Hello- I am happy to have found this forum and I am in desperate need of advice

kellybrad

For over 2 years now I have been on what seems like a wild goose chase looking for proper professional guidance for my mother's increasing concerning behavior. She is 78 years old and I have been living in the house with her and dad for several years due to her having a previous illness that had her in the ICU and hospitals/rehab for over 3 months. She literally almost died from Sepsis. She made an almost 100% recovery, though and it was amazing. That took a couple of years, but just as I was getting prepared to go back to work and get my own life back.... the pandemic. I have my own struggles with mental health and physical health which went on the back burner for way too long. My NANA (my mom's mom) had Alzheimer's and for the past year, my mom has exhibited worrying memory lapses and aggressive/combative behaviors that have increased in frequency and severity over this past year. The last month her behavior ratcheted up to a new level and she mainly stayed in bed, not able to eat much and the last few days she ate nothing at all and could not stand or follow instructions so we took her to the ER where we discovered she was dangerously dehydrated. She was admitted to the hospital to get things stabilized and that was just over 1 week ago. I stayed with her the first few nights but she seemed to become increasingly delusional, combative and hateful towards me and the nurses-one night she ripped out her foley catheter! aaso my Dad has been trying to stay with her the last few nights and this behavior just continued to escalate. The hospital staff seemed uninterested in addressing the behavioral issues despite my pleas for help. I told my dad to come home and get rest as he is not handling this well and she was attacking him verbally all hours of the night and is physically and emotionally exhausted. I am trying to prepare for a major surgery to remove an ovarian tumor that was discovered the week before she went into the hospital, so my stress level has been through the roof and i've had little to no sleep.

After my dad left tonight, we got a call from the hospital informing us that mom was extremely agitated and they had to sedate her with a powerful sedative.

I don't know what to do. Are we doing the right thing by taking time out because I honestly don't see how we can move forward on THIS particular path and also take care of her when we aren't able to take care of ourselves. The hospital says once her blood chemistry is better, they recommend she go to a facility for rehab, but I feel like something more should be happening here to help her. any advice would be GREATLY appreciated.

towhee

Kelly, hello and welcome though sorry for the reason you are here. What you are describing is called hospital delirium and it is fairly common in the elderly, even in those without Alzheimer's. When you are older you do not have as much physical or cognitive reserve or extra capacity. Think of it like this. If you have the ability to lift 50 lbs, it does not affect you much in your daily life if now you can only lift 40. But if you could only lift 15, and now you can only lift 5 it really makes a difference.

What happens is that an older person, especially one with Alzheimers gets sick, could be just something minor, it starts to temporarily erode some of that reserve. Then they are not eating and drinking properly, salt, blood sugar, hydration all start to "get wacky" causing temporary cognitive decline. They end up in the hospital. Maybe they get started on antibiotics or other medication which can cause mental side effects. They are in an unfamiliar location and missing the support of routine and familiar surroundings, there are noises they cannot understand and intrusive and maybe painful things in their body. Their sleep gets interrupted. Google hospital delirium, the better Health While Aging article is good, also Heathline or Johns Hopkins. Also,

delirium-older-persons.pdf

Treatment is to fix the underlying medical condition, here it is blood chemistry. Try to minimize noise, let the person sleep uninterrupted as much as possible, bring a few familiar things, and if at all possible have someone to sit with them and reassure them that they will be ok. Friends, family or even a hired aide. I would say here that your dad cannot do this, he seems to trigger her, and you need rest. Sometimes if you really push the hospital will provide a sitter. If not is there any possibility you could hire an aide? If the person is so upset that nothing helps, they do have to resort to medications. The lowest effective dose and usually it is an antipsychotic. Rehab is better than the hospital, although home is best but only if she can be physically handled at home and only if you can bring in care. I have been thru this, my LO literally fought off a sedative and as soon as the medical condition was stable we hired care and brought her home, It took several weeks for her to return close to baseline.

Wish you well.

H1235

Welcome. Since you said she has had aggressive behavior prior to the hospital visit, I would think this is not entirely related to her hospital stay. She is probably in need of medication to stabilize her mood. This can be very tricky for doctors to figure out. A geriatric psychiatric unit would probably be best for his. I don’t think the hospital will be working to figure this out. I would ask (maybe even demand) that she have a psychiatric evaluation. This would hopefully be followed by a stay in geriatric psych. Since you suspect dementia it would probably be a good idea to have an actual diagnosis. It probably won’t change things, but it would be good to know what’s happening. I would think a rehab facility is not going to allow her in if there are behavioral issues. Whatever you do, do not let the hospital talk you into taking her home! If she is still struggling with angry outbursts she is not ready to go home! Unfortunately if they can’t find a place for her this is something they may do to free up a bed. Don’t do it!