I am upset that mom's PCP did not suspect this possibility instead of dementia. Her meds for HPB have never been adjusted despite her extreme weight loss in the last 4 years. I took her to ER after reading an article about UTI's and dehydration causing confusion and memory issues. I feel terrible !
What should I do next ??
Would of, should of, could of...... Hindsight is twenty twenty I guess. :(
It is good to remember that all nurses and Dr's are not necessarily trained in all the areas they are practicing in. A very good PCG may have absolutely no experience with dementia and not know what to look for. A nurse with an acute care background is used to infections presenting with high fevers. yes she should know if she is working with hospice patients but anyone new to hospice has a very steep learning curve to climb and there is no special training. Another thing to consider is whether you want to put your loved one through the discomfort of antibiotics when they will feel nausious, off their food and have diarrhea.
Anyone who feels their loved on has a lot of quality of life ahead of them and wants agressive treatment for things like UTI should take the patient to see a specialist. Some Drs will treat frequent UTIs with various combinations of continuous antibiotics. Maybe 2 weeks on drug A then 2 weeks off and two weeks of drug B. the caregivers do have to do their part though keeping the patient really clean and changed as soon as they are wet. a warm wet depends is an ideal breeding ground for nasty bugs. You changed your babies every few hours and washed their nether regions so it is just as important to do the same with the elders. As we age weare less concerned with personal hygiene and consider a quick swipe with a wet wipe is good enough. It isn't, the genital area needs to cleaned with warm water and possibly soap at least twice daily with someone who gets frequent UTIs. use good quality paper towels for this Handwashing must also be supervised. yes you may have a fight on your hands but that may be better than three nights of hallucinations and wandering till the antibiotic kicks in.
It is also very very important for the correct antibiotic to be prescribed and this means a specimen has to be sent to the lab for what are called culture and sensitivities. The urine is spread on an agar plate and discs of common antibiotics are spread around. the pathologist looks at the bugs that have grown and can identify them and sees which areas are clear around the antibiotic discs. that way he knows which antibiotic shouls be prescribed. That may be the test the Dr said would not be covered frequently by Medicare as it is probably quite expensive.
Speaking from experience dealing with my grandmother, she never presented with the telltale sign of fever or complaining about pain. This very own sight mentioned this is due to the aging process. Don't let anyone be flippant about this. When I took my grandmother to her PCP, he told me "We don't have to treat this. We can let it run it's course." To get to the point, I had to fight for the med. After he told me this twice, I decided to change tactics. I developed some sudden "delicate sensibilities" & started to whine about her confusion, the smell & whatever I could whine about I did. My brother, who accompanied us, said to me "I get the impression that (he) gave the script for your benefit but grandma has to take the antibiotic." Ultimately, a UTI will result in death & I just feel you don't live to be 99 & not taking any medications whatsoever to end like this. I asked my grandmother point blank if she ready to be with grandfather yet or does she want to live? She told me she wants to live. I asked her what does that mean. She replied she doesn't want to be pushing up daisies. Have the talk your mother. Know what her wishes are.
My grandmother also had a short stint in hospice (PCP's 3rd attempt) & had problems treating another UTI (UTIs don't get you accepted but I was told to not mention this during the intake). I am going to put this out there. Is the medical community using UTIs as euthanasia? I told the hospice intake I don't want her dying of a UTI & was assured this would be treated because it is comfort care. Her damn nurse told me she was fine because she did not have a fever & like your situation it was dementia. I should mention I wasn't POA but when I got it done, guess what? It was then treated. Are you POA? If not, get it done.
Make sure your mother is drinking plenty of fluids & also try to incorporate 4-8 oz. of cranberry juice into her diet. Don't get the kind that is essentially glorified apple juice because how much cranberries is one really consuming? Look for the one that is 100% juice. You can dilute it with some water. Also, if your mother is wearing depends, don't let her sit in a soiled diaper for long & it may be better if you clean her up rather than having her do it herself. I noticed my grandmother was wiping too far back to front & fecal matter was getting smeared all over.
She has had recurring UTI in the recent past and also has had short term unexplained fevers. I'm beginning to think that many of her symptoms, including confusion, delirium, hallucinations may be caused by UTI and not dementia as suggested.
My sympathies and admiration go to all carers who are struggling to make the right medical decisions to keep their loved ones comfortable.
Thank you for your wonderful website.
Hardest part is finding new ways to get liquid into mom. She just does not feel thirsty as often as she needs. We have tried check boxes and various flavorings and etc. Suggestions?
There are test strips you can buy that indicate possible UTI. We are going to invest in some if we can ever get further than 3 weeks from a UTI treatment.
Primary care Dr has orders for Urine check at lab...I can take sample down.
my biggest complaint is that all the docs keep using the same antibiotic (which I can not touch due to allergy) and I keep suggesting that they consider longer term and a different antibiotic and maybe we could stop this cycle.
After hospitalization and treatment of UTI and Septic infection, Mom was thinking clearer than she has been in YEARS! Yay - not dementia!
Moral of the story if you suspect beginnings of dementia with a loved one or even yourself, get checked for a UTI first!
I've tried everything, the 'real' cold pressed all cranberry juices which I put in a shot glass and drink it like whiskey, i.e., fast) to lots of water, and the list goes on. Years ago, as a preventive, I was given Bactrim that I could take upon the first sigh, but apparently in an effort to stop needless antibiotic prescriptions, doctors don't prescribe as a preventive anymore.
I finally started the cranberry capsules that I thought weren't going to work. First thing in the morning, before I even enter the kitchen, I take one with a large glass of water. Last thing at night, one with a large glass of water (yes, I have to get up to pee, but it's better than the alternative).
It's been eight weeks. My fingers are crossed.
p.s. a UTI is why I brought my mom to the doctor after she was using the bathroom numerous times. She fell after giving a sample in that office, landing in rehab. Turns out she did have a UTI, but that was missed in the chaos of the fall. I had to ask the doctor again to test her because after a few weeks of rehab, she was still presenting with the need to pee. It's a shame when you have to ask the doctor for something she should be doing anyway.
I'm tired of doctors. I'm tired of caregiving. I'm tired of having to apply to Medicaid, having to listen to my mother complain about a beautiful place she's in, and the list goes on.
I'm just plain tired! Stick with us, kid, and you'll learn a lot :)
Darcy!
It's not your fault.
That being said, is her 'dementia' better?
One person above suggested geriatrics doctor. I've got nothing but good things to say about this specialization, however, you need to understand that not all doctors are board certified in this field.
I was of the opinion when I studied this back in 1999/2000 that this would be a growing field. Unfortunately, it is not given the gross income is not as good as it would be if a doctor was to take up being a PCP.
As usual, unless you find someone who isn't out for the monetary aspects of a profession, we'll have to bone up on our medical knowledge and seriously ask the doctor to check these things first.
Sad, but true.
I've met up with such incompetence everywhere I've turned for professional 'expertise' lately that I'm sickened. Just because a person has that degree under their belt, doesn't mean they've kept up with the current practices or what's available out there.
I know when I worked at the Nursing home (for many years as a charge nurse) it got to the point when someone suddenly had a change in mental status, we would first run a UA to rule out UTI. BUT, if the Dr isn't used to working with Geriatric, they don't always think along those lines. If you have a General Practitioner it might be a good idea to find someone who specializes in Geriatrics! I switched my parents to a ARNP (Nurse Practitioner) who studied IN DEPTH geriatrics. I had the advantage of knowing her skills by working in the Nursing home, but you can do some homework and find someone who knows the issues your mom is facing. Geriatrics is a special field, much different from their needs even just a few years ago.
Hope this helps. Keep an open mind.
I wonder, though, having read these responses, why geriatric doctors don't just do regular UTI tests? Does anyone reading this know why that might be?