Any experience with mental state improving after correcting fecal impaction?

What Do We Do

My mother (86) has steadily declined this year. A couple months ago she didn't know who my sister & I were, didn't remember being pregnant or living as a family unit with us & our father, etc. We've been begging her to go into AL but she's refused. A month ago she locked herself out of her house all night long, had hypothermia & was in the hospital for a week. While there they discovered she had fecal impaction & resolved it. We decided it was time, whether she liked it or not, to put her in MC. She's been there a month & HATES it. The thing that's got me feeling awful is it seems she's improved. One example: she knows who we are & even knows the name of the other daughter if just one of us is there. She still has memory deficiency but pretty much carries on a rational conversation (all about wanting to go home because that's all she'll talk about when we visit). Has anyone else seen cognitive improvement after correcting severe constipation/impaction? Could this be the reason she seems to have improved or is this just a blip in the progress of her dementia?

SDianeL

medical issues like UTIs and medical procedures can cause a decline and some may return to baseline after it’s resolved. But there really is no way to be sure. Some PWD do improve temporarily after being placed in MC due to more care and better routine. But again no way to know for sure what causes it. Someone posted on this forum that Dementia brains are like a loose wire that sometimes connects. It causes caregivers to second guess and even doubt the diagnosis. As far as her hating it there that’s common. Her safety is the most important thing, not her happiness. To people with dementia, home is a feeling not a physical place. Many say they want to go home although they are living in the home they have lived in for decades. Wanting to go home is caused by anxiety. Redirect or distract with a snack. See if you can find out what’s causing the anxiety. It’s tough.

harshedbuzz

@What Do We Do

I could see where it's possible for there to be improvement in cognition after having an impaction resolved; these are often associated with UTIs and dehydration which can cause a change in mental status. Many elderly, even without dementia, will also develop hospital induced psychosis from just being in the hospital.

My aunt, who'd been living alone, actually thrived with improved nutrition, social interaction and routine when she was placed. She did so well that the CCRC where she was moved included her in the AL activities which suited her better than the MC ones for the first couple of years.

It's almost universal for PWD to talk about nothing but getting home. This almost always passes in a month or two. That said, if you made the decisions based on hospital delirium or confusion caused by illness and AL seems appropriate, there's no harm in trialing that.

HB

SiberianIris

Give it time - a month is still very early days. My mom has been in MC for 5 months. She is in early stage 6. Since being in MC, her ability to converse has improved, she is walking better, and falling with less frequency. She gets more mental stimulation. Even the passive activities, like people coming in to play music are mentally stimulating. She's even taken a liking to playing the drums - something I never could've pictured my mom doing. Her walking has improved because she has to walk to meals and activities. She participates in the variety of chair exercise activities they offer.

Now, I doubt she'll ever say to me "thank you for moving me here", but the questions of "when can I go home?" have changed to "can you take me to see my house?" To these I always answer "Yes, but not today because I … (fill in the blank)" and then distract her with something else. I don't take her out of MC because at age 97 she is frail and high fall risk.

Prior to moving her to MC, she had progressed to 24/7 caregivers. Some were great and engaged with her, but others just sat on their phones while Mom shuffled from room to room looking out the windows and overwatering her plants. (I had cameras in her house.) Her only visitors were her children. Most of her friends are dead or too incapacitated to come visit her. She was really losing her words due to lack of mental stimulation. In MC, she's made friends with some of the other residents. One of my best memories was when I was walking her to lunch in MC - there were several ladies in the dining room waving to my mom to come sit with them.

MN Chickadee

Give it time. Improvement is a good thing! It means she is in a better place, literally and figuratively. The extra supports and structure in MC may be helping her function better and focus her mental energies better (even if that means focusing on leaving, which is extremely common.) Resolving a medical issue like impaction may indeed help a lot. The extra stress on the body from such a thing creates stress on the failing brain. I would think long and hard before taking her out of MC where she is thriving to place her in a setting where she may get herself into trouble again. Her mind was failing before this, as evidenced by her not knowing she had a bowel obstruction. That would have at minimum caused toileting habit changes that she didn't report to anyone or know it was unusual. I would think it would have also been uncomfortable and painful, and people with middle sages of dementia often don't know how to communicate that. I know it's really difficult, moving a loved one to a locked unit and having them begging to go home. It was probably the hardest thing I have ever done. But you have done the hardest part, so stay the course and give it a chance, see what happens. If in a couple months it seems like she has improved so much she doesn't belong in MC you can assess then knowing you did your due diligence. I'd be surprised if you end up wanting to move her once you get through the transition period that is normal after the move to MC. Use therapeutic fibs. Treat it like rehab, you need to stay here to get stronger. Blame the doctor. You'll go home soon. Rinse and repeat.

What Do We Do

Thank you for your responses. Everything everyone said makes sense. After months of desperately trying to get her into AL I now wish nothing more than to get her back into her house because she's mentally tortured feeling like she's in prison! But I know she's better off where she is. I also wondered if the socialization & MUCH better & frequent nutrition might be helping. They take her to some of the AL activities too. If she went back home she'd again be alone, start eating/drinking less, and be less physically active.

eaglemom

You've the the hardest job, placing her. Of course she wants to go to her home - that's where she thinks she's safe. But you know better. On a personal note when I placed my mom (because of Parkinson's ) she threw s fit. The fact she could walk or function at her house didn't matter - she wanted to be home. I ask her who in the dining room did she think walked in saying 'yea I'm in AS?' She sort of giggled and said none. I said she was correct, no one wants to be there, but just try to see its for your safety and protection. She never stopped asking to go home, but after a month or so they were more & more infrequent.

Don't let her wear you down. Your seeing how she's doing with care and people around her.

eagle

JulietteBee

I am glad you are seeing imorovement. Sadly, it has nothing to do with the reversal of her impacting

What you are seeing is her THRIVING on social interactions & mental stimulus.

I saw the same improvement in my mom, who had frequently told me, "Loneliness is going to kill me." I moved her from her own house into an independent living facility in the fall of 2024.

Kat63

My DH is still at home with me under Hospice care and we recently had a bout of constipation that caused impacting. He also was retaining fluid and had edema. This did cause his symptoms to worsen quite a bit. He has trouble walking and needs my help or a walker. When he had severe constipation, he was in a wheel chair and slept most of the day. Once both were corrected he is back to where he was before, able to walk with assistance and now awake again for most of the day.

What Do We Do

https://alzconnected.org/discussion/comment/262827#Comment_262827

That's so great for both of you! Glad he improved.