My 85-year-old father has been in and out of the hospital and 2 different rehabs since Christmas Day. He had an infection in gallbladder and gallstones but they would not do surgery because he was too high risk at the time because of some kidney and heart issues so instead they placed a tube and drain. Moved to a terrible rehab (that's another post!) for 2 weeks where he continued to decline. I screamed and yelled something was wrong, no one listened even after 2 trips to 2 different doctors. Finally, last Weds, on the day it snowed 8" here in NC, I called my dad to check on him (also had daughter at home puking with stomach bug so between that and snow, I couldn't go see him) and he was slurring his words and severely confused. Also he'd been very lethargic, falling asleep mid-conversation and very weak, no appetite. Needless to say, the terrible rehab kept telling me he was fine but I listened to my instincts and had my husband go get him and take him to ER, where his BP was dangerously low and he was severely dehydrated. Turns out he was septic!!! So he spent several days in stepdown unit by ICU then moved to regular floor, total stay a week. Surgeon still refusing to do surgery (also another story for a separate post!) so kept tube in and have him on IV antibiotics - had to place picc line last night and finally we got him into a good rehab late last night, the one where he and my mom both were for several months after they both suffered strokes 2 weeks apart, 3 years ago. He's even in the same room and has one of his fave CNAs there. This is all good but the big problem is he has developed what the Dr. told me could be "hospital delirium." It is so, so bad. My dad is not my dad right now. It started on the first week hospital stay but was more confusion now it's full-blown delusions and argumentative behavior. He is convinced 5 people have been staying at his house and that he was there to see it and they are robbing it (my mom died a year ago and he lives alone), that the hospital rooms were his living room, it was his tv, that they did surgery and drilled holes into him, that he needs 8 blood transfusions. On and on crazy talk and he doesn't understand what the picc line is and what is happening to him. It is very distressing to witness and I don't know what to do. Please know before this initial hospital stay at Christmas he had NO dementia and no memory issues, very sharp, independent, driving, etc. I just had a p/t caregiver who cared for my mom thru cancer stay on and help him with things around the house, grocery shopping, meds etc. She is wonderful and this sudden cognitive change is distressing to her too. I have read it can get better but it may take weeks or may not get better till he gets home. But the dr also said sometimes it doesn't improve or it kicks off dementia that may have been underlying. My dad has Parkinson's (the kind that affects balance no shaking), Afib, T2 diabetes, previous stroke (he recovered completely from that), high BP, stage 3 kidney disease, so he has lots of issues but this latest episode has caused a severe decline and I am worried what will happen. I am worried this state of delirium won't get better. I am going to hire more caregivers for when he gets home but we'll run out of money for that in a year and he won't qualify for Medicaid b/c I didn't put his house in my name till 2.5 years ago. So worried about the future, if he makes it that long. And very worried about his quality of life, which for a month has been 0 and before this was wonderful. I am an only child btw and care for my dad just me and my p/t caregiver. Husband helps as he can but he has to help with my daughter when I am dealing with crises like this. It is taking its toll on me as well, I haven't slept a full night in weeks and I am stressed to the max. I am most worried about this delirium and if it will get better or what to do. Does anyone have any experience with their elder experiencing this type of delirium in the hospital? It happened very suddenly after the first few days and hasn't gotten better even though the sepsis is clearing and his WBC is back to normal. Any help is appreciated. Thank you.
First, let me say I’m sorry you and your Dad are dealing with this. I too am an only child, with no husband or other family to assist me. I was a primary caregiver for my Dad in my own home with some part-time caregivers. Take a deep breath, I got through this, and you can get through it too.
Overnight, my 72 yr old Dad went from being a hospital volunteer strong enough to help push people in wheelchairs - - to suddenly being a delirious patient.
He had been 100% independent with no known heart issues. That day he’d had a cold, so before bed he took Nyquil. An hour later, we were in the hospital where he was diagnosed with CHF.
He became delirious, and it was truly frightening as it was so unexpected. The hospital called it ICU delirium, and said can clear up once the patient’s brain chemistry improves and/or the patient goes home.
In this case, the delirium made him happy—he thought he was at a friend’s house for Thanksgiving. It so happened the hospital was serving turkey for dinner, which made him even happier. That made it a little more bearable for me to witness.
Thankfully, this first bout of delirium cleared up overnight, but he could no longer walk. They reviewed his few meds and said they were ok, forbid him from ever taking any kind of cold medicine, Advil, Aleve, or other NSAID pain reliever ever again (Tylenol ok), and gave him a staggering number of heart medicines to start on.
He recovered after months of home/outpatient PT, but a few months later suffered a stroke during an unrelated procedure. More delirium, and this time he wasn't happy and it did not clear up quickly.
The delirium eventually subsided, but not until he was back at home, where the surroundings were familiar. He went back to being himself, but now had memory/cognitive issues.
I am not a doctor, but I learned a lot about this, some of which echoes what others have said:
- As people age, people can function fine but the brain can start to shrink behind the scenes as a part of the aging process. Older people may do fine going to everyday places doing everyday things, but a sudden illness which takes them to unfamiliar surroundings can bring out age-diminished cognitive ability
- sepsis and other infections can contribute, as you already found out
-ICU delirium can take a while improve. If its not improving, keep digging for the reason (as you have been doing). Sometimes hospitals will see an older person and assume they were congitively impaired before. Keep telling them this is not normal for him, and get a neurologist involved to get a brain scan so you can better know what you are dealing with.
- if medically possible, bring him to his home or to a familiar place. The 2nd round, that helped pop my Dad out of it after a few weeks in the hospital. Eventually, I figured out ways to get him help at home from visiting nurses without going to hospitals...hospitals only sped his decline.
- review all medicines with a doctor, many can contribute to delirium or memory issues. Cold meds, sleeping pills, melatonin were all off the list for my Dad. Some heart meds may require balancing the dosage.
-certain vitamin/mineral deficiencies can contribute to weakness and confusion considerably. Again, pay attention to what they are giving him and why.
At the risk of sounding like a Hallmark card, I have one parting thought:
You seem like a very caring person who loves her Dad. Trust your instincts, and do the best you can for him.
Yes it may get hard, the money may get tight, and you may not know the right thing to do. Just let your love for him continue to guide you, and you will find it helps you both.
They cleared the infection. He got less crazy, and he went home to his apartment. Someone saw him every day for a month. He eventually got better. The hallucinations had stopped before he left the hospital, but he still had more severe signs of dementia. Those did not go away entirely. After a year or so, the dementia began to get worse and we moved him into our house where all sorts of other problems arose. Again, this was still the dementia which he apparently had all along.
The surgery and hospitalization probably speeded up his decline. His brain just couldn’t compensate for the incredible changes and stress of those events: medical, physical, emotional, situational... everything was too much for him. If he hadn’t had the surgery, he would have died, so that needed to happen. But we had never guessed that he also had dementia. Looking back, we realize many signs were there. He was in early dementia going in. The hospitalization just brought it out more.
Your father may get better, maybe even completely, but he also might not recover completely. My FIL went on two more cruises with us (he stayed in our cabin) and we had a few more good years. I hope your father has a complete recovery and can continue living independently and happily for a long time.
I finally took her to my home on hospice after nearly a year of in and out of delirium and hospitals and rehabs. I would wake up several times each night and listen. It was so scary when she would tell me she saw men looking in the window, (impossible), that the doorbell rang at 3 am, and a woman sitting on the TV with her head rotating around. She would have episodes of scary hallucinations on and off a few times for 8 months before she began sleeping nearly all the time, eating little. I don't know what I would have done without the great hospice staff that came into our home. My Mom was in her 90's but some people in their 80's sometimes bounce back from delirium, and I am hoping this is the case for your Dad. Please remember to take care of yourself too at this time...even little things help keep you strong.
In the case of your Dad, I suggest you get the name of every medication he is taking or has been taking, and then go on line and look them up for yourself and see if you find anything that causes delirium.
If you find nothing there get the physician to temporarily take off one medication at a time and see if there is any improvement. One would think that that type of experiment would happen as a matter of course. Well, its not. You are the only hope your father has and you have to ride herd of them to see if that testing is being followed.
These days patients like your father have an almost impossible additional problem to contend with. In many facilities the staff is just not adequately equipped to handle English speaking patients. So when for father has a lucid period and something relevant to say, he is either misunderstood or ignored because that's much easier than trying to make sense out of words spoken in a language you don't always understand, by a sick old man, who doesn't really know what he's saying most of the time. As I say, its an additional problem most patients, particularly in rehab facilities, have to deal with.
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