After rehab stay cognitive decrease?

This is from my personal experience, the experience of friends and general online research I have done: After a fall and/or medical procedure, particularly with anesthesia, with an older person, it is common to see a cognitive decline that is noticeably significant. This can be immediate, in cases of a medical procedure, or delayed or a slow progression in the case of a fall. Why this is is subject to theories and speculation and has in recent years become more widely studied and published in the medical community with regards to after anesthesia.

In most cases it's a decline that does not improve. However, depending on the cause, and the care after, the decline may be stable for a time or reversible in a wide range, from staying the same to improving to better than it was before!

I don't believe people get mentally lazy to what would be called "cognitive decline" just from not doing things for themselves or thinking for themselves. They may not learn some things that would make them more independent but they will not develop cognitive degeneration. That's my theory.

Definitely.....there is normally a marked decline in cognition and even hospital delirium present after a stay in rehab, especially an extended stay. It's not "mental laziness" and shouldn't be attributable to having things done for them by others, but by being out of their environment, disoriented, medicated differently, and those sorts of things. I've witnessed it in both of my parents after hospital stays and rehab stays. Both of them DID improve after getting back to their normal environment within a couple of months. I'd honestly say, though, neither recovered 100% bc each step down w an ilness takes a bit more away from them each time.

Give mom some time and the chance to reacclimate herself back home and I'll bet you'll see a marked improvement in her mentation. That's my hope for you.

This happened with my mother-in-law after a rehab stay. She didn't remember paintings that were hanging on the wall and didn't even remember how to use her nebulizer machine that she had previously used 2-3 times a day. Thankfully, she bounced right back mentally and was able to continue living alone.

Long answer-March of 2021 my mom was hospitalized 8 days for hyponatremia, 3 were in ICU. She had no cognitive impairment prior to this. Developed UTI's from a catheter the ER placed that wasn't removed prior to rehab & she also had delirium so the SNF assumed mom was incontinent and had dementia. Day 2 of rehab she was back in the hospital (a different one)for another week. We're not sure how, but 2 of her medications were tripled& the hospital records had 'history of dementia'. Anyway she was sent back to the rehab, had a positive covid test 2 weeks later, fell twice while in isolation and went back to the hospital (third admission in a month) After another week she was discharged home with skilled nursing &24hr caregivers. Its been 2 years but the catheter & caregivers are gone, the benzos & narcotics have cleared her system & the brain fog/confusion has improved tremendously. She's never going to be the same but I'm very glad for the improvement.

I was there every day and her room was a disgusting mess of linens, garbage & the floor was sticky. She had the same red slipper socks on for a week! Gross!! I told the Dr my mother worked 35 years in that hospital as an RN. The next day I went to visit & her room was spotless. Lol

Thank you for your reply! We have a team of folks visiting with a great social worker helping. We had a telephone visit with her primary doctor and told him about her anxiety. He suggested a med to help alleviate that so we’ll go from there.

It’s hard on her as she’s always been independent and was a caregiver herself until she was 82. One step at a time 😊

I think any "answers" are guesses on our part or on yours. This may be as a result of confusion after transfer hospital to rehab facility to back home, or it may simply be more rapid progression of the disorder.

The one change that most often IS as a result of institutional care is the one that occurs sometimes after administration of anesthesia. That may be temporary or permanent.

Sure wish I had a better answer for you, but it comes down to "who really can know".

@87 years old, it is not unusual for a decline after a medical event involving a prolonged stay at hospital / rehab . You may or may not notice some improvement once you get her home.

Give her time. 5 months away is long. She needs to get reoriented. These places (hospitals etc) are mentally disruptive. She may never get totally back to what she was, but you’ll see some much more normal behavior after she reorients herself.

In 2014, my (then 88 yo) dad had heart surgery and was away from home 3+ months with his hospital and rehabSN stays. When we brought him home he told me he was scared to leave, because these facilities felt like “cocoons” to him (his word). I suggested “prison” but he said cocoon was a “nicer” word. He had forgotten how life was- outside the cocoons - and was afraid of what would be expected of him when he returned home. He had gotten a kind of dementia there with hallucinations (like while I was talking with him he reached out tried to grab ahold of a “cake that went flying past you, didn’t you see it?”). Lol. That kind of stuff went away once he was home but overall he was never as sharp as before his surgery.
Recently my 92 yo mom went in and out of hospitals and rehabs due to extremely high anxiety & pain. Because she already naturally self-limits, these cocoons exacerbated dependency issues. She went straight into AL from rehab and has been in AL for 6 months. She’s now able to function cognitively and be more normal in her thinking. There has been decline that’s permanent though I wonder if that is due to the high anxiety and mental breakdown she had.

May I suggest you WebMD the negative side effects of each of her medications? It may be that one of them causes confusion or neurological side effects. My mom was sounding 'goofy' and confused when she was in rehab, and I requested a list of her meds. Turns out they were giving her a powerful pain medication that she didn't need, and as soon as they stopped giving it to her, she improved.