After rehab stay cognitive decrease?

This is from my personal experience, the experience of friends and general online research I have done: After a fall and/or medical procedure, particularly with anesthesia, with an older person, it is common to see a cognitive decline that is noticeably significant. This can be immediate, in cases of a medical procedure, or delayed or a slow progression in the case of a fall. Why this is is subject to theories and speculation and has in recent years become more widely studied and published in the medical community with regards to after anesthesia.

In most cases it's a decline that does not improve. However, depending on the cause, and the care after, the decline may be stable for a time or reversible in a wide range, from staying the same to improving to better than it was before!

I don't believe people get mentally lazy to what would be called "cognitive decline" just from not doing things for themselves or thinking for themselves. They may not learn some things that would make them more independent but they will not develop cognitive degeneration. That's my theory.

@87 years old, it is not unusual for a decline after a medical event involving a prolonged stay at hospital / rehab . You may or may not notice some improvement once you get her home.

Definitely.....there is normally a marked decline in cognition and even hospital delirium present after a stay in rehab, especially an extended stay. It's not "mental laziness" and shouldn't be attributable to having things done for them by others, but by being out of their environment, disoriented, medicated differently, and those sorts of things. I've witnessed it in both of my parents after hospital stays and rehab stays. Both of them DID improve after getting back to their normal environment within a couple of months. I'd honestly say, though, neither recovered 100% bc each step down w an ilness takes a bit more away from them each time.

Give mom some time and the chance to reacclimate herself back home and I'll bet you'll see a marked improvement in her mentation. That's my hope for you.

This happened with my mother-in-law after a rehab stay. She didn't remember paintings that were hanging on the wall and didn't even remember how to use her nebulizer machine that she had previously used 2-3 times a day. Thankfully, she bounced right back mentally and was able to continue living alone.

Give her time. 5 months away is long. She needs to get reoriented. These places (hospitals etc) are mentally disruptive. She may never get totally back to what she was, but you’ll see some much more normal behavior after she reorients herself.

In 2014, my (then 88 yo) dad had heart surgery and was away from home 3+ months with his hospital and rehabSN stays. When we brought him home he told me he was scared to leave, because these facilities felt like “cocoons” to him (his word). I suggested “prison” but he said cocoon was a “nicer” word. He had forgotten how life was- outside the cocoons - and was afraid of what would be expected of him when he returned home. He had gotten a kind of dementia there with hallucinations (like while I was talking with him he reached out tried to grab ahold of a “cake that went flying past you, didn’t you see it?”). Lol. That kind of stuff went away once he was home but overall he was never as sharp as before his surgery.
Recently my 92 yo mom went in and out of hospitals and rehabs due to extremely high anxiety & pain. Because she already naturally self-limits, these cocoons exacerbated dependency issues. She went straight into AL from rehab and has been in AL for 6 months. She’s now able to function cognitively and be more normal in her thinking. There has been decline that’s permanent though I wonder if that is due to the high anxiety and mental breakdown she had.

Thank you for your reply! We have a team of folks visiting with a great social worker helping. We had a telephone visit with her primary doctor and told him about her anxiety. He suggested a med to help alleviate that so we’ll go from there.

It’s hard on her as she’s always been independent and was a caregiver herself until she was 82. One step at a time 😊

Long answer-March of 2021 my mom was hospitalized 8 days for hyponatremia, 3 were in ICU. She had no cognitive impairment prior to this. Developed UTI's from a catheter the ER placed that wasn't removed prior to rehab & she also had delirium so the SNF assumed mom was incontinent and had dementia. Day 2 of rehab she was back in the hospital (a different one)for another week. We're not sure how, but 2 of her medications were tripled& the hospital records had 'history of dementia'. Anyway she was sent back to the rehab, had a positive covid test 2 weeks later, fell twice while in isolation and went back to the hospital (third admission in a month) After another week she was discharged home with skilled nursing &24hr caregivers. Its been 2 years but the catheter & caregivers are gone, the benzos & narcotics have cleared her system & the brain fog/confusion has improved tremendously. She's never going to be the same but I'm very glad for the improvement.

I was there every day and her room was a disgusting mess of linens, garbage & the floor was sticky. She had the same red slipper socks on for a week! Gross!! I told the Dr my mother worked 35 years in that hospital as an RN. The next day I went to visit & her room was spotless. Lol

It has happened to me to. After a fall and a rehab stay my wife was never the same. She now has dementia and is bed-bound. The care in rehab was terrible. She will probably never recover.

Very common. Temporary in my Dad's case.

This is not unusual; and, although she is home, she may be declined and declining in health and ability to care for self, safely and appropriately. Her memory issues may be from diagnosed illness; speak with her PCP, for her safety and, your well being.
Your observations should be reported to her PCP asap. You can of course do this on your video visit or call them prior to that if increasing challenges observed.

Unfortunately just because someone comes home, it doesn't mean that they will necessarily bounce back to safe, independent self care. Some form of in home assistant may be needed. Ask the PCP, what her
" level of care needs assessment" shows her as needing and, then include your observations in the
discussion .

Practice good self care for yourself....you are important too and, the journey you are on is exhausting and unending.

I think any "answers" are guesses on our part or on yours. This may be as a result of confusion after transfer hospital to rehab facility to back home, or it may simply be more rapid progression of the disorder.

The one change that most often IS as a result of institutional care is the one that occurs sometimes after administration of anesthesia. That may be temporary or permanent.

Sure wish I had a better answer for you, but it comes down to "who really can know".

May I suggest you WebMD the negative side effects of each of her medications? It may be that one of them causes confusion or neurological side effects. My mom was sounding 'goofy' and confused when she was in rehab, and I requested a list of her meds. Turns out they were giving her a powerful pain medication that she didn't need, and as soon as they stopped giving it to her, she improved.

I Know from experience these rehabs can be chaotic with other patients Blasting the Tv or radio , to dirty Bathrooms and Nurses not answering the phones - To Other Patients acting Out - Think about a Hospital stay you dont get Much sleep . At these rehabs The help is Not always the best . I Know I Visited My Mom and it looked Like One Lady had been Punched in the face . No One wanted to escort my Mother to the bathroom so she became incontinent . Eventually No one Bothered with my Mom and she got a Huge bedsore on her back . Other Patients May steal or even the Employees. I wasn't too Impressed with several Places I visited - sometimes Clothes were hung up - Often times new clothes and Pajamas dissappeared . The food wasn't great either . So yes 5 Months In a Institutional setting will throw a person off . My Mother came out a vegetable after 80 days . I Hope you Can get your Mom back into a routine and that she will feel safe and Loved .

Yes I have seen a cognitive change after my Dad was in rehab. I don’t know how long your mom was in rehab but that is confusing as is any treatment she received. It is all frightening and disorienting for a senior. Once back in familiar surroundings, it takes time (several months) for her to get reoriented and to adjust to her situation. She probably is very anxious.

orangemonster99: My late mother was in the rehab unit of a nursing home. They claimed that she was too well to stay there. They were incorrect as my mother suffered an ischemic stroke 48 hours later, ending her life a week later.

I'm sure that you already know that cognitive decline after a big change is on of the hallmarks of Dementia. I'm sure that most of us have experienced it.

Sometimes our loved-ones bounce back from it, but often not.

Mom was in rehab 30 days..it just took 4 months for her to get back to pre-hospital/rehab cognitive status. She came back almost memory care confused. She has Lewy Body Dementia.