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Trouble getting my father diagnosed with suspected Korsakoff's Syndrome

Discussion in 'Memory concerns and seeking a diagnosis' started by JFK, Mar 30, 2015.

  1. JFK

    JFK Registered User

    Mar 30, 2015
    4
    Please forgive the lengthy post, but I wanted to give as much information as I could in the hope of getting the appropriate help.

    My 65 year old father was admitted to Medway Hospital A&E on February 27th 2015 with a broken hip. The previous night he had fallen, on the first floor of his rented property, and consequently spent the night where he fell, until he was able to get his phone and call me at 10am the next morning. Upon being admitted to Medway, he was also informed that he also has COPD, due to smoking heavily throughout his life.

    He has been an alcoholic for over 40 years and - since living on his own for the last 5 or 6 years - has declined both physically and mentally. In the last year he has been complaining about his eyesight deteriorating and has been to see several specialists, all of whom have told him he has 20/20 vision. However, he still insists on driving his car on short trips to the supermarkets for cigarettes, alcohol and a minimal amount of food. He has extremely poor mobility and slowly shuffles around his house, partly owing to his eyesight problems, which - along with drinking heavily (1 litre of vodka a day) - was the cause of his fall. He had already fallen 5 times (that I am aware of) in the last year, his penultimate fall left him immobile on his sofa for two weeks, before he even informed me of what had happened. He has had a number of operations over his life and broken many of his bones, which is another reason for his poor mobility. His diet is extremely poor and another factor in his physical and mental deterioration.

    He currently lives in a three storey townhouse, with a kitchen on the ground floor, bathroom and living area on the first floor and bedrooms on the top floor. In recent months he has resorted to sleeping on an old sofa so that he doesn't have to negotiate the stairs in the night whilst intoxicated, prior to this he was sleeping on a mattress on his bedroom floor. However he refuses to move to a more suitable property on the basis that he doesn't believe he has a problem.

    Having had surgery on February 28th to replace his hip, within 24 to 48 hours he quickly began to experience alcohol withdrawal symptoms and was given diazepam in an attempt to counter them. He was also detained for his own protection and deemed not to have capacity. Now in the dementia section of the Orthopedic Ward since his surgery, he has rapidly declined and he is now physically and mentally a fraction of the person he was prior to the fall. He has been uncooperative, aggressive and refused all help offered to him by the hospital with regards to care in the future, purely on the grounds that he simply wants to return home in order to drink. He simply doesn't believe that he is a danger to himself or that he is desperately in need of some sort of care and/or support. He believes that he is fine as he is, which he is not.

    Within the first few weeks of his admittance, I was told by one consultant that it is likely that he has Korsakoff's Syndrome and this has also been suggested by a number of other medical staff. Having read more about this myself, I truly believe that this is the case. Some of the key factors that have become apparent to me over the last year or so - and now much more prominently - are:

    - Poor short term and long term memory; unable to remember simple information about where he is and why, along with confusion about people around him.
    - Lack of concentration; he quickly forgets what he's trying to say when attempting to have a conversation.
    - His speech is slurred; he is much more softly spoken and no longer pronouncing words correctly.
    - Extremely bad a judging distances; he will use his foot to feel for steps when attempting to climb stairs instead of judging the distance with his eyes.
    - Misunderstanding time; he doesn't know how long he's been in hospital and what he does believe will vary greatly on a day to day basis.

    Although he hasn't actually been given a proper diagnosis and, now that his hip is repairing and is allowing him to move around with a frame, he may well never get one.

    His consultant (whom I believe is a Junior Doctor) has recently deemed him to now have capacity, on the basis that he is retaining information about their brief conversations each day. I do not agree with this decision as he is still extremely delusional and over the last 4 weeks he has been regularly telling me in person and on the phone a great number of scenarios about where he is and why he is there; none of which are even close to reality. Just this weekend he thought I was his brother (who he doesn't speak to anymore and has lived in the United States since I was a child) and that the patient in the bed opposite to him is my brother (who has lived in Bristol for the past 3 years), along with strongly believing that he is on a television programme and all the medical staff are actors. This is just one example of what he believes he has experienced during his time in hospital and he becomes extremely aggressive and agitated if I attempt to explain to him that these delusions are simply not true. In addition, this week Kent Police have been to his property to remove his certified firearms on the instruction of the medical staff.

    With all of this in mind, I am struggling to understand why he is now allowed to return home - provided he can do so unaided - as I strongly feel that he is a danger to himself; so much more so than he was before. I had already predicted that he would eventually hurt himself to this extent and truly believed that this would then allow him to get the help he needs.

    I feel like I have come up against a dead end and don't know who to turn to with regards to him getting a proper diagnosis, or even the 24 hour care that (one nurse had already mentioned that) he needs. If he is allowed to return home without any further care then myself and my sister are the only two people in his life and neither of us are able to care for him, not only because of the difficult relationship we have had with him throughout our lives, but also because we simply do not have the time to give him the 24 hour attention that he clearly needs.

    I'm hoping that someone with have some suggestions as to what I can do, because I'm running out of patience and this is currently taking over my life, with no promise of a solution in sight.

    Thanks for reading.
     
  2. Gosh. In my opinion your father needs a full psychiatric assessment 'before he is discharged'. Fight tooth and nail for that. You have a right to seek a second opinion if the consultant overrides your request. Don't accept responsibility or cooperate with a discharge and register your concerns in the strongest possible but courteous terms. Recruit PALS to help if necessary.

    Good luck.
     
  3. JFK

    JFK Registered User

    Mar 30, 2015
    4
    Thanks for the reply.

    I have already been in touch with PALS and all they did was contact the ward he is currently on for more information, I was then told that there was nothing else that could be done.

    I have emailed Social Services this morning, in the the hope they can intervene somehow, but I'm feeling a bit deflated from being defeated at every turn.

    My main worry is that once he's out of hospital, it's going to be even harder to get him back into the system.

    Perhaps I have been too polite and cooperative so far and need to put my foot down a bit. The thing is, all the nursing staff are aware of my concerns and can see where I'm coming from, but now he has been deemed to have capacity (which he really doesn't) they are leaving him to make all the decisions regarding reassessment because that is his right as a patient.
     
  4. chick1962

    chick1962 Registered User

    Apr 3, 2014
    11,265
    Female
    near Folkestone
    I agree with your father needing mental health assessment and urgently . You must be near me as you talk about Medway hospitali would speak with them , hospital to get mental health involved as even if they do let him out they can arrange for Crisis Team to keep taps on him x


    Sent from my iPhone using Talking Point
     
  5. #5 DazeInOurLives, Mar 30, 2015
    Last edited: Mar 30, 2015
    I recommend getting one of the senior nursing staff who accept your opinion to help you advocate for your father.

    You probably need to request that he is represented by an Independent Mental Capacity Advocate in relation to the proposed discharge. The advocate may challenge the assessment of capacity.

    When a mental capacity assessment is challenged, it is necessary to provide objective reasons why a person believes the person has, or lacks, capacity to make the decision. This is why it is important to keep a very clear note of your own opinion and evidence of his lack of capacity, particularly as the decision has serious consequences for him.

    PALS should be able to help you arrange this.

    Resolving disagreements and disputes regarding the Mental Capacity Act
     
  6. JFK

    JFK Registered User

    Mar 30, 2015
    4
    Again, thanks for the helpful replies. Yes, I am based in the Medway/Maidstone area.

    You all seem to be suggesting the same thing, so I have put my concerns in writing to PALS and said that I insist on a second opinion and full assessment with a diagnosis. It's just not good enough to turf him out on the street to care for himself, when he clearly doesn't understand or accept the gravity of the situation.

    I guess I'll just have to wait and see what they come back with this time.
     
  7. chick1962

    chick1962 Registered User

    Apr 3, 2014
    11,265
    Female
    near Folkestone
    Good luck JFK I am sure they will be supportive once you pushed hard ;) I'm near Folkestone so not that many miles away :) x


    Sent from my iPhone using Talking Point
     
  8. 'In writing' also means by email. It's the quickest way plus you get to keep a copy. Keep records of every conversation, who, what and when.

    Be objective in stating your reasons for wanting a reassessment for your Dad. Focus specifically on your father's needs, not on the impact a discharge will have on you and your sister; they won't consider any of that.

    Good luck. If you find a good advocate you'll be ok. PALS will fend off who they can, but you really need their support now.
     
  9. JFK

    JFK Registered User

    Mar 30, 2015
    4
    I've had a call from Social Services, from the most helpful person I've spoken to throughout this entire process, and he's taken everything I've said seriously and is now taking over the entire situation with regards to a diagnosis and getting the care in place that he needs. He's also told me to back off a bit and look after myself and he is now the first point of contact for anyone from the hospital.

    To say I'm relieved is an understatement...
     
  10. That's wonderful. Amazing and wonderful.
     
  11. lin1

    lin1 Registered User

    Jan 14, 2010
    9,322
    Female
    East Kent
    That is good news. Do let us know how you get on
     

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