Refusal to stand

Discussion in 'I care for a person with dementia' started by Ithuriel, May 13, 2018.

  1. Ithuriel

    Ithuriel Registered User

    May 13, 2018
    13
    My mother (88) an Alzheimer patient since diagnosis in Sept 2014 was admitted to hospital on Friday 4th May with a bad chest infection.( and a possible water infection was mentioned when she was assessed in the evaluation unit) The previous evening she could not stand to get out of her chair to go to bed ( mobility is poor but this was the physical act of rising from the chair) . Now, since she has been in hospital her infection has cleared up, but she refuses to stand and now has to be hoisted from bed to chair and back again. This is quite sudden and I am unsure of what it is linked to. X rays and scans reveal no fractures or damage to her legs/ hips, but she screams the place down and is very distressed ( not something she is normally) when nurses try to transfer her. I obviously want her out of the hospital asap and back home, but thus far the dementia nurse has not been to see her nor have the social services team despite being alerted the day she was admitted. If this is possibly a sudden 'fear' thing of falling or a result of the infection Has anyone else experienced this sudden condition? ( she was walking and getting out of bed/ chair up until the night before her hospital admission) There is a prospect of an intermediate care placement and I wondered if anyone has similar experience of any actions they can take? All/ any information greatly appreciated
     
  2. Bunpoots

    Bunpoots Registered User

    Apr 1, 2016
    1,879
    Nottinghamshire
    I experienced this with my mum. She'd been in hospital after an infection and a stroke which caused a fall. She eventually did accepted standing again for transfers but as she'd broken her hip and had a stroke she never did regain her mobility. Hopefully your mum will.
     
  3. Ithuriel

    Ithuriel Registered User

    May 13, 2018
    13
    Thanks Bunpoots. Interesting. The hospital staff show absolutely no urgency around this matter, or ever comment if they have experienced it before. Mum has mentioned before she feels a sensation as if she is being "pushed over a cliff edge" when certain people or situations intervene to 'make' her stand when she doesn't wish to. How well did your mothers broken hip take to heal btw?
     
  4. Louise7

    Louise7 Registered User

    Mar 25, 2016
    509
    Has your Mum been seen by physios / Occ. Therapists or has it just been the nurses trying to get her to walk/transfer? It could be that she is scared so needs to get her confidence back, which may take some time. Although x-rays & scans have been done has pain been ruled out? My Mum has arthritis and spending longer than normal laying in bed in hospital left her in so much pain that she was unable to walk, despite being fully mobile prior to admittance. I found the dementia nurses to be really good so it would be worth trying to see if you can get hold of them to ask if they would take a look at your Mum.
     
  5. Ithuriel

    Ithuriel Registered User

    May 13, 2018
    13
    Hi Louise. Physios have tried twice but as she screams with distress (pain?) when they try to lift her to her feet they abandon it at that point. I am to attend a "best interest" meeting with the Doctor this week at which I am hoping the OT Dementia Nurse and Social Worker will be present at. However the risk averse system won't dicharge her until such time as she can stand and walk or willingly interect with others in an intermediate care facility. In the interim she is declining whilst in the hospital.
     
  6. Hickory dickory dock

    May 3, 2018
    5
    I wonder how much is fear on her part? Fear of the people trying to help her? What is she like if you help her up with someone? Fear of the effort to stand up? How would she be if she just did small exercises and make it a bit of fun with singing and clapping etc, eg sit and raise legs up and down , do marching movements with legs from sitting. Hope this might help a bit.
     
  7. Amy in the US

    Amy in the US Registered User

    Feb 28, 2015
    4,234
    USA
    Sorry to hear of the situation with your mother; hospital stays are never good for a person with dementia and this must be extra stressful.

    It could be the dementia, but I would also make sure there isn't something else going on. She could feel dizzy or unsteady from a medication or medication change, or a blood pressure problem, or from the infection itself. I think your instinct to get her out of hospital as soon as possible is a good one, but of course if she isn't standing at the moment, let alone walking, that's going to require a lot of changes at home before it would be safe for her to return, and maybe additional carers to manage transfers and hygiene.

    I hope you can get in touch with the relevant people, soon, to get some info. Have PT/OT seen and assessed your mum and the house? Have you talked to the PALS person or department at the hospital to see if they can help with communication? I'm sorry I haven't better advice. Best wishes to you and your family.
     
  8. Ithuriel

    Ithuriel Registered User

    May 13, 2018
    13
    Hi Hickory. Yes good points. I am taking one of her carers down tomorrow to see if she can get her to try. Amy in the US:- You are right of course and thst's a lot of the issues I need to get on the table with the Doctor..no one has been to see mum or myself to assess her in csse this is purely infection related or to see if the house requires adsption/is suitable. They (hospitsl staff) just keep refering to "base line"following recovery fron infection, however thst 'base line' of mums character and general mental wellness is declining before my eyes. If she could only try to stand and not shreik like a banshee when assisted we would be a lot further down the road to getting her rehabilitation care with a clear goal to get her home.
     
  9. Ithuriel

    Ithuriel Registered User

    May 13, 2018
    13
    Speaking to the main Doctor at the Hospital it appears this refusal to stand could be the result of Delirium which can accompany infections - this worries me of course as those with Alzheimer's can be quite affected by this long term. Does anyone else have experience of Delirium and recovery?
     
  10. Amy in the US

    Amy in the US Registered User

    Feb 28, 2015
    4,234
    USA
    Yes, I do. My mother had very bad hospital induced delirium after a fall, broken bone, surgery, and hospital and rehab stay last year. I should have mentioned this in my earlier post. Best cures are time, getting the person into a more stable environment, getting them off any meds that aren't helping, treating any underlying medical conditions, and keeping them company as much as possible (for those who get agitated when alone and are soothed by company).

    I have to go but will check back when I can. Please don't hesitate to ask questions. Delirium is a real problem in both geriatric and dementia populations, although it can happen to anyone.
     
  11. Ithuriel

    Ithuriel Registered User

    May 13, 2018
    13
    Thank you Amy. This is very interesting. I am conscious from some further reading that a percentage of Alzheimer's patients do not recover to their pre delirium baseline and obviously I am hoping desperately mum is not so affected. However, the hospital stay - coming up to 2 weeks now is not the best and I am having to really push for answers. Delirium is supposedly a specialism of mums consultant yet there seems little commitment around this to say for certain it is delirium that is both affecting her ability to stand or the fact that cognitively she has declined a good deal since her second or third day on the ward. I shot a little phone cam video of her on her first day as I wanted to benchmark this. Despite her then being in the grip of her infections she was far more cognitively engaged than she is now. I ask the staff is this is typical post infection but there is nothing concrete coming back to me. May I ask how long did your mothers recovery take? I worry that mum will be discharged and have to have bed and joist etc; in our downstairs sitting room. if this aid s recovery then so be it, as I do not believe the hospital environment ( where she seems unaware now where she is -something that has also changed since her admission) is not conducive. Apologies for late reply as you can imagine trying to keep both working and hospital visiting and all the chasing through departments for answers has somewhat occupied most of my waking hours!.. Kindest Regards Mike
     
  12. Linbrusco

    Linbrusco Registered User

    Mar 4, 2013
    1,418
    Female
    Auckland...... New Zealand
    Im not from the UK, but we have back in March, experienced an awful time with Mum at her care home, arising from a UTI, which delirium ensued, but being admitted to hospital made it so much worse.
    In Mums case she was agitated, physically agressive, sleep deprived, eating & drinking little, refusing meds, hallucinating,
    Hospital made Mums agression go through the roof. She refused food, fluids & meds for 4 days straight.
    As soon as she calmed down a little enough to eat & drink, and all Mums tests were cleared, they transferred Mum back to her care home.
    Mums care home were not happy with her discharge, but we worked closely with carers, RN, GP, mental health nurse and Psycho Geritrician.
    Its taken a great deal of perseverance especially with getting her to eat & drink and back in a consistent sleep pattern.
    The biggest difference is doing a complete review of Mums meds. They have taken her off what isnt absolutely necessary and increased her Quetiapine. ( mum had been in this 7 mnths)
    Mum is doing so much better now.
    Makes you wonder if on top of her UTI & delirium her current medications plus sedatives they gave her in hospital all interacted with each other?

    It could be with your Mum that the hospital environment is a psychological barrier?
     
  13. Ithuriel

    Ithuriel Registered User

    May 13, 2018
    13
    Hi Linbrusco

    I think that could very well be the issue. Mum is generally very placid but has been quite sharp with the Hospital staff and refused them quite strongly from taking bloods or trying to help her. It is out of character but then again her character has changed since admission n to a much more rambly and distant person. She isn't on many meds at all, and I often jettison the statin the doc insists upon as she doesn't have vascular dementia and a dementia nurse explained to me back in October they often do more harm in term of confusion than do good. She is probably back on it in the hospital though. How long did your mother take to eventually be 'clear' of the delirium and was she ever back to her pre infection baseline in your opinion?
     
  14. Linbrusco

    Linbrusco Registered User

    Mar 4, 2013
    1,418
    Female
    Auckland...... New Zealand
    At time of Mum going into care she was only on Statins, Vesicare ( over active bladder) Nortiptyline at night to help her sleep due to bladder spasms. In a higher dose Nortriptyline is an older anti depressant.
    This time last year after a UTI, Mum declined considerably. Anxiius & agitated much of the time, and her appetite was poor. They had her on Ensure supplements.
    They tried Lorazepam which made her too sedated and wobbly on her feet. They then tried Quetiapine in a small dose. Which worked much better although they adjusted the dose twice.

    After this recent UTI and her delirium, upon return to her care home she was still agitated & agressive. Not as bad as the hospital environment. Still refusing meds off & on, but they did a lot of one on one care with her.
    Within the first 2 weeks after not a huge deal of improvement, we saw a Psycho Geritrician and Mental Health Nurse.
    Mum was taken off Statins, Bladder Meds,( has been in pullup pants for a while) Nortriptyline reduced. Quetiapine increased.
    Within a week of this we saw a massive improvement to the point where she is almost as she was when she first went into care 2 yrs ago. Still crossing fingers.
     

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