Not sure what’s happening - post hospitalization

Hope5757

I’m hoping for some insight from experienced members.

MIL was hospitalized for two nights and was doing great. Good appetite, baseline clarity and baseline ambulatory.

She had a long phone conversation with her daughter four days after discharge. That’s usual as they talk for hours once or twice a week.

My SIL texted me while they were talking and said MIL was agitated, bringing up many old grievances, and more confused than normal.

That night, shortly after the phone call, MIL had a catastrophic reaction. The next day, she had an incident of urinary incontinence (very unusual), was unable to walk more than a few feet, was extremely confused, slept all day and was unwilling to eat or take her medication.

After the fourth day, she gradually got better but it’s as if she skipped right over stage 5 and is at stage 6 in many ways.

Although she was confused at the hospital, she didn’t really show delirium and staff even called her their favorite patient.

Can delirium set in four days after discharge? Could a change in anticoagulants be the cause (from eliquis to lovemox)? I’ve been in regular contact with her PCP and we’re scheduled for a follow up next week.

H1235

what kind of dementia does she have? I know with vascular dementia the progression is more in steps vs a steady decline that you would see in AD.

Hope5757

Hi @Chug,

She’s been diagnosed as having mixed (vascular/alzheimers) dementia. But she’s progressed in a steady Alzheimer’s fashion - albeit at a faster pace.

M1

So hard to say—-was Lovenox the only medication change? I wouldn't expect it to do this. Could she have a UTI or any other hospital-related infection? Or a reaction to another med?

Hope5757

Thanks for answering M1. I was hoping you would! ;)

She was on doxy for 5 days and Heparin for 2 days.

No other med changes.

I have an order for a urine test but haven’t been able to go pick up the containers.

CaliforniaGirl-1

The sad fact is that for a PWD every health crisis and every hospitalization can accelerate the progression of the disease. I will also say that if she had a catheter or Foley in during her hospitalization it is quite possible she has a UTI.

Hope5757

Thanks @CaliforniaGirl-1,

I think you’re right. I still don’t understand why the first 4 days after discharge were fine. But I guess it doesn’t matter.

harshedbuzz

I'd prioritize the testing for a UTI.

Your description of onset is very suggestive of one. My mom— who doesn't have dementia— had an atypical symptomless UTI over the summer which presented as abrupt change in mental status (lots of paranoia and grievances here too). TBH, she presented exactly like stage 5 dad with agitation. We ended up at the ER on her doctor's orders.

HB

Hope5757

Thanks @harshedbuzz. I need to figure out a way to catch a clean sample at home. But haven’t been able to think how to do that. MIL seems to have little control over urine flow. Sometimes she can’t quite make it in time and sometime she has to sit for many minutes. And I don’t know how to get her lifted enough to get the container in place. I’m sure there’s ways - I just don’t know how to do it.

We see the doctor next week and they’ll test then.

harshedbuzz

If you can get her on a toilet or commode chair, you could use a nun's cap. The lab should have these.

LOL, DH had to do a 24-hour collection and when they gave him his kit, it came with one. He had no idea what it was.

Hope5757

Thanks @harshedbuzz for the tip. I haven’t had time to research so really appreciate the help.

I’ll definitely ask for a “nun’s cap”!