Tuesday, August 11, 2009

Dementia or Delirium

I recently heard a story on NPR which caught my attention since it mirrored an experience we had with my mother. It discussed the problem of delirium in the hospitalized elderly.

After my dad died my mother came to live with us. Her mobility was impaired but not her mind. She formed a special bond with our grandson, Michael. Since his mobility was also impaired she was able to watch him while I did other chores. If he crawled out of her field of vision she would call out "I don't see Michael" and I would come and find him and put him back where she could see him. It made her feel useful and Michael enjoyed being with her.

After five years with us it became evident that it was no longer safe for her to be alone as she had started to fall and we were away a lot of the time. It was decided that Hubby and I would move to a retirement community in Northern California and Mother would move into an assisted living facility nearby where she would have more companionship and more care.

Eventually one of her falls resulted in an injury that required hospitalization and then placement into a rehab facility. This went well for several weeks and then another fall and the woman I knew disappeared. Most of the time she was unresponsive, if she did respond she made no sense. She was seeing things that terrified her. The facility was noisy and sometimes felt chaotic. The woman in the next bed was agitated, calling for help.

My mother was an intelligent woman with two degrees from UCLA. She was a tough lady, I once saw here chase a bear out of the back seat of our car in Yellowstone. Another time a purse snatcher had tried to grab her bag but she held on and he ran off. This frightened, disoriented woman was not the mother I knew and I wanted my mother back.

The discharge planner insisted that I should find a place where she would be in a room with another woman. I insisted that she needed a private room but I had little co-operation in finding such a place. Eventually I prevailed.

Within 24 hours of moving her to the new nursing home, a calm, well managed facility where she could have her own room, Mother was back. She told of frightening hallucinations that still felt real.

While it's true that the morphine patch she had to control the pain may have contributed to the delirium, she continued to wear the patch in the new nursing home with no such symptoms. The delirium only returned during one brief hospital visit later and on this occasion she received only her usual meds.

This is meant to be a cautionary tale, many of us have elderly parents or are seniors ourselves. Be wary of new meds and chaotic situations. Don't let professionals tell you a loved one is suffering from dementia when a week ago they were fine, look for environmental factors.
Mother lived contentedly for 14 months at Manor Care. She usually left her door open so she could observe what was going on. When she wanted more quiet she asked someone to close it. There was little turnover in the staff and they knew and cared about the patients. The night my mother died they called me at 2 am so that I could be with her. It was five days from her 90th birthday.

We were fortunate, my parents had lived frugally all their lives and my mother could afford the best, most people can't. Everyone is different, but every elderly person needs an advocate, someone who knows them well and will not give in to professionals who do not know the patient well.

There is a lot of talk about how society will afford to care for the growing population of elderly. What I worry about even more is will there be enough caring, compitent caregivers to do the job even if the money can be found.


Yogi♪♪♪ said...

Great post. I've seen the same thing in much younger person. Its kind of an involved story but a friend in his late 40's who was on morphine and in a hospital became all strange and incoherant but became his old self when he went home.
He said the halloucinations were real and he couldn't figure out why we were not seeing what he was seeing.

Unseen Rajasthan said...

Lovely post...I really loved the cute kid...Thanks for sharing..Unseen Rajasthan

Katney said...

Very good points and I can see some parallels from when my MIL was hospitalized years ago.

Linda Reeder said...

This is very timely for me. My siblings and I are about to make decisions about my mother's care. Her doctor says she should no longer be living on her own. she is spending two weeks with my sister to recieve wound care for sores discovered on her feet. Then what? Mom wants to go back to her house. None of us live near by. This will be a difficult time. thanks for the words of wisdom.

Diane AZ said...

There are some important life lessons here and your mother was fortunate to have you as an advocate. Great pictures.

Barb said...

Very sad, Martha, that your Mother had to experience this loss of personality. Thankfully,you advocated for her. I believe that people who are very sick shouldn't even be left alone in the hospital. If they are weak or in a coma, they definitely need someone else to take charge for them. Negative crises can happen - if there is nobody to watch out for them,it could be too late. I loved the pictures of your Mother with Michael! The sleeping one is precious. What a joy to have those photos of them together!

Susan said...

Your story touched my heart and I couldn't agree more. I'm a retired health care professional and have seen how the medical system has changed over the years. The TLC and compassion seems to have faded and has been replaced by less quality time being spent with the elderly rushed conclusions.

I'm so happy to hear that you stuck to you guns and made sure your dear mother received the care that she rightfully deserved. Bless your heart!

I love the photo of your mother sleeping with Michael - a memory to be cherished!

Thank you for sharing your story and for reminding us that the elderly are precious and deserve to be treated as such. You did your mother proud, my friend!

Hugssss, Susan

Ebie said...

This is my main blog.
I am so touched by your story. I also remember your story about Michael. What a great person you are. I can relate about care, because I used to work part time as a caregiver on weekends. My heart always aches to see my patients in different situations. Right now, I try not to worry too much about anything, and hopefully, my daughter (future RN) can take care of me in my "almost old" age. I enjoyed that post too.
P.S. I get motivated by you and Barb about your adventures in hiking...such inspirations...