Mum in hospital... delirium through the roof

[Linbrusco]

I had posted in Middle Stages of Dementia but reposting here.

My Mum was admitted to hospital yesterday (Monday)
Urine test came back negative.
They now think there is something else and want to do a chest xray & abdo/head CT for signs of a stroke ( Mum is leaning to one side)
Mum has had Chronic Lymphocytic Leukemia for 7 yrs also. ( could have swollen lymph nodes/spleen)
Mum is still not eating, drinking, taking meds, (now 4 days) she is agressive & highly agitated.... but on the ambulance ride and being admitted she was docile and cooperative and slept all night.
Mum was so agressive hitting carers & patients in the corridor they had to call security and with two nurses had to hold her down and give her a shot of Halperidol.
It had no effect.
They are deciding what to do as being a General Medicine ward they are trying to get to bottom of infection before transferring her to the Geriatric Mental Health Ward.
It’s a nightmare!

Update
Mums delirium at her care home of course has increased with being in hospital. The night before still highly agitated and agressive. They have Mum in her own room, with an Aid sitting watch. They also had to give her another shot of Halperidol and Lorazepam.
Yesterday morning Mum was calmer. Doctor spoke with her, to which Mum replied and smiled !!
How are you feeling this morning " Oh I'm allright" Mum said
As soon as he left, giving me the death stare, didnt utter a single word.
Still refusing meds, food & fluids, but at least lying in bed. Never sleeps more than 30 mns max at a time.
The sleeping has been like this now for well over a week.

Last night we had a call, to say they had to sedate Mum for a chest Xray & CT scan.
But was calmer, and even ate some dinner, and took all her meds

Im under no illusion that this means she's turned a corner, but will find out more today.

I truly hope that they find nothing, and we can get Mum on right track and back to her Care Home.
Mums birthday was just 3 weeks ago, and she was really good, and got some great photos.
The difference is just heartbreaking.... has not had a shower in 5 days, hair bedraggled, no bottom teeth in ( she took them out, and we cant get them back in) bruises all over her arms, badly bruised pinky finger which they thought at first she had broken.

 

[Shedrech]

oh Linbrusco, what a sorry tale - your poor mum
you must be exhausted with the worry of it all
just posting to express sympathy

 

[Tin]

Sounds terrible. Hope you can get some rest through all this.

 

[love.dad.but..]

Sorry to hear that your mum has had problems and hope she can get back on track and tgat you get some rest

 

[Rolypoly]

Sounds a nightmare. Hope it all gets sorted and you can breathe again.

 

[lambchop]

So, so sorry - it is appalling to see your mum in this condition and the stress on you -----

You said delerium but it isn't being treated, it seems, apart from the sedation. What have the doctors said about her xray and CT scan? I wasn't sure if her symptoms were present before she went into hospital, but the hospital environment and the fact she is not sleeping properly, all contribute to her agitated state. My heart goes out to you both and I hope a solution or reason is found quickly.

 

[Amy in the US]

Lin, I'm so sorry.

 

[Linbrusco]

So Mums chest xray and head CT scan came back all clear other than evidence of brain related changes due to her dementia.
The delirium was present at her care home and they are still thinking UTI which cleared on the few doses of anti bs that she had had.
Without a doubt the delirium, agitation & agression had increased with going to hospital.

Yesterday, though and possibly with the effects of halperidol & lorazepam was a changed woman.
Pleasant, cooperative, had a shower!! ate her dinner, took her meds. Didnt even leave her bed, and slept most of the night.
This morning though, back to being aggressive. No breakfast or meds.
Within 20 mns of me being there she had calmed down but still a bit stroppy.
3 Drs arrived. Good as gold.
They are looking at discharging her on the weekend back to her care home.
Mum ate some yoghurt, took her tablets. Positively charming for the Nurse and Carer.
Agreed to have a shower. Got out of bed quite willingly.

I went off for a coffee, 20 mns later Mum was back to being aggro.
They had struggled to give her a shower, put a hospital gown on her, but she refused to put on inco pants and ended up wetting herself and all on the floor.
We then had a job trying to change her again plus her gown was wet which had to be changed.
Mum said a few not so nice things to me, and then dug her nails into my arm. Just as well the Care Home had managed to cut them 2 weeks ago
Called the nurse, and I left.

Care Home wont want her back af this rate

Prior to all of this Mum has been Quetiapine for 5 mnths which worked well and she was stable for past 3 mnths.
Surely that will need to be reviewed.

 

[Kikki21]

So sorry to read this. It is really hard when the PWD has such a good hostess mode because you can really think you’re imagining it. I hope the drs manage to get your mum feeling better again @Linbrusco

 

[LynneMcV]

Hi @Linbrusco , I just wanted to stop by and say I understand what you are going through.

My husband went into hospital with severe delirium towards the end of January and was discharged after a couple of weeks after I was told his medical needs had been sorted. It is so scary to watch the effects of delirium and, what they didn't tell me when he was discharged, was that even when the acute medical needs have been addressed, the effects from delirium can continue for many months afterwards.

My husband lasted 10 days at home before having to be admitted to an NHS secure mental health unit due to a range of behaviours caused by the delirium, including high agitation, violence, refusal to eat meals or take meds - and having a high risk of falls through inability to sleep.

Like your mum, he started attacking staff and patients and is covered in bruises from having to be restrained. Since January he has needed 24/7 1:1 support. Some days he has had to have two dedicated supporters. It is heartbreaking to watch, and I do feel for you.

I don't know how long it will take to be able manage the situation I do know that people rarely get back to the stage they were at prior to having delirium. My husband's abilities are already much less than they were since first going into hospital.

They are looking at all his medication but so far, have decided to keep him on Quetiapine. He is far from recovered but at least he is eating again (with help), taking meds covertly and he hasn't attacked anyone for a few days, so there is improvement. It might be that your mum will need to go through a similar assessment period to see what her new needs might be following delirium.

They never really did get to the bottom of what caused my husband's delirium. Like your mum, all his tests, scans etc came back negative. There were signs of kidney damage early on (now rectified) which was put down to dehydration (probably because prior to hospitalisation he was sleeping such long periods of time that he wasn't getting enough fluids into him).

I am thinking of you and your poor mum. Hopefully, with the right support and a medication review she can reach a calmer and more peaceful state of mind.

 

[Linbrusco]

Thanks all so much for your replies.
LynneMcV I’m sorry to read about your husband, but thankyou for replying. At least I know someone out there has been through similar.

Although you have to see it and hear it to believe it.
My 77yo Mum all 5ft nothing!

Mum had delirium following 2 UTI’s this time last year but no where like this.... which still led to eventually medication.
Increasing her anti depressant did nothing. Lorazepam even a small dose made her too sedated and unsteady on her feet.
The Quetiapine worked eventually.

Problem with Mum is when she wakes up, or wakes up in the morning in particular shes at her most difficult.
If Nursing staff cant persuade her to take her meds first thing, it sets her up for a bad morning or day

Dr has already said that Mums delirium could take many weeks to resolve, and she may be at a new level from before.

Only my sister & I have been to see Mum.
My brother is too upset.
And for those of you who know my story we are purposely keeping Dad away. ( he is a trigger for her agitation regardless)

 

[Redjen]

I think just being in hospital, the change in environment is enough to cause the delirium. My mum (who as far as we know has no dementia or any cognitive problems previously) had a fall, broke & dislocated her shoulder. Within 24 hours we'd got full blown confusion & paranoia about where she was, what the nurses were up to etc. 2 months later and this hasn't abated at all, and got significantly worse after getting a staph infection in her broken shoulder, and then last week caught c diff. But even when she had no infection, & was on nothing stronger than paracaetamol, she was still confused & talking nonsense etc.

So you're definitely not alone, it's horrible to see someone so out of character and distressed. If it worsened when she was admitted then hopefully she'll settle down once she's back home, even if it takes a while. X

 

[lambchop]

Hi LIn,

This is probably of no help to you whatsoever, but you say that, when your mum wakes in teh morning, if she cannot be persuaded to take her Quetiapine, she is in a bad way for the rest of the day (poor woman). Is it possible to discuss giving the Quet covertly, in her food or drink (assuming she willingly eats and drinks?) If the staff are amenable to this idea, this wil be the only way to try and give your poor mum and you some semblance of peace.

 

[Amy in the US]

Lin, I've been out of town and am getting caught up. I'm so sorry to hear your mum is still in hospital and still not doing well, and that they didn't find any other issues. That is, I'm sorry there isn't an easily identifiable cause for her issues. Delirium is such a bad thing. I experienced this with my mother in hospital last year. It was so bad, that I don't ever want her to go back to hospital, ever ever again.

It is smart to not take your dad to see her in hospital. I know that can't feel easy, but it's the right decision. I'm sorry.

How are you, and she, doing today?

 

[Linbrusco]

Mum was discharged from hospital yesterday. No medical reason to keep her and back to her care home yesterday morning.
My sister went with her back by ambulance as I was back at work.

By the time Mum was discharged her agitation & agression had subsided considerably and they hadnt had to give her any Halperidol or Lorazepam since Tuesday night. Its now Saturday morning here.
However my sister seems to think the Hospital painted a bit of a rosy picture of Mums current state of delirium and fluctuating agitation & aggression but on discharge she was eating, drinking and taking meds. Mind you it was the first time since last Friday that my Mum hadnt hit my sister or given her verbal abuse
Ringing this morning to see how she went over night.
Care Home have said possibly not to visit for the weekend for her to settle in and for them to observe her.
We have a meeting with Mental Health Nurse next Wedenesday.