Wits End with Mom's delusion, etc.

HeyDforDaughter

Hello All, 

1st of all, yes, my Mom (92) was checked for a UTI. And has been on antibiotics (correct ones per the urine culture for the past 4 days now.

However, her delusions have seemed to become worse in over the past few days and most especially today. Every time the t.v. is on now she thinks they are talking to her and she gets up and says she has to go talk to them. 

Now she suddenly talking about going to see people (family) who are dead. Or looking for people who don't live in this house. 

She's up and she looking around her room with I'm sorry to say it, "crazy eyes." 

Sundowning?

Contrast to yesterday when she slept most of the day. 

Less than a week ago, she had an episode at the house where it's almost like she fainted with her eyes open. She wouldn't respond to our questions - just stared straight, eyes fixed and breathing seemed labored but her hands were clenched and clammy. We called 911 and the paramedics took her B/P on arrival which was very low 90/62. 

AT ER they an a battery of tests (including head CT, labs, EKG) and nothing abnormal but a mild UTI. She was diagnosed with altered mental state and uti.

We saw her primary care in follow up today. She couldn't pinpoint a cause; thought about a referral to a neurologist (for possible seizure_) - but not really sure how it would be treated other than with a medication and then deal with side effects of that medication. So she didn't want to mess with any of her meds (ie.,for hypertension, diabetes, Zoloft for agitation)

Just suppose to observe her.

I've been sitting right next to her while writing this and she just called out my name - asking where I was and I'm literally right next to her. This is the first episode where she has asked me where is my mother? And I ask her who I am and she just laughs.

What is this?

Am I suppose to fib and redirect and distract? How?

She is also on palliative care. The palliative care doctor seems to be in charge of her behavior meds. But if she's not like this (delusional) then she's groggy starting in the afternoon after her noon time meds.And sometimes is asleep while she is eating. 

Does dementia just progress like this over a short period of time?

Should I have a pharmacist review her meds and time of day when we give them?

How do you deal? She doesn't sleep soundly. If we didn't take turn staying in her room I think she would be a wander-er around the house (or even outside) but she isn't due to constant companionship plus arthritis in both knees, her cane or walker her movement is limited.

Thanks for listening

Tross760

I don’t have much to add except that this sounds very similar to what we are going through with my mom right now. Literally from a couple days to the next my mother is all over the place. Palliative nurse today says mom seems like she has a very rapidly progressing AD/VD.

towhee

Our LOs often get to a point where almost any little thing can knock them for a loop.

She has an infection. That can cause confusion.

She possibly had a seizure. Same.

She was in a strange environment (Hospital, tests). Again, confusion.

She is on antibiotics, which can cause, you guessed it, confusion.

Possible mild dehydration, confusion.

All these things together can cause delirium, (sometimes that looks like her dementia gets worse really fast) which takes time to clear up. She might not recover back to where she was.

Should you contact the pharmacist? Yes, information is good.

What else can you do? Calm, routine, good physical care, familiar things, simplify. If the TV bothers her, try letting her listen to music. Fiblets are fine. Give her whatever answer will bring her comfort, just go with the flow. Her mother is visiting a friend and will be back soon, etc. That laugh when you asked her who you were, that's a defense mechanism, she probably didn't know you in that moment. 

Let the doctor know what you are seeing. Sometimes they forget that "observe" needs the words "and report" after it.

Sleeping in her room? I used alarms to know when my LO was getting up, but it is what works for you.

How do you deal? It is different with everyone. Prayer, outside caregivers, relaxation techniques, talking with friends or therapists, screaming in the shower, learning all you can. But always remember your health is just as important as hers. Plan ahead so that if you need help, you can get it quickly. 

HeyDforDaughter

Thank you both very much. Very helpful.

graceblessed

HeyD.. I just want to add some support. I am right where you are. My dad is experiencing almost the exact same set of symptoms and I too have so many questions along the way. The only difference for us seems to be a sudden onset of aggression to the point that I was worried if he knew where weapons were he might try to use it because of his heightened paranoid state. He thinks people are the "devil" at times and goes into this major protective mode. It's made worse by increase in BP, infection or disruption in sleep, but lately it is increased a lot. Does anyone have experience with a LO and aggression and what are some tips during those episodes? The only psych med he's on is sertraline- doc says he doesn't want to overload him on meds. The other problem is when he is going through these episodes he won't take his meds because he doesn't trust the "devil", so BP gets higher etc.  They seem to go on for a long period of time. Any tips would be appreciated!

Cynbar

HeyD and Grace, both of your LOs are taking Zoloft (sertraline) ---- that is an anti-depressant and can be helpful for that. But many PWD are prescribed an anti-psychotic for issues like paranoia, delusions, aggression, agitation. My DH takes Zyprexa and it has helped him a lot with sundowning and agitation. Seroquel is another commonly used one and I believe there are others. You may want to talk to the doctor about trying one of those. No one wants to take meds they don't need, but sometimes the benefits outweigh the risks.

jfkoc

Hey...your first sentence "1st of all, yes, my Mom (92) was checked for a UTI. And has been on antibiotics (correct ones per the urine culture for the past 4 days now."  is read with a certain joy.  Would you believe that several years ago that sentence would not have been written?

This site is truly where important information is shared.

Back to your mother...I would check all of her meds including OTC on a site like drugs.com. Look at the side effects and interactions. I learned this from our pharmacist who caught a mistake made by the AZ neurologist at the neurology dept of our University.

From what you wrote I have surmised that the delusions are worrying you more than your mother. Understood. My rule of thumb is that unless the delusion is really upsetting to a loved one to just go with the flow. Mildly upsetting? Do validate by repeating the concern then lead the conversation in a calming direction. Note... this is not the same as immediately diverting.

Your mother's  reality is real to her. Accept that...work with that. Teppa Snow's example to "the little boy under the table needs help" is to repeat the concern and then do what one would do if there were a little boy in distress...."I will get help for him right away" ...then move away from the fear. 

There are many good Teppa Snow cites online. 

I know what you are seeing is frightening and sad. I too would be looking for something to change the behavior and maybe drugs are the answer but you and the environment  are equally important. We must do a lot of changing and it is not easy.

I suggest you read one of Naomi Feil books or Allan Power. Another good book is I'm Still Here by Zeisel.

Kjboxermom

We are experiencing the same issues with my mom. She is 79 and was diagnosed with AD about 12 years ago. She has recently become delusional and combative. She is also hallucinating. It is definitely sundowning because it starts at dusk and continues until early morning. She has been on seroquel for 2 weeks, 25mg the first week then 50 mg the second week. We aren’t seeing much improvement. In fact the past few days have been hell. She has threatened to kill both me and my sister. She asks for her deceased siblings and her mother. She wants to go home. To complicate matters, my father was diagnosed with a terminal blood cancer 2 months ago and is home with us on hospice care. She says mean things to and about him and insists he is not her husband. I hate this for my dad. We are exhausted and getting near our wits end. I don’t know if increasing her seroquel would help. I would prefer a sedative to knock her out when she’s out of control. The problem there is I don’t know how we’d get her to take it since she gets so paranoid that we’re trying to poison her. If anyone has any suggestions I would be so grateful.

Karen

abc123

@ Karen, some pills and be crushed and capsules can be taken apart. Sprinkler the powder form of the meds over chocolate ice cream or pudding and stir. Or stir into her favorite liquid. Check with pharmacist to make sure her meds and be crushed. About her threat to kill you, please be mindful of it. Hide anything that can be used as a weapon. It has been my experience that a PWD can be very strong while sundowning. Ny MIL had broken her back years ago, she was always sort of hunched over and walked slowly. She was a small women, frail and underweight. But, while sundowning, she walked upright and was fast! She could also move furniture while trying to wander. When she was on a roll, it was sometimes really hard to keep up with her. I was in great shape and had a rough time staying one step ahead of her. Good luck to you and stay safe.

Kjboxermom

Thank you, abc123. I’m hoping her doctor will prescribe something to help. We have tried mixing meds with her tea but if she’s delusional, sometimes she won’t eat or drink anything we give her. But she loves ice cream sandwiches so that may work. She’s a tiny little woman but we will be careful. Thanks for the heads up.

HeyDforDaughter

Thank you for the info.  Means a lot.