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.