When urgent care, when to accept what cannot be controlled?

pnw23

Thank you in advance. 94 YO mom has moderate mixed AD/VD and severe small vessel disease. Low BP, no history of stroke, never-smoker. Doesn’t drink enough water. Zero meds except eyedrops. Lives in an independent community with AL services for eyedrop administration. She functions mostly on her own still. We suspect she has fallen in her apartment at least once since moving here 1.5 years ago but no injury. There was also an incident of stumbling on a sloped sidewalk outside of her building but she sat into the fall without injury. Mention these falls both to note that she is shuffling more now but also because we wonder if they may be related to small seizures/TIAs. Because…Last week her neighbor called me at work to tell me Mom couldn’t get up from her chair after exercise class and she walked mom back to her apt. Mom seemed off and said she didn’t know what happened—acknowledging that something occurred. My sis called shortly after and Mom was low energy and speaking gibberish. Alarmed, sis said she was coming over but then Mom’s speech slowly returned and she said not to come and was irritated by the fuss. I called the community’s nurse: she checked Mom and vitals were good, no UTI; she seemed a bit out of it but okay enough to stare at the news, take a nap. The nurse wondered about dehyration - getting mom to drink water is a big challenge. Concerned it was a TIA and reading that the chance of full stroke after is highest within 48 hours/and stays high for 90 days, I also called the neurologist who said it was hard to know—could be seizure, TIA. If I felt she should be checked I could take her to urgent care. Here I was thinking someone would be concerned and scan her brain, give her a bunch of aspirin but no one seemed alarmed. Should I have been? Later, Mom was confused about the UTI pan in the toilet; didn’t know how it got here and was holding two TV remotes saying she didn’t know how to call the front desk to ask. (She has confused them for the phone before but it was months ago.) This all resolved. However, last year, I also had a call with Mom where she was speaking gibberish yet she had regular energy and seemed incredulous that I couldn't understand a word she was saying. But like this recent call with my sister, her words returned. Was that a seizure? TIA? How am I supposed to know? And what am I supposed to do when the decision is totally left up to me: her youngest child, who works full-time (sis is moving out of state soon). Anyone face a similar situation, not knowing what’s happening/what to do? And anyone have a loved one who had these moments of gibberish? Did you find out what it was? I cannot imagine dropping everything to rush her to urgent care every time. She's due to see her regular doc and neurologist this month and I'll be trying to get more info. Thanks, everyone. I wish all of you well.

M1

Welcome to the forum. I am an internist, just fyi. I would completely leave this alone, there is no intervention that is going to make a huge difference at age 94. It's not typical of a seizure at all, more likely a vascular event, but nothing to do about it, I would not put her through any evaluation. Her need for an increased level of care eventually is inevitable, and your energy would likely be better spent arranging that. if it were me at age 94, I'd want palliative care only. Have you considered that?

terei

If you have not, please read ‘Being Mortal’. Your mother is at the end of her life + depending on what her wishes are/were about DNRs, etc, should dictate how you will handle these issues.

Her quality of life at this time…calm + comfort, are far more important than diagnosing her..especially since it is doubtful that treatments for her are likely counter to the ‘calm + comfort’ scenario.

If you have not, I would also have her evaluated for hospice.

pnw23

Thank you both M1 and Terei for replying so quickly. Really appreciate your time and expertise.

M1: I understand and agree. We don't want to put her through anything unnecessary/stressful/confusing; nor would I want that for myself. What I dread is a fall and the aftermath of drawn-out suffering/confusion. She uses a cane but refuses to use her walker. Very open to palliative care. Guessing she would need to move again. The move from Fl back to the PNW was so hard on her some 18 mos ago and gives me pause to do it again. She has LTC but is still managing her ADLs on her own. Goes to exercise and dinner. But there's a lot she doesn't do anymore, too and I know she'll decline further. In fact, today was not a great one. I keep thinking the time between events is decreasing but then she'll have a good day and be very funny, conversing, etc. Is a vascular event like a clot working itself through a narrow artery, stopping blood flow?

Terei: I've read Being Mortal and it was profound. We avoid as much stress as possible. She's a very, very funny lady. Even now she's witty and playful with words, rhymes, etc. Loves to sing. That's part of why I'm wondering what to do and when. I have all of her wishes, POLST, POA, etc. She has a very strong faith and once told me she wasn't afraid to die. And I know she would want to fade out like this or burden us. So thank you for your words. I've read them many times now.

M1

I am in the same boat regarding the walker and it seems that the falls are inevitable, there's really not much you can do in this situation except grit your teeth and wait for the phone call. The theory (very hard to prove) is that the moments of confusion etc. are related to tiny capillary vessels getting blocked- not so much a clot moving through, more like the are stiff and brittle with atherosclerosis plaque and just become occluded.