Possible admission to psychiatric hospital

Discussion in 'I care for a person with dementia' started by Marnie63, Jan 4, 2016.

  1. Marnie63

    Marnie63 Registered User

    Dec 26, 2015
    1,612
    Hampshire
    Just wondering if anyone has been down this path with their caree? My mum, 89, recent very rapid cognitive decline, has been worsening. Today she has spent from 9 am this morning until now (still going strong!) repeating the same few statements, over and over again and at times getting very agitated and very upset. I haven't been able to distract her with anything. Needless to say, my head is fit to burst. I've had a visit from a CPN today who suggested an extra 0.5mg Lorazepam which so far seems to have had no effect whatsoever. She's still going strong. I had to call them again and they have suggested that if I'm happy to, then I can give her another 0.5.mg. Am trying to hang on a bit as I usually give her this at night and it helps her sleep a bit at least. One of the psychiatrists is due to come out to see her tomorrow and they may put her with the team who do daily visits so that they can monitor her behaviour more closely. A possible admission to the local psychiatric hospital was mentioned - in order to get her medications right. Has anyone had experience of their very confused caree going into such a hospital? Would it be a good move, or should I try to hang on and get the meds right at home with their home visits? Any views would be gratefully received. Thanks. I'm starting to feel a bit desperate now as next step after carer at home was going to be day care, but in her current state, I don't think anyone would take her - or would they?
     
  2. Amy in the US

    Amy in the US Registered User

    Feb 28, 2015
    4,619
    USA
    Hi, Marnie, and if nobody has said it yet, welcome to TP.

    I'm sorry to hear about your mum and her agitation/confusion/repetitive statements.

    Apologies if you've done this already, but I suggest you rule out a UTI/other type of infection. These can cause a sudden change in behaviour and cognitive decline. I hear a lot of stories about that here on TP and in my support groups.

    You asked if anyone had experience of having their caree going into a psychiatric ward/hospital for assessment, and yes, I have, although in the States, which is a different system to yours.

    The short version is that my mother, age then 72, living alone with no services, was found outside one cold winter morning, no coat, injured, disoriented, and hallucinating. She was taken to our version of A&E for evaluation and then transferred to another hospital for psychiatric evaluation. Here in the States this is now sometimes called Senior Behavioural Health, but we used to call it the Geriatric Psychiatry Ward (GeriPsych).

    She stayed for 12 days and as she was on a lot of medications, and clearly hadn't been taking them properly, they did have to sort out her meds. She was not nearly as upset or agitated as I thought she would be in hospital, and the admission was the best thing that could have happened (as I previously didn't have a dementia diagnosis, had no idea what was wrong with her, and was killing myself with worry about what might happen to her, as she was refusing all help but was not coping on any level). I got a proper assessment and diagnosis and she got the care she needed. The nursing staff were well trained and very good and she improved markedly after about 3 days of proper nutrition and sleep. I was also able to get reliable data for the first time in years, as they checked each patient and charted their behaviour/activities, every 15 minutes around the clock.

    Obviously this is very different to your current situation, and I have no idea what the psychiatric hospital in your area is like, or what they can or cannot offer, or how your mum would react, but I did want to speak up and say I had a positive experience.

    I wish I could give you better advice. Is there a nurse or GP or specialist you feel very comfortable with, to ask their advice/opinion of?

    Wishing you all the best.
     
  3. Brenda16

    Brenda16 Registered User

    Feb 13, 2015
    69
    Not applicable
    Hi Marnie

    My Mum was sectioned in England 4 months ago and taken to a Mental Clinic.
    It was an awful thing for siblings to have to do but we were assured by the extremely professional staff that it was the only thing we could have done. They informed us that she would not have survived very much longer if she had continued living alone.
    The care team had previously put in movement sensors which showed that Mum was getting practically no sleep.
    The police had to be involved in getting Mum to leave the house but she eventually went into the ambulance of her own free will. She was extremely agitated when she got to the clinic but settled within a few days. It took them about 10 days to get her medication balanced.

    I think it very much depends of the patient themselves. Mum was in denial, got aggresive only a couple of times but you never know how they will react.
    Thanks to the medication Mum is much healthier now than when she was living alone.

    Mum is now in a care home. The move was a bit stressful for her but she settled within days.

    If we had not had her sectioned, Mum would most certainly no longer be a part of our lives.
     
  4. fizzie

    fizzie Registered User

    Jul 20, 2011
    2,731
    We also hit near crisis at one point but like you I preferred that they at least give a fair whack at getting it sorted at home. My Ma wasn't aggressive, just very confused and disoriented so I think it depends on your circumstances. In some instances you won't have any choice but if they are offering a choice then my (and this is very personal and relates only to my experiences) would be to try it at home.

    Any move adds hugely to confusion and distress and my general rule of thumb is that if it isn't absolutely essential then try at home first but don't put yourself at risk xxxx

    Daily monitoring sounds good if you can handle it and it is worth getting them to check for infections - it's just that if it is upsetting your mum then there is a level of awareness and a rapid decline can often indicates infection and an infection might either be present or on the horizon but that's just a backstop! Daily monitoring is a great support and it sounds as though you CPN is supportive too, all of those things make a positive difference to home recovery. If there is an infection our area also has a service called home first and you have similar it means that the medics will come into the home to sort out antibiotics, even intravenous.

    Welcome to TP xxx
     
  5. Marnie63

    Marnie63 Registered User

    Dec 26, 2015
    1,612
    Hampshire
    Thanks all. I think I will try to see if the medics can sort mum's medications at home first, if that's still an option. To be honest, the way I feel tonight, I'd just be glad for anyone to take her away! It's only been three weeks since her last hospital discharge and I'm really struggling with this already.

    There are no more infections Amy, but thanks for the pointers. She has had numerous tests during her three recent hospital admissions and although she did have a UTI at one point, it was never a serious one, and they did sort it.

    This is getting harder and harder for me to deal with (she lives with me and I don't really have anyone else to help me) so I'm just hanging on, day by day. I'm still checking out local care homes as eventually I will have to give in, it's just a case of how long it takes for me to reach that stage ...

    In the meantime, I am very grateful that our local Community Mental Health Team are so responsive - hopefully the doctor who comes tomorrow will be able to give further advice and suggest a new course of medication.
     
  6. fizzie

    fizzie Registered User

    Jul 20, 2011
    2,731
    Don't put yourself under too much pressure xx Good idea to take advice tomorrow and try to get some sleep tonight. Sleep deprivation is unbearable.

    It might be the right time to let her go and get her meds sorted and you have a break and then when she returns you may find it easier and manageable but if not you will have a clear head to deal with it.

    Thinking of you x
     
  7. canary

    canary Registered User

    Feb 25, 2014
    10,803
    Female
    South coast
    It sounds to me like you have reached that stage already..........
     
  8. Marnie63

    Marnie63 Registered User

    Dec 26, 2015
    1,612
    Hampshire
    Yes, I believe I have. Mum had me up all night again. Each day she seems to be getting a little worse. I think now I'm at the stage that once meds are sorted to stabilise her mood/behaviours, I'll be onto Social Services to take a place at whatever home is available. Then I can keep looking at other homes and wait for a place to come up at a nice one (assuming SS find one that I don't think is acceptable!). The problem is, while you are dealing with such an extreme situation, you don't have time to do anything else, which is why my care home recces have been suspended - I just don't have any time! Hopefully the visit of the psychiatric team today will move us forward a step to a better place. I'm in a very, very bad place myself right now. I have never felt this bad before in my life.
     
  9. lin1

    lin1 Registered User

    Jan 14, 2010
    9,320
    Female
    East Kent
    #9 lin1, Jan 5, 2016
    Last edited: Jan 5, 2016
    Hello Marnie.
    I am so sorry you are going through this with your Mum.

    I'm wondering if your Mum could be in pain and unable to let you know.
    It turned out that a lot of my mums Sundowning was caused by pain and once we got this under better control the Sundowning eased considerably.

    We also have an old thread on here regarding Paracetamol helping with agitation, you might want to discuss this with the doc/ physch who is coming today.
    http://forum.alzheimers.org.uk/show...llers-may-ease-agitation-in-dementia-patients

    Many people on here have been helped by going in for an assessment so please don't be upset if this is suggested today.
    It will not only help your Mum, but you too.
     
  10. Marnie63

    Marnie63 Registered User

    Dec 26, 2015
    1,612
    Hampshire
    Amisulpride

    Well, the visit by the psychiatrist and nurse was helpful. They asked me what outcome I wanted and I told them that as difficult as things are, I still want to try to get mum's behaviours under control so that she can stay at home with me for a bit longer. TBH I'd rather get this sorted before she goes (maybe) into a home anyway as I'd like to know she's 'comfortable' before we get to that stage. Anyway, Amisulpride has been prescribed now - 50mg once a day - so will see how that goes. They are also going to monitor her by visit or phone once a day, so reassuring for me to know that. Someone very helpfully replied to an earlier post of mine saying that this particular drug had really helped their caree settle, so I hope it does for my mum too, but time will tell.

    I have thought about the pain issue myself - mum always had aches and pains before this confusion started, but now nothing. I will ask about this aspect when I next speak to someone. I guess it wouldn't hurt to give a small dose of Paracetamol as she was taking this before anyway for her aches and pains and occasional headaches.

    I think her severe confusion is actually down to her state of mind, sadly, and I'm not sure any drug will unmuddle those thoughts now, but hopefully something will help the paranoid ideas she has all the time. I just want her to be happier and to be able to take her out and about somewhere without her being terrified of everything.
     
  11. fizzie

    fizzie Registered User

    Jul 20, 2011
    2,731
    My Ma always had 2 paracetamol at night and slept through. We all know what it is like in the wee hours to be in pain and not to be able to express it would be terrible. I have never heard that there any issue with giving them, only positives xxx
    So glad to hear today went well
     
  12. Marnie63

    Marnie63 Registered User

    Dec 26, 2015
    1,612
    Hampshire
    Thanks Fizzie. I've made an appointment with mum's GP to review all her meds so will wait until then to ask about the use of Paracetamol. I love the Maya Angelou quote by the way - I can easily apply that to some of my friends who have helped me through the past few months!

    Mum is a lot calmer this evening, not sure if it's the Amisulpride or just a better evening for her. Either way I've stepped away from the 'precipice' again tonight and feel stronger to carry on supporting her at home for a bit longer.

    Some very good and welcome news today (not much of that around at the moment for us!) - a day place has come up at a very nice, local care home I visited a while back, so mum can go there any day of the week. First visit next week, just hope it goes well. It will give me the 'lifeline' of a full day's break from looking after her and one day it may help with an easier transition to her becoming a resident there.

    Also, psychiatrist who visited mum today said that he is going to give an official diagnosis of Vascular Dementia now (they've dithered on this as it was so sudden) as this may open up other support networks for us. The CPN is going to let me have details of a course on Dementia for carers (I understand there is a 'creche' for carees!!).

    Thanks again to everyone for your comments and advice - I am very grateful for your support.
     
  13. fizzie

    fizzie Registered User

    Jul 20, 2011
    2,731
    Marnie this is such good news - all of it. The day care place is just the right timing - see someone is watching out for you xxx

    Great news about the diagnosis and so pleased that this evening, so far, has been more peaceful.

    I really hope you get some sleep tonight
    keep posting, thinking of you
     
  14. Hubbard

    Hubbard Registered User

    Jan 5, 2016
    2
    just a quicky,our caree is only 61 but she will speak gobbledegook non-stop and i give her three juicy fruit just to fill the void.when she came back from 2 weeks respite we found they didn't insist she got into a shower daily,or keep giving her knife & fork during her meal,so she came back smelly and skinny.i know you are doing a great job and i think it is you who are suffering the most.good luck.
     
  15. Amy in the US

    Amy in the US Registered User

    Feb 28, 2015
    4,619
    USA
    Marnie, thanks for coming back with updates. I'm glad to hear you seem to be getting a good response from the medical team.

    If it's okay to give your mum the paracetamol, then I'd give it a try.

    Excellent news on the possibility of day care, and good for you for booking it for next week. I hope it works out for you.

    And a diagnosis, and some support for you! That is all such good news, you ought to be able to hear me cheering all the way across the Atlantic.

    Others who are in the UK will know better than I, but I think Age UK and maybe some other agencies might offer carers cafes/groups, support groups, Singing for the Brain, maybe some other possibilities that might be of interest to you. Some care homes also offer support groups. Couldn't hurt to ask.

    Hope everyone in your house sleeps better tonight.
     
  16. Marnie63

    Marnie63 Registered User

    Dec 26, 2015
    1,612
    Hampshire
    I'm stepping a bit closer to the edge again today, but just about hanging on in there! The Amisulpride (50mg, once a day) doesn't seem to be doing anything at all. I gave mum one this morning and haven't noticed any difference to her behaviour. I have also given her Lorazepam this afternoon and it hasn't had the usual effect of calming her quickly. Will be giving her another 0.5mg shortly. Each day the severity of her confusion seems to 'step up' a bit and, sadly, last night was the second night in a row she was up at exactly 0300 for a wee, and then could not get back to sleep and kept popping back up again. CPN came again today and I gave her update. She told me to continue with the Amisulpride for a few more days.

    Mum seems to have bypassed the memory loss stage and in three months gone straight to complete and utter confusion. She has absolutely no comprehension of reality any more. I ordered a calendar for 2016 on ebay and it arrived today (she actually asked me to order one a few days ago). I showed it to her and she just didn't understand anything. Seemed to think she was born in 2016, because it said 2016 on the calendar, did not understand sequence of months, told me she thought it was 2026 and, as she was born in 1926, asked me why the calendar didn't show that year! The CPN said she has seen this level of confusion recently with another patient who had a TIA. I'm going to try two Paracetamol tonight as well as the CPN said this was OK.

    I'm still going to try for the day care next week, but will definitely resume my care home visits next week as well. One day, very soon, this will just all become too much for one person (me) to do 24/7. I just can't do it. I've spent all my life helping my parents as an only child, then I looked after mum more closely after Dad died, then I moved mum in with me 8 years ago, so have cared for her more 'closely'. Now this. I'm only 52, I refuse to give up the next 10 years or so of my life for this and in any case, what's the point? Mum has no idea of what's going on any more. What's the point of me struggling with this and getting frustrated with her when it's not her fault she's like this and in a care home there will be several people helping her over 24 hours, not just me, and they, hopefully, won't get as frustrated!

    Sorry folks, this has turned into a bit of a rant, but I think I've just made my decision .....
     
  17. fizzie

    fizzie Registered User

    Jul 20, 2011
    2,731
    Time is one of the major confusions. We learned very quickly to avoid discussions around time and dates. We did have big clocks on the wall in every room and a day chart in the kitchen which was large and divided into morning, afternoon and evening by days and I would write down anything that was happening but to be honest it was great in the early days but quickly she had no idea really of how to relate to it.

    I had to half chuckle to myself at the thought of me having that conversation about dates with my Ma!!!!! it really doesn't bear thinking about - Alice in wonderland here we come!

    Good idea to look around again and be well prepared for when the time comes and a great idea to try day centre but be aware that it make take a few weeks for her to settle to a pattern. Don't give her lots of advance warning, just the morning or it will cause more confusion.

    Here's hoping the paracetamol does its magic tonight!!!
     
  18. notsogooddtr

    notsogooddtr Registered User

    Jul 2, 2011
    877
    It sounds as though you are at the end of the road but it's so difficult to make the final decision.Everything you say is true,your mum needs more care than one person can provide,and yes,your life is important too.You won't get another.
     

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