Dramatic cognitive decline after hospitalization. Thoughts?

It could be from all the drugs but if he's still doing it then he could be from an infection.

Ot happened to my Dad but he had a bad infection which also damaged his kidneys.

I have heard that anesthesia can affect seniors in a negative way. I have to have nerve blocks in my lower back from time to time (I'm 81) and I've been told the anesthesiologist gives the least amount possible because sometimes it can have an adverse effect.

As others have said, hopsital-induced delerium is sadly somewhat common. I'd contact a neurologist and/or geriatric psychiatrist, who'd be familair with this, and (hopefully) not dismiss your concerns.

Sounds like "ICU psychosis". Many patients, not just those with dementia, can get confused and loopy while staying in the hospital. As an RN and having been inpatient for surgery, I can tell you that most patients do not get enough rest in the hospital. All the noise, the lights, the people coming and going all day and night, and the strangeness can rob most people of a good night's sleep. Multiple this lack of sleep by several days and folks start hallucinating and reacting with anxiety and fear.

Your loved one should get more rest in rehab in the evenings. Make sure that he has sleeping medications ordered to help ensure he gets better rest for a week or 2. He will also benefit from having a mild anti-anxiety medication until he is rested and recovers from his sleep deprivation.

If you do not see improvement in a couple weeks, then talk to his doctor about evaluations for other causes of his confusion and agitation.

My dad also had Hospital Delirium years ago when he was hospitalized for treatment of one of his chronic conditions. The staff at his hospital, a V.A. facility, told me that it isn’t an uncommon occurrence with people with mild dementia. We were so devastated by the change in his behavior. He was very disoriented, did not sleep for 4 days, went into other patient’s rooms, but he did recognize us.

This did eventually clear up for him, however, I think you’re wise connecting with your dad’s PCP about it. Something similar happened to an aunt of ours, and her delirium never went away. She became very hostile and combative.

My husband was in the hospital often and between the meds, no sleep due to constant. Nurse interaction (I’m not complaining) and his medical issues his cognitive abilities declined. But once he was home and sleeping well he recovered and was his old mildly forgetful self. It is better to evaluate when he is resting at home or at least where he has uninterrupted sleep and temporary meds are out of his system.

I have had that happen with both my mother and my MIL. A good doctor I know said the stress of being in a hospital can cause a person to “use up” nutrients and put them in a tailspin mentally, as well as causing them to not be able to “clear” the meds they are taking and the anesthesia. He said stress is a very important but unrecognized player in many of these situations. I gave my MIL additional vitamin C (2,000 mg a day) and a good B complex (I think it was a B100, and I cut the tablet in half and gave half in late morning and half early afternoon. Doctor said B vitamins are cleared out of the body in 5 hours.) My MIL was bright-eyed and really on the upswing in three days. My mom lives out of town, and she drank a nutritional shake called “Alive!” for a few days and it really stabilized her, but the family around her didn’t connect the improvement to the extra nutrition and they stopped it after a short time. And she slid again—and now is well into dementia. So, I am not clear about how much good the extra vitamins did for her.

Vitamins are safe, easy and maybe worth a try. You will need, though, a vitamin complex with higher doses of vitamins; they will have, say, 2,000% or the RDA for most B vitamins because the body does not absorb them well. A Boost shake with only 25% of the RDA of vitamins might help some, but a person needs larger doses if they have slipped into crisis.

This was just our experience, but something this simple was surprisingly helpful here. Best of luck with this—it seems to be pretty common, unfortunately.

My mom had cataract surgery where they used some drugs to relax her. After that, she started having delusions. It was awful. I thought, I hope this is not how it's going to be... I had to quit work. But, after a few weeks, it just stopped. I think it was because of the meds/antibiotics she was given for the procedure. After they got out of her system, she was back to normal. There's hope.

I has the same experience with my mom, years ago, when she had a hip replacement surgery after a fall. Doctors just thought "an elderly woman with Alzheimer" when she was having delirium, talking nonsense. Later on I learned it is pretty common to have postsurgical dementia and postsurgical delirium. I'm so annoyed by the fact most doctors know nothing about it. My mom had tons of different medicines at the time, including several psychiatric (antidepressives, anxiollitics and even an incontinence drug she had without really needing it, but that has a psychoactive effect). Doctors just told us to continue with her regular medicines, and they even provided some more, supposedly trying to calm her down. Though my mother recovered a little bit, she never came back to her baseline.

My husband had mild dementia and then needed surgery for kidney stones… after that his dementia really took big step down with hallucinations and delirium…. Anesthesia is dangerous for elderly and if they have alittle dementia can make it huge !!! It may go away relatively quickly or it may take a very long time … like a year. You need him to see a geriatric psychiatrist/doctor !!!
Seroquel is what worked .. but be very careful to stay away from the
newer antipsychotics!!!! Can be very dangerous for dementia!!!
try to get it established while he’s still in hospital … insist on geriatric specialist … and be very patient
best luck

Hospital delirium. Mom did the same thing 2 years ago. Went in for possible stroke. It was a TIA. Less than 24 hours later she was talking like a crazy woman who was on a cruise. She had no change in her meds during visit. The dr told us the best thing to do was to get her home, in familiar surroundings and she would slowly come out of it. I wasn’t so optimistic. I knew I wasn’t cut out to be a caretaker to the mentally impaired. But they kept reassuring me and gave me avenues to take if she didn’t come out of her state. I took her back to her apartment and stayed with her. Within 24-48 we talked about her hospital stay and she went from some crazy lady on a cruise ship back to mom who had a medical moment. When she said something off the wall I would look at her and say, Mom do you really think you went on a ship? She answered, in my mind I did. I said well a cruise is better than the hospital stay so I’m glad you had a good time. Each hour got better as she asked if this or that actually happened. I answered her truthfully. We still laugh about it from time to time (she’s 95 now). I give the dr all the credit for her knowledge and for telling me to get her home ASAP although I was very, very reluctant. Good luck.

This happened to us and it was meds. Were any meds added during the hospitalization? For us the problem wax both old meds and newly added meds.

No one believed me at first. I couldn’t easily get the doctors to listen.

When I later saw her records the doctors had attributed everything to dementia.

This is what you should do…

Jot down a list of the changes you have noticed. Confusion? Balance? Dizziness? Loss of appetite? Mood changes?

Gather up discharge directions itemizing a list of meds. (Were there any additional hospital only meds?)

Go to the pharmacy and get those stapled-on printout packets OR pull the same info from the internet.

Sort names of new meds from old meds. And add new meds that were working well to your chart first.

Chart - at least purpose, interactions, warnings and potential side effects.

(When I did this, I couldn’t believe that the pharmacy would even fill the prescriptions! There were so many warnings that drug A cannot be taken with drug D and drug B may cause serious confusion if taken with a class of medicines of which drug G belongs.)

Mom was getting side effects from some, dangerous interactions from others. Her life would have been over if no one would have stepped up.

Her doctor refused to make any changes. She said mom was fine and I was in denial regarding the aging process. Then her doctor went out of town and I took her back and saw the doctor’s partner.

The doctor’s partner listened and, having not prescribed anything herself, had no reason to take personal offense. She agreed with me and started slowly weaning Mom off. The change was a miracle.

A visiting nurse, who watched the whole thing unfold, helped another of her patients who had experienced the same thing.

I ended up moving mom closer to me and accordingly, all her doctors changed. I worked with an excellent specialist who continued to wean her off unnecessary medications. She felt better than she had in years. She lived years happier and healthier than she would have otherwise.

We had the same situation, with our dad having minor symptoms until he had surgery. After 4 months we thank God for new meds and a great doctor and staff . He is almost back to pre surgery cognitive and memory function.

Does your father have a primary care physician who you can talk to about this? Can you get a second opinion to evaluate the drugs he is on?

My thoughts on this is that I know what you are experiencing. My grandmother became ill on the 4th of July, has a three week hospital stay, and in that time, lost her mobility. Was sent to rehabilitate at a rehabilitation center, and when she came home to me, it was apparent she could not walk. She has vascular dementia, but it seemed to have went downhill to a level of “new normal” after her hospital stay and rehab stint. Her cognitive level is not the same, and I would say she’s at the middle stage of this disease. Prayers to you with dealing with your loved one’s issue, as I’m needing all the prayers I can get for help with my grandmother. It’s sad to see someone go from paying their own bills, cooking for themselves, and them taking themselves to the bathroom to now needing ADL with EVERYTHING.

Yes check his meds! My mother began hallucinating after being put on anti-psychotics. Also, when a person with cognitive issues is relocated, even briefly, it adds to confusion and disorientation.. After coming home and changing meds the hallucinations stopped but it took a while.

Financially, this would be a big expense, but maybe worth it if possible. After one of Mom's hospitalizations, she was ready for discharge, and they were talking rehab because she is in Memory Care, not a nursing home and she needed extra assistance

My mom has bad delirium in hospital situations; we are talking hallucinations,( ninjas outside windows, dogs roaming in her room), every blinking light, every beep scares her, she's combative, pulls at IVs, etc.
I was scared that she would never get back to her MC, if we went the rehab route, plus this was in 2020, full blown covid, no Vax yet and I probably would have been locked out of rehab, so couldn't gage the situation.

So her MC agreed to let her come back, as long as we paid for caregivers to stay in her room with her. Which we did for about a month, then gradually pulled back to just nighttime, then none, as she improved and could be monitored in the common room during the day. They had in house PT and OT that came to her while she recovered her strength.

It made such a difference, she was back to her usual self in a couple of days, really even saw a big difference the next morning. The caregiver set up the video call and she was actually smiling and eating breakfast in her recliner.

UPDATE: My Dad's primary doctor went to go see him in the rehab and she too was concerned by how far he was from his baseline. She talked to all his caregivers to explain what he's capable of, got him an appointment with a psychologist because of his anxiety and depression, and is taking over what medications he's being given (she thinks they are over medicating him because he's getting so upset and I agree)
So glad he has a great doctor in his corner! She says it can take time but she believes he will "come back" especially once he can get back to his AL.

Tried my mom on Memantine prescription after just such a situation and she started getting UTIS. Stopped memantine and started her in Source Naturals Huperzine A. Can’t vouch for other brands but vetted this one through consumer lab and it works great. She is better and remaining stable. While her short term memory has suffered she still retains her long term memory and sundowners is no longer an issue!

Hospital delirium is very common in the elderly and can last from days to forever. If the doctors you are coming across have forgotten this then perhaps you should remind them. One never knows when an elder comes out of hospital quite what the effect will be and have to take things as they come whilst the person gets over being hospitalised. Don't be too down at this point, your father may improve back to where he was, if not then I am sure you will deal with it, but be positive and don't be afraid to remind Drs they are missing something they need to take on board before they tie a label to your Dad.

My 85 yr old moms dementia started very slowly {mild cognitive decline} until we hit 12 utis in 18 months and then we had the isolation of Covid at her independent living situation {no social activities}. Finally she was diagnosed with Lewy Body Dementia while in an apartment 2 years later. A hospitalization pushed her to a memory care facility where she remained in deep dementia for 6 months…she had even lost the ability to walk for a few weeks. then she “woke up”. She was shocked she was there {why did I go to prison?} and she was mild to moderately confused at times. I got her moved to assisted and a year later she is mildly confused at times but mostly very forgetful. A wild ride these past 2 years. when I saw cognitive issues 2.5 yrs ago I got her a geriatric MD. He finally diagnosed Lewy Body. Mom knows she has it and when she forgets a day she tells me..Lewy acted up..I can not remember much from yesterday. Yet other days she talk investing in the stock market!! Good luck…

My mom’s dramatic cognitive decline seemed to start with a UTI in late August. The UTI was treated, but ever since, she was having weekly bouts of acute confusion and restlessness.

I’ve been googling “delirium” and “dementia” a ton. Generally speaking, delirium is reversible, and dementia is not. In my mom’s case, I think we’re looking at delirium - the disorientation comes and goes, and a fluctuating course generally points to delirium. Also, she doesn’t have major memory issues. She had an MRI as recently as April, there was nothing to indicate signs of dementia then. (Although I’ve read there is such a thing as rapid onset dementia.)

The first important thing to do seems to be to rule out infection and dehydration. Secondly, have the rehab MD review his meds, and deprescribe as much as possible. My mom is in hospice, and I had to suggest we try taking her off a diuretic, given her edema has fully resolved for the time being. Also, hospice put her on Ativan to try and control the restlessness, and for her it only made matters worse. They also wanted to prescribe Haloperidol, which I had to research to find would be dangerous for her (long QT). She does seem to be doing better on Trazodone.

Three, nerdmafia posted about “cabin fever.” Not sure how mobile your dad is, but my mom is bedbound, and I know it’s driving her nuts to mostly just be looking at the same three walls. I would be mourning the loss of my independence too. When I saw her “restless,” she was asking me to help pull her clothes off and get her up so she could go take a bath. Just getting her up to sit in a wheelchair in a different room seems to help somewhat.

I’m now waiting to speak to an MD to see if a multivitamin is ill-advised for any reason. In mom’s case, she is cachetic (difficulty absorbing nutrients), and while she has a good appetite and eats well, possibly nutritional deficiencies could be behind the cognitive decline. Probably a multivitamin isn’t going to do much, but I just really, really don’t want my mom to go out like this if she doesn’t have to.

Each crisis will bring a decline in cognition and overall health that they don't usually bounce all the way back from.

With my mother, she didn't decline gradually and consistently but instead would take a dive if she was in the hospital (delirium) or there was a big crisis like my dad's death or moving to her nursing home. I finally made the decision at the end of last year that the big dive she'd take when she was in the hospital was no longer worth it compared to the care she received there. She wasn't going to recover from either problem -- medical or cognitive -- so we brought her back to her memory care place and I said we're done with hospitals. From that point on, we brought in hospice and treated what ailed her in place. It was the best decision I made.

Sounds a little like ICU psychosis - which can happen to people of all ages in any unit of a hospital. From my own experiences as a hospital-based RN and a patient in a hospital, patients tend to get very little rest. There are a myriad of machines, lights and sounds and routines that ruin a good night's sleep. It takes only a couple of days of poor sleep to start going a bit bonkers. At first, you are tired and a bit loopy. Go long enough and you start having daytime dreams (hallucinations).

Give your dad time to catch up on several nights of good sleep and clearing up his medical issues. If he doesn't return to more of his normal self, then talk to his doctor about an examination for neurological issues.

Me too. My mom. Today was the first time she did not recognize me.
Just as author describes, not even two weeks. First it was normal to slight impairment, shy of a year ago. All that went was her abilitty to keep track of monthly affairs and the like. Occcasional dreamy talk. Then unexpected hospitalization.
2.5 weeks in and she is a vegetable. I know they give her two anti psychotics.
And she has always been "My way or the highway" sort of person.
"My dad was no question freaking out because he didn’t know where he was or why. "

Yup. I keep telling my mom's doctors that my impression is that they are over complicating things. It's clearly just cabin fever.

my name is John. I’m 76. I’ve had 2 major stomach surgeries in my life followed by pain meds which were derivatives of morphine. When I went through withdrawal, I became depressed, sad and figity. I also suffer from mild depression. Age comes on and we find our lives devoid of pleasure, exciting activities and full of various aches and pains.

it sounds like your Mom is suffering from either age related depression, or withdrawal from the procedure she underwent. This forum may answer all this but also I recommend seeing a geriatric physician. Also exercise and visits by loving family members. An anti- depressant may work too. Best of luck!

I’m going through something similar with my own father.

I’m not privy to everything with your situation, but for mine, I knew a lot of his behavior was from anxiety. Children and seniors are actually alike in a lot of ways, because of their cognitive development level. Children’s anxieties can manifest in a lot of ways because they are unable to verbally express what they’re feeling or thinking.

My dad was no question freaking out because he didn’t know where he was or why. You’d tell him, he’d be looking at me, seeming like he understands, but might forget quickly, or be pretending to understand. Take nothing you see at face value.

Might it be because the hospital was familiar. But suddenly, he’s moved and he goes nuts. That happened to my dad. I wasn’t sure if it was because he used to read too many spy novels, but he thought that he was being held against his will, and multiple times tried to escape and attacked the hospital staff.

Patience with him. Give it a couple of weeks so that he can get used to the rhythm of the rehab facility. Everyone is I’m sure trying their best to meet ALL of his needs. Including you.

hugs!!

you wrote:
"I feel like it's an uphill battle with the doctors because they meet him and think "agitated senior with dementia" and I'm like, but no, this is NEW."

doctors often don't want to admit that they're in any way the cause for this.

as others have mentioned:
anesthesia while in hospital can definitely affect cognitive ability.
other drugs, too.
delirium is also possible.

moreover, sometimes the elderly are drugged, so they cause less "trouble" (ask for less help).

my LO -- every time -- after hospital has less cognitive ability; also slurred speech.
very luckily it's always been temporary, and 2, 3 weeks later, my LO is back to the same level as before.

i always gave my LO lots of water.
flush things out.

keep your father hydrated. i hope your father will be ok!!
hugs!!

I just saw 2 quick posts and yes hospital delirium is so real!! I have seen my mom have it with UTIs and from medications but a few weeks back we went in for her feeding tube to be changed out (no other issues or infections ) and I saw her with plain hospital delirium from nothing other than being there.

Everything I have heard is to try to keep them on their normal routine as best as they can - sometimes I will give mom a small 1/2 dose of the lowest level Xanax (but she is allowed to have that as needed). You could speak with his doctors to see if they will prescribed something very small to take the edge off and not knock him out. I find even a 1/4 of the lowest dose just helps mom with the agitation and she can still fully participate in her day while she balances out. It usually balances out after a few days. Again I was told to keep mom on her regular schedule - remind her of the date and time and doing her normal routine. If you feel he needs something to help for daytime or even nighttime to sleep - even a small dose may help as they need sound sleep and that is hard in most anywhere outside of your home. Wishing him a speedy recovery 🦋

Hospital delirium and the doctors don't know his previous pre-hospitalization baseline. Ask for consultation and what they can do right now to help him.