My dad fell in December and had a lumbar compression fracture and 2 subdural hematomas. As a result, he had to have 2 surgeries within 2 weeks of each other and a long period of hospitalization. Two days after surgery, my dad was recovering and was functioning well cognitively. He went to an intensive inpatient rehab for therapy but developed a UTI and cholecystitis and his VS and mental status deteriorated quickly. He was experiencing episodes of low BP there when he changed positions, was agitated, and was confused. The rehab doctors diagnosed him with dementia but I said isn't it really delirium since it came on quickly? I was told by the nurses that they didn't have time to worry about his BP and other medical issues as they were there to do the rehab. He continued to be treated as a dementia patient. He was admitted to the regular hospital through the ED after 1 1/2 weeks because he reportedly had a seizure which ended up being low BP and urosepsis. Two days later, my dad has his gallbladder removed. This time he didn't bounce back and his altered mental status has continued. Some days he is more with it than others but that can change from day to night. Yesterday, he was a little hyper but was aware of where he was, and why he was there and was generally with it. Today, he was anxious, confused, and had hallucinations. I don't think he has been properly diagnosed and treated so I am reaching out to find out if others have gone through this and what they did. Thanks!
They also placed him on an anti-psychotic medication, then sent him off to rehab after 2 weeks. The medication made him completely out of it. I kept fighting with them to have the medication removed after he moved to rehab and started improving. They would remove it a day or 2 and then he would be back on it. The nurse on shift would remove, but I couldnt get them to remove it from his chart. It affected his ability to successfully do rehab there. They basically got him up for an hour a day and left him medicated in bed the rest of the time. During that time, he became incontinent from being in bed with a brief on all day.
He moved to another rehab after 3 weeks where we successfully had him removed from the medication and he improved mentally almost immediately and almost 100% back to himself in that aspect, but unfortunately after the 5 weeks of hospital and the first rehab stay, he still has not been able to progress very well physically which has resulted in him not being able to return to AL and is now remaining in long term care.
I know his decline is due to his age and other health conditions, but I truly feel the speed of his decline is very likely due to how they treated the "hospital induced delirium".
A couple of suggestions I would make if you have an elderly loved one hospitalized is, have family/friends visit as much as possible so they have some familiar surroundings and also keep the hospital blinds open to help them differentiate between day and night. The first room my Dad was in had very small windows near the ceilings and the blinds were closed the entire time and I think it really added to the start of his confusion and sleep patterns.
All in all, I do believe those with the 'hospital induced delirium" have a very good chance of returning to their normal mental state with the proper treatment and support from family, it may just take a little time. Wishing you the best with you parent!
From personal experience, he improved dramatically when he was back in a more comfortable and known environment (in our case, his AL)
We went thru the exact same things with my Mom and I hope your posts help others going thru this to be vigilant when their loved one is in the hospital.
Another issue is sleep disruption/deprivation when the patient is sharing a ward with those with severe dementia who shout out and wander regularly. It's bound to affect their cognition.
I would say from what you describe it seems the doctors were a little hasty to diagnose your dad with Dementia. What he's been and is going through is bound to cause a cognitive decline. He may well have early stages of Dementia but a mental health team should wait and assess him once he's physically more stable. I just keep calling and pestering the doctors and nurses on my dad's ward, mental health team and Dad's GP. Ask for second opinions! I'm also keeping a diary of everything, including who I spoke with and when, what they said, how Dad is and what his cognition is like when I see him. Also just trying to talk to my dad every day, visit him often and reassure him that he's not being neglected, ignored or forgotten. We're trying to get him out of hospital and back to the nursing home (he liked it there) where he's much more likely to shake the delirium and make significant improvements.
Keep fighting to be heard. Let us know how it goes and I wish you and your dad all the best.
Ask if they have checked him for UTI - ask for test if they have not.
Ask for list of meds he's getting and review it yourself if you understand medical jargon or take to his pharmacist to review for you. Tramadol, gabapentin are two that come to mind that can alter mental status. Norco is a common pain med and some folks don't do well on it.
Don't let them just tell you mental status is normal for people his age after surgery. Rule out other contributing factors yourself.
I hope your dad recovers fully from this experience. Sounds like he’s been through quite a lot.
Wishing you and your father all the best.
See All Answers