibiotics for a urine infection - passing blood - 10 tablets in all to be taken morning and night. We told the warden and also the carer, who could remind him to take the morning tablet. After a few days the bleeding stopped. However, because of his memory problems we have discovered he's not been taking the tablets and the bleeding has now resumed.

He's managing to get dressed/undressed etc so doesn't really need an evening carer. But this is the sort of thing which makes me realise he does need more support.

We're now trying to work out how to get him to take the rest of the course regularly. There isn't much point going back to the doctor re the infection if he's not taken all the tablets prescribed....

 

[Abbsy]

Medicine, memory and water infections

I've been through something similar over the past 2 years with my mother, living (semi) independently with the support of myself, carers and a manager of the housing complex where she lives.

Our problem was that mum needed medication 4, sometimes 5 times a day, and at the time we only had carers going in twice a day. Mum was also getting frequent water infections (and still does), mainly caused by a lack of fluid intake - no one's fault, she just doesn't want to drink much. We tried all sorts of ways to prompt mum to drink and to take the tablets, even paying nearly £100 for an electronic carousel which popped open when it was time to take the tablets - complete waste of time as mum didn't like the noise it made and took the batteries out on day 1.....

Finally we went back to the GP, who reassessed the meds and managed to change the dosage of everything so that she only needed to take them twice-daily to tie in with the carers' visits.

I'd suggest going back to your father-in-law's GP and explain the situation - we did this over the phone - there may be just as effective alternatives to the antibiotics he's taking that can be given less frequently. If not, could you ask for a social work assessment to increase carer visits? (Ideally whilst he needs the antibiotics, but social services probably won't move that quickly).

Just a further note about water infections: mum quickly got sucked into a 'revolving door' situation, whereby she'd get an infection, the GP would be reluctant to manage the risk in the community, they'd urge mum to go into hospital, where she'd be put on a saline drip for a couple of days, but not discharged for several days/weeks........only for the same thing to happen a month or so later, and so on.

Hospital has not been the best place for mum, and the treatment given was minimal: no antibiotics were ever administered via a drip and the underlying cause never addressed. As mum suffers from social phobia and hates interacting with too many people, the treatment was not justifying the psychological upset.

I fully understand the impact of water infections upon health and behaviour, and would never underestimate the seriousness of the condition. However, we've now found that there are alternatives to going into hospital: mum's GP is able to send in a short-term nursing team in from the hospital to administer meds and monitor progress over four or five days. Possibly a more expensive option, hence hospital admission being the default treatment offered?

We've become much more assertive now: only today she's been diagnosed with yet another water infection and a locum doctor wanted to have her admitted. Mum and I politely refused.

Sorry for the long-winded response, I hope it may be of use and I hope that your father-in-law feels better soon.

 

[MrsMoose]

Thanks, both of you.

It has also emerged that my father-in-law was deliberately restricting his fluid intake as he was finding passing urine painful and didn't want to go too often. Not really ideal given there was an infection.

It's hard when he's doing things that are not in his best interests, but there isn't really a structure that will ensure proper care is taken.

 

[Amy in the US]

Hello, MrsMoose. I don't know that I have any advice other than what you've been given, but wanted to offer sympathy.

I agree with talking to the GP, just so they know that there is an issue with taking meds and fluid intake. They may want to do a urine culture to check they are giving him the best antibiotic for the infection. Many people here on TP have posted that their PWD (person with dementia) is on a maintenance dose of antibiotics, so if this is a recurring issue, it would be worth discussing with the GP.

My best guess for the short term, is to increase the carer visits to include medication supervision and to help push fluids. Nothing you hadn't already thought of, I am sure.

I agree that it is a tricky and upsetting situation all round. I hope you can get the infection kicked, to begin with, and then see what needs to happen going forward. The UTIs can be difficult to get rid of and can cause so many problems (changed behaviour and personality, et cetera) besides just the infection.

Best wishes.