My Dad has a lot of health issues which is why I've moved him down to assisted living near me, because I was on a plane every other week this summer. I know he had some short term memory issues that have become increasingly apparent as I spend more time with him, but no diagnosis.
He had an episode related to one of his chronic conditions about 10 days ago, was in the hospital, and is now moved to a rehab. But I feel like his cognitive abilities have gone downhill very, very dramatically. Some of it might be meds, but it still feels very sudden. It's like he went from being a little confused but able to have a nice conversation over the dinner table with my family, to screaming inappropriate things and pulling out his IV and not even knowing where he is or why. In less than two weeks!
I feel like it's an uphill battle with the doctors because they meet him and think "agitated senior with dementia" and I'm like, but no, this is NEW.
Hospital Delerium
1. The medication the nursing home's medical director puts her on to keep her quiet and compliant
2. lntense isolation forced on residents when covid quarantines are in place
Currently, the facility has my mother on two anti-psychotics and when they put her on the first one, i noticed an immediate decline (at the time, i did not know they had put her on it because they didn't tell me but I had visited her one week and she was normal, and two weeks later at a window visit, she was literally drooling). i am now insisting they wean her off both. I am at a loss as to what to do about the isolation, though. Social interactions are extremely important to seniors and many studies show that lack of such increases the risk of dementia and altzheimers https://www.cdc.gov/aging/publications/features/lonely-older-adults.html . In the area my mother lives, one positive covid test is cause for a complete facility lockdown. Patients may not leave their room and they can have no visitors. During these lockdowns the only interaction they have with another human is when an aide or other worker brings them their meals, cleans them up, etc. The rest of the time, they lay in bed doing nothing. Our lockdowns have lasted as long as two months. Add to this - low income nursing homes have used covid restrictions as a means to reduce their staff and the services they provide. I don't know what the answer is to all this. If you open your mouth to the nursing home (which I've done) they just blame it on the state's covid restrictions and lack of staff to be able to provide adequate activities during these times.
i pray for you dad too.
Try to bring things he remembers to his room. A favorite picture or blanket will bring him comfort. I put together a collage of family member's pictures. Talk with him about them and ask for favorite memories or stories.
The good news is my mom returned to her old self once back in her familiar surroundings. Hopefully this will be the case for your dad. My mom’s rehab put her on Nimenda and Aricept (generics) which I promptly stopped with primary care’s agreement.
Hang on to hope. He was ok before. Should be ok again. This is what I believed tho hospital doc said my mom was in end of life dementia. He was wrong and I was right. They do not know our people. We do.
Sending a hug!
After so much fighting they decided that even delirious he was able to make his own decisions and was transported back home alone. He was not given any medications and left to his own devices. They did take his driving privileges so we made the drive while he was in the hospital to take his car and keep people safe.
We didn't know he was going to be released until that morning and were left scrambling. Weekend and nobody was in offices for home care providers.
So now it's Monday and we are trying to get things lined up for him to at least be a level of safe. I am confused why someone who is a fall risk, can't remember anything longer than 10 minutes, and in no way able to take care of his basic needs was sent home that way.
This was done knowing we have medical and durable POA. The two things we can't do even with POA in our state is take his driving privileges and tell him where he is going to live. He is fiercely independent and refuses to go anywhere.
We are arranging for people to come and check on him for a couple hours daily and he is resisting even that. He wants to be left alone.
This is so stressful!
I spoke repeatedly to his PCP who was willing to evaluate him if the hospital wouldn't but he needed to do it via Telehealth as the hospital he was in was not in the PCP's privileges. The hospital refused repeatedly.
It is beyond hard when you are trying to take care of someone but are fighting the health care system on top of it.
Most common reason is medication related, esp. if no previous meds have been discontinued if possible, when new meds are started.
I'm a retired mental health/geriatric RN
I had general anesthesia for a knee replacement (my second) and had a strange reaction to the anesthesia. I was only 77 yrs old and had no prior mental confusion. But when I entered a rehab facility I was easily angered and believed some strange things about about the therapists and nurses. (It probably didn't help that I was myself a nurse in the past) Somehow, I knew I wasn't being logical or reasonable but it all seemed so real to me. My friends didn't know what to make of me (I had no family near). I succeeded in making enemies of almost everyone who worked there!
Getting home again was a big help, but it took awhile to return to my normal amiable self. The facility closed down within the year for reasons I never knew.
The next surgery I had (unrelated to the other two), a few years later, required a general anesthesia. And I was very reluctant to have it, though it was necessary. I told my new surgeon of my past experience. Fortunately, he inquired about about the anesthesia and assured me I would not get the same one. He said that "older" people often did not react well to it. I was somewhat comforted to know I hadn't (even temporarily) lost my mind! This surgery went well and I recovered as clear-headed as usual.
2) In terms of any advise you're receiving from folks on this website regarding changing medication, please keep in mind that (probably) they do NOT have an academic background in medicine. There advise is probably based on their own personal experiences (anecdotal evidence). Any changes in your father's medication should not be undertaken without the physician's input. When certain drugs are immediately stopped, there can be catastrophic results---even death. Doctors would be able to advise you in this regard. Also, those of us on the website do not have access to your father's health history and we don't know what medication he is taking and why. So please, take advise or suggestions about medication given here as "something to look into and learn about" but NOT "something to do ASAP".
3) There is an actual condition called "ICU Psychosis", which is frequently seen in patients (especially elderly ones) who have spent extended time in the ICU or similar hospital classification. It is a stress reaction to the environment. I would bring this up with social worker and/or physician and ask for their input on it.
Lastly, keep referring to this website! It is so helpful and can keep YOU feeling sane during a stressful and difficult time in your life as well. For me, its been a Godsend.
It's a bunch of things, could be the side effects of the drugs or anesthesia, sundowning, being out of their home and in a totally non-familiar environment with total strangers. It's upsetting for anyone.
Have a talk with your Dad when he is calm and listen to his fears. Stand your ground with the doctors. Find out if he is taking drugs that contribute to his agitation. Listen to your gut - you know your father best. Many times hospitals push for a rehab center, but please consider rehab at home. If that is an option, pull him out and do that. Last and most of all, reassure your Dad that you will always protect him and are working out the best plan for him to come home ASAP.
The delirium is usually very temporary, lasting perhaps a couple of days, but sometimes it lasts for weeks before resolving, especially if the person has a history of a stroke or milder TIAs. (Basically, a damaged brain has a harder time getting over it.) In some very unfortunate cases, the delirium lasts longer and can even be permanent.
Do check to see what medications your dad has received. Check the dosages, and potential interactions. Ask if he was put under light anesthesia for any tests, or if he had general anesthesia during surgery. Knowing this information will help you research the possible side effects. You need to stay on top of this, because in his current state, your dad can't be an advocate for himself. Be patient, and hopefully by the time you read this, the problem will have resolved and your dad will be back to his usual self.