The two extremes of a UTI!

[Linbrusco]

We all know how a UTI can wreak havoc in a LO with dementia, but this is just to inform anyone, that may not know, the extremes in behaviours it can cause.

I cared for Mum ( now 78) with Alzheimers for 4 yrs before she went into care 2 yrs ago.
Mum has a compromised immune system due to Chronic Lymphocytic Leukemia.
When at home, I always suspected a UTI when Mum was suddenly more confused or an increase in repeating herself.
A glazed look in her eye, and not talking as much.

In her care home a UTI March 2017.
Increased agitation, anxiety and physically agressive, hallucinating and delusional.
Mild delirium.
Once treated the behaviours continued although to a lesser degree. No two days the same, so after a few different meds to help calm her, by the Septemeber Mum was trialled on an anti psychotic, Quetiapine. It worked really well, without making her sedated.

March this year another UTI.
Same as March the previous although this was on a whole new level x 100.
Hitting & swinging for anyone in her path. Wouldnt sleep more than 15 mns at a time. Refusing food, fluids & meds. Mum was admitted to our public hospital where they had to sedate her to obtain a chest xray & brain CT and bloods. Hospital just increased Mums delirium.
This was an absolute horrendous time. I was being asked about Resuscitation orders and asked about end of life decisions.
Mum however recovered after treatment and went back to her care home.
She had a complete review of her meds.
Some removed completely and Quetiapine increased slightly.

From end of March till over a week ago Mum has been the best she had been mood and behaviour wise. Quite settled.

A week ago I get a call from Mums care home.
Shes been quite sleepy, and they noticed a slight lean to the right. Obs were all fine.
The following day, Mums lean was more pronounced.
They checked her over for stroke symptoms. Body, face, symmetrical. Speech not slurred.
She was sleeping off & on 20hrs+ and was now not walking let alone standing. She was complaining off & on of a sore back.
Dr was called. Nothing glaringly obvious. Mum said her back was fine. They did some blood tests but were unable to obtain a UTI sample from Mum.
They arranged an Xray of Mums lower pelvis for fractures. Nothing. They started Mum on anti bs for a UTI as a precaution and gave her anti flams & pain releif.
Its taken a further 6 days where Mums mobility meant 2 carers with a hoist, pressure mattress in her bed, special chair, carers having to feed her and give her drinks when awake. We were told it could be a sudden Alzheimers decline.
She was being assesed for a move toHospital level, when she suddenly picked up and was more alert.
By the 7th day she was up and walking again !!
Her assesment for Hospital level has been put on hold.

Mum is still recovering, & regaining her strength. Talking less, but almost back to her prior level. No delirium this time.
Mums care home have never seen anything like it with a UTI.

Goes to show the extremes.

 

[Louise7]

Are you sure that a UTI caused the loss of mobility? My Mum had a similar experience in hospital recently. She walked in and shortly afterwards was unable to mobilise. I was told that this was due to dementia and the OT said that as Mum now needed two people and a hoist to get her out of bed, couldn't mobilise and was unsafe to be left in a chair she would have to go into nursing care. Turns out that Mum was actually in pain (in her back) and when the right level of pain relief was given she just stood up and walked again. It's great news that your Mum is back on her feet but it may be that it is the pain relief had has caused the improvement, not the antibiotics for UTI.

 

[Linbrusco]

Sorry didnt add, she had a low grade fever too.
Although she complained of a sore back it was intermittent and all smiles with the GP and said it was fine. Even when he checked her back, pressed it, no signs of pain.
The stronger pain releif she was on for two days, now just paracetamol.
She is walking unaided with no lean to the side.
Nursing staff and GP, and physio seem to think all from a UTI, combined with temp and increased sleeping.
In absence of a UTI test, I suppose they can only surmise.

 

[Tired Team Leader]

Brilliant that you posted this. It's so true. As someone without dementia I know when I have a UTI or a chest infection. In a care home residents and their relatives need the staff to understand the signs. That if someone is suddenly beating up the staff then it's might be due to a UTI or chest infection and it's something I install into my staff. It's not always a change in their dementia.

A million years ago I cared for a woman that barely said anything. She would respond to questions about meals and needing the toilet and going to bed. When we went in of a morning and she greeted us with "well, how are you this morning? I feel like I could have a shower before I go for breakfast and then if you could dry my hair that would be lovely!" we knew straight away she had a UTI. The GP didn't even ask for a specimen, he'd known her for years and knew this was a symptom. I would phone him and explain and he'd prescribe antibiotics and a week later she'd be back to her usual, quiet, self. A very genteel woman who appreciated that we knew her symptoms.