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Mother refusing treatments

Discussion in 'ARCHIVE FORUM: Support discussions' started by sheila d, Dec 14, 2007.

  1. sheila d

    sheila d Registered User

    Dec 8, 2007
    25
    liverpool
    Mum went in to hospital last Sunday, after a very sudden decline into mental confusion and serious ocd behaviour.( 4 weeks ago she had only mild recall problems, nothing more than usually expected for a person of 83)
    She hss been treated for a urine infection and is on a genito urinanry ward, but her mental health is still declining and today she is having hallucinations for the first time. Before being admitted she could manage to walk a little with her walking frame from the lounge to the toilet at home and used the toilet unaided. Now she is no longer walking, she has a commode by the bed and it is taking 2 people to lift her on to the toilet.

    So the plan is to move her to a rehab hospital and then I imagine some sort of care home, although Dad desperately wants her home.

    Now I have asked for a mental health assessment, on the basis that we cannot decide what is best for her care if we have no idea of what is wrong with her. She is down to have a CT scan of the brain, but she is absolutely refusing any further treatment - she won't let the physios do anything, can't take her temp etc.

    I am really worried that the NHS will say ok, we have offered treatment, she has refused, so we can't do any more for her, now find a care home and take her away.

    Anyone else had this problem, if so, how do you get a patient to accept treatment. I don't want her discharged without knowing that I have done everything to get her the right help.
     
  2. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Hi Sheila

    I'm afraid what has happened to your mum sounds very familiar, it's exactly what happened to John three months ago. These UTIs can cause huge neurological damage, I wouldn't have believed it if I hadn't seen it.

    John also became agitated and ,violent and refused to let anyone touch him, and that was completely out of character.

    They put him on a low dose of quetiapine, which settled him.

    He is now in a nursing home, because he never regained the use of his legs. His speech has gone completely, and he is doubly incontinent.

    Your mum may not react as badly as that, some people recover from infections with little damage, but it's as well to be prepared.

    I think you should ask for an appointment to see the ward doctor, and ask what they are going to do -- it might be as well to wait until they have the result of the scan.

    But they can't discharge your mum without a full multi-disciplinary assessment, and if they say she can't manage at home, they have to keep her until a suitable placement is found.

    I have so much sympathy for you, I was out of my mind when it happened to John.

    Please let us know how you get on.

    Love,
     
  3. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,417
    Hazel's right - they won't/can't discharge her until they've conducted an assessment. However, if she won't cooperate with the assessment I'm not sanguine that they will really delve into the issues - it's far too easy for them to skirt over them. Also, I think it's fair to say that you may never get a definitve diagnosis. They can tell you what it probably is, or what the balance of evidence suggests but medical diagnosis is an art as well as a science and I'm afraid that truly gifted diagnosticians are thin on the ground. I suppose in the final analysis though, it probably won't make a great deal of difference: it's not as if there are cures available for the various types of dementia (with one or two fairly rare exceptions). So, it ends up as being all about management of the symptoms and the situation.

    However, if what you say is really true - that she has gone from mild memory problems to imobility in less than 4 weeks then you need to tell everyone you come in contact with that. I'm sorry to say that people are not always as efficient as they might be at reading files, and the last thing you want to happen is for assumptions to be made that this has been a gradual decline, when clearly it has not.

    Hopefully the CT scan will give a more definitive idea of what is going on.

    best wishes
     
  4. peppa

    peppa Registered User

    Jun 5, 2007
    26
    london
    Dear Sheila,

    This does sound tricky. I would agree with Hazel that you need to speak to the doctor, and also know you can argue that it would be 'unsafe' for her to go home if her needs have changed. This might be a way of persuading your mother to have more tests so that it may be possible to return home.

    My mum also had 'mild' dementia earlier this year and became seriously confused by a UTI. It got so bad in one of her stints in hospital that she did have very serious delusions plus hallucinating about animals in the ward and babies. The doctors initially thought this was a progression in her dementia and were quite pessimistic about the future. She also 'forgot' how to walk. However, she surprised everyone and within weeks she was up on her feet with a frame and being the most lucid and engaged she's been in about two years. So I would say don't panic. Luckily my mother never refused treatment but everyone said she had 'very little insight' into her condition, which was true. She absolutely refused to believe she really needed the help that clearly she did need, and would stubbornly try to walk totally unaided when this was utter madness! (Her balance was particularly poor for multiple reasons.)

    My mother is now very unwell, but that has nothing to do with the hallucinations/earlier hospital stints. Everyone is different, but I would say that your mother's confusion may well pass soon after the infection has cleared.

    Hope things look brighter soon,

    Peppa
     
  5. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    dear Peppa,has there been a change in any medication since hospitalisation?i ask because i had a resident go into hospital,fully mobile but showing sympytoms of aggression.G.P concluded that there was infection somewhere?Since their return they cannot walk,present with hallucinations etc.All ckecked out and its the change in meds thats causing it.just a thought hun.love elaine
     
  6. germain

    germain Registered User

    Jul 7, 2007
    342
    Hello

    Our Mum also came out of hospital seemingly unable to walk at all. But after a few days of TLC in the CH she has started to try again - in the absence of any other infection etc (after the antibiotics had worked) it was proposed to us that every time she spent days in bed her muscles had weakened so much and her arthritis stiffness had increased so much that it wasn't surprising that she didn't even want to try ! Things are getting better but very slowly - she is being really encouraged to try little steps and to join in the morning "exercise in your chair" sessions. I think we can see an improvement but it will be a long job.
    Don't give up tho' - it can be done but I think with AZ it will take 10 times longer than a healthy 85 year old.
    regards
    germain
     
  7. Natashalou

    Natashalou Registered User

    Mar 22, 2007
    426
    london
    not dis similar to what happened to my mother. A year ago she was a forgetful and rather awkward old lady, but she was managing pretty well in her bungalow with support from me. Then she had a fall and broke her pelvis...admitted to hospital..and the next thing I know she is being violent and aggressive and hallucinating.
    Mental health assesment came back..too bad for rehab and care package wouldnt be enough to return home. Mum herself was very un co operative which didnt help...basically they couldnt wait to get shot of her.
    Had no choice but to find her a nursing home..was told if I didnt they would and she would then have still been 70 miles away.
    I guess it was the right decision...but I do sometimes wonder if she really ought to have been given a chance at rehab etc. And I often wonder what caused her dramatic down turn .
     

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