How do I know for sure if my mother's delirium and confusion are coming from the anesthetic? She just had back surgery one week ago?

My mother at 95 fell, broke her femur and had a 5 hour surgery to repair it. While she was recovering in the hospital before she would go to rehab, she was totally confused - didn't know where she was, what year it was etc and continued her entire stay in the hospital. The doctors made notes on her chart that she had dementia. YET, up to the day before she fell, she had zero dementia or any type of mental impairment.

I kept arguing with the doctors that she didn't have dementia, showed them videos on my phone of her being totally coherent and present the week prior to, but they were unconvinced. It wasn't until she went to rehab that I heard 'post-operative delirium'. Which was strongly evident upon her entry to rehab.

During the first 3 weeks of rehab following the surgery, my mother thought she was back home in her home country, that war had broken out (yes, she did go through WW2), and kept having hallucinatory nightmares that were prompted by what was on the tv that was on in her room (one example that stood out was that she had fallen asleep with the news on and upon waking, she was insistent that I, her daughter, had been killed in a car accident. And following this nightmare, she accused me of not being her daughter, that I was an imposter - even though I tried everything to prove I wasn't - brought up past childhood events, vacations, places, spoke to her in our native language, reminded her of things that we had done/experienced in the past 10-20 years - nothing, absolutely nothing convinced her that I was her daughter - I was an imposter who was made to look like, and sound like her daughter (and the accurate memories were 'implanted'). And she told EVERYONE at the rehab that I was an imposter - the admin, the nurses...everyone.

The post operative delirium finally started lessening about 3 weeks after surgery. It wasn't a overnight thing, but instead, small tiny gradual steps that took another 2 weeks to abate. However, word of caution, I was told by the nurses that at her age, post operative delirium can remain permanently.

It was a scary time for me, and of course, she didn't remember anything.

I'm wondering if your mom's better now because being home since you asked this question. I hope she is. I wouldn't take her to that hospital where they tied her to the bed again. People are saying that's suposedly illegal.

That is a question for her doctors and not this forum. So many factors go into what caused her symptoms: reactions to medications, infections, out of control blood sugar, possible oxygenation problems, possible electrolyte imbalances - just a few causes, but can't way without through evaluation or access to her records.

When I was working as a nurse, some time ago, we were told that restraints were no longer allowed to be used on confused and/or combative patients. Other, less restricting methods could be used. Wonder when that changed?
On the other hand, I'm not sure that tranquilizers are always a good answer since medication may well be partly responsible for the post-op "mania".

I experienced this post-op condition a few years ago after being admitted to a "rehab facility" following a knee replacement. I knew I was not thinking logically, became angry, I could say almost paranoid, at the rehab facility (actually a nursing home with "rehab" as a side line.) I didn't understand what was wrong with me. It isn't my usual temperament. But, to my great relief, my thinking began to clear as soon as I returned home.

However, I would still advise caution re: the nursing home/rehab facilities.. I asked to see the "incident" or "accident" reports I accumulated over a three week period. It appeared to me that much information was falsified. I didn't feel well enough to complain (and had no advocate at the time). However the facility closed down shortly after I left. I believe that now, there are more actual REHAB hospitals available for a short post-op stay.

Npierson: You should pose your concerns and questions to her physician and medical team.

NPierson:
It's been a few weeks. How is your Mom doing now? I would love an update from you.

Perhaps. I know after the treatment my mother had in the hospital she had hallucinations. In a few weeks she was back to normal.

Be sure to have this conversation with her PCP, who best knows her medical history . Also, often various illnesses or procedures can sometimes exacerbate conditions that were already there but not as obvious. Or sometime things like UTI can cause dramatic behavior changes. Be sure that her PCP is in the communication loop with any other specialist or ER staff treating her. You may also need to request her PCP or other appropriate medical staff to refer her to a " rehab" facility for some period of recovery,rehab and she can be assessed further there for her " level of care needs" BEFORE being sent home.

Be sure to practice self care for yourself!

Call her dr.

First, yes, the drugs they give in the hospital could cause all kinds of adverse behavior in seniors because seniors do not metabolize the drugs in the same way as a normal adult. You were smart to get her out of there.

After reading yours and other's posts, oh WOW! Earlier in June, my Mom, dementia, arthritis, scoliosis, went to the hospital for oral surgery under general anesthesia. She was tied to the bed at night (12 hours) because 1) they said she was combative and 2) she was a fall risk.

The reason why she was combative was because she was trying to follow her routine which includes waiting in the hallway to get a bath. Obviously that wasn't going to happen at the hospital, however, this was after hours so I couldn't be there to calm her down (hospital rules, not mine). The other reason for the restraints was because she is a fall risk and they didn't want to take the chance that she would get out of bed on her own and fall down. I verbally gave them the okay for the soft restraints.

Little did I know that most of our facilities will not allow a person back into them if they have been restrained for the last 24 hours. What a mess...the hospital restrains her at night to keep her from falling (or walking), and that action prevents her from getting out of the hospital the following day (and therefore the hospital collects more money for the stay.) The way it was phrased to the MC facility "we are not releasing xxx today" The way it was phrased to me "the facility said they will not accept your Mom back at the facility today". <Little did they know that my Mom and I are well known to all the nurses and caregivers at the facility>

On top of that, the hospital doctor gave her an anti-depressant to calm her down. They said that it had been previously prescribed for her so it must be safe. What they didn't know is that she never took the anti-depressant since that doctor was the one that got my Mom upset. (Ironically, we saw the doctor to find out if she had dementia or not). The office visit where the doctor prescribed the medicine was over 2 years ago. The drug NEVER showed up in the drug list that the MC facility gave to the hospital and of course no followup visit to the doctor. I was even told by her PCP that the drug they prescribed was quite dangerous as it could stop her breathing due to age.

Anyway, she went directly back to the MC facility. She was really confused that first night, and slept a lot the following day. However, after 2 days of routine and being out of the hospital, my Mom returned back to normal dementia self.

...and she doesn't remember anything about the hospital stay or that she was even in a hospital.

This is the 3rd time she has been in the hospital since turning 93. Each time, they (2 different hospitals) have done something(s) that has been detrimental to her health, however, benefitted them. As I was yet again verbally sparring with the hospital doctor, I knew this time, I wasn't going to give in until there was a suitable reason.

So yes, if you are able, go to the hospital and stay with the person as much time as you are allowed. Make sure that you advocate for the person and understand everything they are doing and their diagnosis. It is easier to do it these days as many medical facilities have stored a sanitized version of the doctors notes electronically....then get that person out of the hospital.

In general, I don't think our hospitals are equipped to deal with seniors with dementia behaviors.

The me that my mother need to stay longer, I said no I'm going to bring her home today I'm sorry I think she'll do better in the home! My mom has done tremendous and she's been home she had no sons of dementia Alzheimer's or anything like that which was excellent news. I already have my father and an Alzheimer's dementia facility because he was fast acting Alzheimer! I don't know what I'd do if my mother had Alzheimer's as well as the hardest disease ever it's cruel and mean my father was an attorney for 53 years one of the smartest men I've ever known! This is all been a nightmare for us it was elderly abuse that my mom suffered they tied her down to a bed put mittens on her hands whenever I went to the hospital to visit her I told them do not strap my mother down to the bed again! And when the doctor told me that they wanted to do more tests on my mom that's when I told her no I've had enough and brought her home and she has done almost a hundred times better here at home then I thought Hospital!

Since bringing my mom home from the hospital she has done so much better! Whenever I left the room they would drop down to the bed and put mittens on her hands I have had the most horrible time with the stupid Hospital! My poor mother has gone through so much she was using a bedpan all by herself and my mother has always been a very independent woman she doesn't wear diaper for incontinence or anything like that! And yes they checked her for UTI and she does not have a UTI! This doctor told me that they were treating her for meningitis however they didn't know spinal tap to get fluid off to see if she had meningitis they were just treating her for it it made no sense to me!!

You can't be certain, and what difference at this point could that make?

Her increased delirium could be from ANYTHING in this whole chain of circumstances.

You have done the right thing, now that she is well enough to be home. Most/many deliriums pass after some time in one's own environment. I hope that is the case for your Mom.

Do update us and I surely wish you both the very vest of luck.

Sadly confusion and delirium is very common in the elderly caused by the anesthesia from any major surgery.
If she wasn't confused before her surgery and is now, it is more than likely caused by the anesthesia. Often times it goes away within a few weeks but sometimes it does not.
Her doctor should have made her and you aware of that before she ever had her surgery, as they are more than aware of the negative effects anesthesia has on the elderly.

My late husband who already had vascular dementia, after having minor surgery to have his supra pubic catheter put in, suffered a significant change in his mental status after the surgery for the worse, and it scared me to say the least.
However in his case, after a few weeks he returned to where he was prior to the surgery.

I'm sorry that your mom is experiencing this and I hope and pray that she will return to her "normal" status.

It could be. And as we age it takes longer for our bodies to get rid of medications. The longer the operation the more likely the confusion. This article says there are medications that help and medications she maybe be taken that actually contribute to the problem.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2546478/

It could be, or it could be a UTI or something else.

Has she seen her regular doctor since the surgery?

I would call her/him and seek advice about next steps-- ER, wait and see or get her admitted to rehab.

Was rehab presented as an option after surgery?