Dramatic cognitive decline after hospitalization. Thoughts?

It could be delirium due to medications or medical condition.

UTI
Hospital Delerium

Yes, I have the same experience with my mother and the nursing home she's in. I get the same response, my mother's nursing home has tried to diagnose her with dementia 3 different times even though the neurologist they selected and sent her to says she does not have dementia. Where my mother differs from your dad is that when she goes to the hospital (as she did a few weeks ago with a severe UTI) she becomes more lucid and aware of her surroundings. I could have a meaningful conversation with her. My opinion is that her condition is caused by two things:

1. The medication the nursing home's medical director puts her on to keep her quiet and compliant
2. lntense isolation forced on residents when covid quarantines are in place

Currently, the facility has my mother on two anti-psychotics and when they put her on the first one, i noticed an immediate decline (at the time, i did not know they had put her on it because they didn't tell me but I had visited her one week and she was normal, and two weeks later at a window visit, she was literally drooling). i am now insisting they wean her off both. I am at a loss as to what to do about the isolation, though. Social interactions are extremely important to seniors and many studies show that lack of such increases the risk of dementia and altzheimers https://www.cdc.gov/aging/publications/features/lonely-older-adults.html . In the area my mother lives, one positive covid test is cause for a complete facility lockdown. Patients may not leave their room and they can have no visitors. During these lockdowns the only interaction they have with another human is when an aide or other worker brings them their meals, cleans them up, etc. The rest of the time, they lay in bed doing nothing. Our lockdowns have lasted as long as two months. Add to this - low income nursing homes have used covid restrictions as a means to reduce their staff and the services they provide. I don't know what the answer is to all this. If you open your mouth to the nursing home (which I've done) they just blame it on the state's covid restrictions and lack of staff to be able to provide adequate activities during these times.

This happened to my mother as well. Please insist on having your dad checked for a UTI (urinary tract infection). It is often overlooked as a common link to sudden cognitive decline and hospital delirium.

It seems to be little known and ignored by medical professionals that many antibiotics have deleterious mental effects and I think this is particularly true of the elderly. If you search for those specific side effects you will be able to confirm that this is true. My brother came home from a hospitalization with two antibiotics and extreme confusion. Within 24 hours of stopping one he was much, much better. Within 24 hours of stopping the second antibiotic, he was back to his normal self. That was what prompted me to search for such side effects.

I have no advise but just wanted to say, I understand. My mom “the caretaker” of my dad broke her hip and shoulder 2 weeks ago. She’s now in skilled nursing for rehab (not much) but she is so confused and it is heartbreaking. I have to keep telling them - this is not my mom!
i pray for you dad too.

Get him off refined sugar!!! Fresh fruit is ok. Also a strict gluten free diet is a must. Gluten spikes blood sugar more than refined sugar. Sugar creates inflammation and goes straight to the brain. An inflamed brain will most likely create aberrant behavior. If his IV has any thing with sugar in it that might be why he's dislodging it or possibly a tranquilizing med which he might not like. Alter his diet! never mind about the grains - try an alternative grain with no gluten for fiber. You must be his advocate.

Change is very difficult for many aging confused people. My father acting the same way. He was confused with his living conditions and changes. He became agitated and angry to combat his confusion. He was given medications to help him. But sometimes there are side effects from them and can cause problems.

Try to bring things he remembers to his room. A favorite picture or blanket will bring him comfort. I put together a collage of family member's pictures. Talk with him about them and ask for favorite memories or stories.

Has your father calmed down some by now? Hopefully, his more bizarre outbursts are temporary reactions to hospital drugs and procedures.

Addendum: I agree with Joan Z on needing medical advice on stopping meds bc abrupt stopping can be very harmful. My mom was only on the drugs I took her off of for a couple days and I consulted her primary care.

I am sorry you and your dad are going thru this and so understand the dismissive “dementia” attitude. My mom similarly experienced this kind of mental decline and agitation during a hospital visit. “Hospital delirium” is common enough to have a name.
The good news is my mom returned to her old self once back in her familiar surroundings. Hopefully this will be the case for your dad. My mom’s rehab put her on Nimenda and Aricept (generics) which I promptly stopped with primary care’s agreement.
Hang on to hope. He was ok before. Should be ok again. This is what I believed tho hospital doc said my mom was in end of life dementia. He was wrong and I was right. They do not know our people. We do.
Sending a hug!

DoingMyBest: Imho, yes, sometimes hospital delirium occurs, unfortunately.

It sounds like the meds made it worse instead of better.

We are currently dealing with this very thing with my FIL. He was just discharged from the hospital (after 6 weeks) on Friday evening. He was suffering delirium from both anaesthesia and medications they were giving him for his agitation (Halidol and Seraquil). We explained so many times to nurses, case workers, social workers and doctors that this was far from his baseline. We were dismissed. He was supposed to go to skilled nursing but because he was so out of it none would take him. Their answer was to try and put it on us. We insisted on an evaluation and that delayed his release from the hospital (every day gave him more of a chance to recover a tiny bit).
After so much fighting they decided that even delirious he was able to make his own decisions and was transported back home alone. He was not given any medications and left to his own devices. They did take his driving privileges so we made the drive while he was in the hospital to take his car and keep people safe.
We didn't know he was going to be released until that morning and were left scrambling. Weekend and nobody was in offices for home care providers.
So now it's Monday and we are trying to get things lined up for him to at least be a level of safe. I am confused why someone who is a fall risk, can't remember anything longer than 10 minutes, and in no way able to take care of his basic needs was sent home that way.
This was done knowing we have medical and durable POA. The two things we can't do even with POA in our state is take his driving privileges and tell him where he is going to live. He is fiercely independent and refuses to go anywhere.
We are arranging for people to come and check on him for a couple hours daily and he is resisting even that. He wants to be left alone.
This is so stressful!
I spoke repeatedly to his PCP who was willing to evaluate him if the hospital wouldn't but he needed to do it via Telehealth as the hospital he was in was not in the PCP's privileges. The hospital refused repeatedly.
It is beyond hard when you are trying to take care of someone but are fighting the health care system on top of it.

Very common after hospitalization. My spouse/s doctor said esp. after anesthesia, being in ICU, (younger people, too), heart problems before, medications, etc. May take weeks/months to resolve. Also may not come all the way back up to previous functioning level.
Most common reason is medication related, esp. if no previous meds have been discontinued if possible, when new meds are started.
I'm a retired mental health/geriatric RN

IF SURGERY, POCD IF USUNG GENERAL ANESTHESIA

I think this sort of reaction is not necessarily related to Alzheimers or other dementia. It may be, but not always.
I had general anesthesia for a knee replacement (my second) and had a strange reaction to the anesthesia. I was only 77 yrs old and had no prior mental confusion. But when I entered a rehab facility I was easily angered and believed some strange things about about the therapists and nurses. (It probably didn't help that I was myself a nurse in the past) Somehow, I knew I wasn't being logical or reasonable but it all seemed so real to me. My friends didn't know what to make of me (I had no family near). I succeeded in making enemies of almost everyone who worked there!
Getting home again was a big help, but it took awhile to return to my normal amiable self. The facility closed down within the year for reasons I never knew.
The next surgery I had (unrelated to the other two), a few years later, required a general anesthesia. And I was very reluctant to have it, though it was necessary. I told my new surgeon of my past experience. Fortunately, he inquired about about the anesthesia and assured me I would not get the same one. He said that "older" people often did not react well to it. I was somewhat comforted to know I hadn't (even temporarily) lost my mind! This surgery went well and I recovered as clear-headed as usual.

1) I would immediately contact the social worker connected with your dad's case at the rehab center. Every facility (should) have one. Explain exactly what you've shared here on the website. Establishing communication with staff is essential and you may have to put in extra effort in this regard. The social worker can be a very helpful liaison among the patient, the family, and the physician. Another helpful person to establish yourself with is the "charge nurse" or "nursing supervisor". Also, there is actually something called the "Patients Bill of Rights" which states you have the right to have conference time with those people providing care for your father. You have a right to explain your concerns, give information that might not be in your dad's medical chart, AND to receive an answer that addresses or resolves all the issues you bring up. Be sure to go to the rehab's admission department, social work department etc. and immediately request a copy of the facility's "Patients Bill of Rights".
2) In terms of any advise you're receiving from folks on this website regarding changing medication, please keep in mind that (probably) they do NOT have an academic background in medicine. There advise is probably based on their own personal experiences (anecdotal evidence). Any changes in your father's medication should not be undertaken without the physician's input. When certain drugs are immediately stopped, there can be catastrophic results---even death. Doctors would be able to advise you in this regard. Also, those of us on the website do not have access to your father's health history and we don't know what medication he is taking and why. So please, take advise or suggestions about medication given here as "something to look into and learn about" but NOT "something to do ASAP".
3) There is an actual condition called "ICU Psychosis", which is frequently seen in patients (especially elderly ones) who have spent extended time in the ICU or similar hospital classification. It is a stress reaction to the environment. I would bring this up with social worker and/or physician and ask for their input on it.

Lastly, keep referring to this website! It is so helpful and can keep YOU feeling sane during a stressful and difficult time in your life as well. For me, its been a Godsend.

It is very likely the drugs they put him on!!! Do NOT let them give him sleeping pills, antidepressants or anxiety drugs! I found those extremely bad for people with dementia! Try to get him off the drugs and look for natural remedies where ever you can.

Very frightening to witness such a change. Did your dad undergo anesthesia for any reason? It lingers longer sometimes and can contribute to wonky behavior. Any chance he has a UTI? That can cause very dramatic changes exceptionally fast. Changes are tough on elderly, esp. those with dementia. Hopefully he’ll get back to a more normal level of functioning. Check for a UTI!

Did he need sedation during his hospital stay for any procedure done? I was told by a doctor when my dad had emergency surgery that it takes a lot longer time for an elderly person to recover from things like that. Also when my husband was dealing with his brain tumor the last few years of his life he had to be hospitalized and undergo anesthesia for some unrelated issues and it was hard for him to recover as well since his brain was already struggling to compensate for the tumor. I would be talking to his doctor about these things and see if there is anything you can do. Any kind of change in routine can really throw them off when they have dementia.

Good answers already. I would just add that my mother started hallucinating after a hospital stay. Going back to a familiar environment, checking med, and it stopped.

It could be delirium! Look it up and ask your doctors. It’s a very common condition.

My Mom's primary doctor used to advise me to keep her out of the hospital as much as I could, because the elderly decline from those stays. I followed that advice as much as I could but the two times she needed to be hospitalized, she became fearful , anxious, and depressed. Thank God it was temporary. It may be for your Dad also.
It's a bunch of things, could be the side effects of the drugs or anesthesia, sundowning, being out of their home and in a totally non-familiar environment with total strangers. It's upsetting for anyone.
Have a talk with your Dad when he is calm and listen to his fears. Stand your ground with the doctors. Find out if he is taking drugs that contribute to his agitation. Listen to your gut - you know your father best. Many times hospitals push for a rehab center, but please consider rehab at home. If that is an option, pull him out and do that. Last and most of all, reassure your Dad that you will always protect him and are working out the best plan for him to come home ASAP.

It's a struggle to watch someone decline and to see sudden changes, but this is very common. My husband had Parkinson's and dementia, and each time he was hospitalized (4 times in a year) his cognition and behavior declined. Get a good neurologist who specializes in dementia related disorders and psychiatrist to examine him. My husband had very bad behavior issues, hitting, biting, yelling all related to his Parkinson's meds and progressing dementia, all as his condition declined. He ended up on antipsychotic meds and was also on depression meds. Once his meds were adjusted he did much better.

Have a nurse review his medications. My dad was in the hospital years ago. He couldn't speak, but was totally lucid and whispered or wrote. I came to visit one day and he was not the same, hallucinating. I went to the nurse's station and asked about his medications. He was given a new drug. I demanded that he be taken off this drug and he returned to his "normal " self.

Anesthesia can often produce what doctors call "delirium." It looks like what lay people call agitated dementia. This occurs so often after heart surgery, in which the patient is temporarily put on a heart-lung machine, that there's even a special term for it: "Pump Head Syndrome."
The delirium is usually very temporary, lasting perhaps a couple of days, but sometimes it lasts for weeks before resolving, especially if the person has a history of a stroke or milder TIAs. (Basically, a damaged brain has a harder time getting over it.) In some very unfortunate cases, the delirium lasts longer and can even be permanent.
Do check to see what medications your dad has received. Check the dosages, and potential interactions. Ask if he was put under light anesthesia for any tests, or if he had general anesthesia during surgery. Knowing this information will help you research the possible side effects. You need to stay on top of this, because in his current state, your dad can't be an advocate for himself. Be patient, and hopefully by the time you read this, the problem will have resolved and your dad will be back to his usual self.

Any person with Alzheimer's or Dementia needs to be kept on a strict routine. Any variation from this or putting them into a strange place will throw them into who knows what. I have learned this with my husband. Encourage him to do all he can for himself keeping him in the same enviroment. Doing quite well actually!!

Examine the medications and procedures. Pay especial attention to any anesthesia used. Cognitive decline is common after anesthetic. Many doctors and anesthesiologists seem not to bed educated enough to acknowledge or deal with it.

My sister went to the VA hospital for emergency surgery. She was in ICU for about 10 days. I flew from Cali to OK to be with her and I’m glad I did. She developed what the doctors said was ICU Dementia. She had to be restrained because she kept pulling out her IV. She bit a nurse and told her she had AIDS, which she doesn’t. She called 911 and told them the VA was holding her hostage. The nurses said this is actually pretty common although her case was pretty severe. It took her a while when she got home to come back to center. I read an article on this condition and most people fully recover but some never do. Good advice above about seeing his neurologist.