My Dad has a lot of health issues which is why I've moved him down to assisted living near me, because I was on a plane every other week this summer. I know he had some short term memory issues that have become increasingly apparent as I spend more time with him, but no diagnosis.

He had an episode related to one of his chronic conditions about 10 days ago, was in the hospital, and is now moved to a rehab. But I feel like his cognitive abilities have gone downhill very, very dramatically. Some of it might be meds, but it still feels very sudden. It's like he went from being a little confused but able to have a nice conversation over the dinner table with my family, to screaming inappropriate things and pulling out his IV and not even knowing where he is or why. In less than two weeks!

I feel like it's an uphill battle with the doctors because they meet him and think "agitated senior with dementia" and I'm like, but no, this is NEW.

Each crisis will bring a decline in cognition and overall health that they don't usually bounce all the way back from.

With my mother, she didn't decline gradually and consistently but instead would take a dive if she was in the hospital (delirium) or there was a big crisis like my dad's death or moving to her nursing home. I finally made the decision at the end of last year that the big dive she'd take when she was in the hospital was no longer worth it compared to the care she received there. She wasn't going to recover from either problem -- medical or cognitive -- so we brought her back to her memory care place and I said we're done with hospitals. From that point on, we brought in hospice and treated what ailed her in place. It was the best decision I made.
Helpful Answer (10)
Reply to MJ1929

Hospital delirium is real...........I witnessed it in both parents during and after a hospitalization & rehab stay. My mother was seeing mice crawling on the floor and trying to pack her things up into the little paper pouch the silverware comes in on the food tray! The delirium worsens in the evenings, Sundowning, as you may see, and gets better in the morning hours. For my folks, it lasted for the entire duration of the rehab stays but DID get better and vanish when they went back to their normal environment. My father had no dementia at play (normally), but my mother was in the later early stages of dementia herself the last time she went to rehab. She got back to her baseline self within a week of getting back to her apartment at the Memory Care ALF.

My father was so bad with his hospital delirium that my daughter slept in his room during his entire stay so that every time he woke up agitated, she was there to calm him down!

All the changes, new meds, the illness itself and the hospital/rehab environment contribute to the delirium these seniors experience, and it's a terrible thing to witness!

Wishing you the best of luck dealing with a difficult situation.
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Reply to lealonnie1

I think this sort of reaction is not necessarily related to Alzheimers or other dementia. It may be, but not always.
I had general anesthesia for a knee replacement (my second) and had a strange reaction to the anesthesia. I was only 77 yrs old and had no prior mental confusion. But when I entered a rehab facility I was easily angered and believed some strange things about about the therapists and nurses. (It probably didn't help that I was myself a nurse in the past) Somehow, I knew I wasn't being logical or reasonable but it all seemed so real to me. My friends didn't know what to make of me (I had no family near). I succeeded in making enemies of almost everyone who worked there!
Getting home again was a big help, but it took awhile to return to my normal amiable self. The facility closed down within the year for reasons I never knew.
The next surgery I had (unrelated to the other two), a few years later, required a general anesthesia. And I was very reluctant to have it, though it was necessary. I told my new surgeon of my past experience. Fortunately, he inquired about about the anesthesia and assured me I would not get the same one. He said that "older" people often did not react well to it. I was somewhat comforted to know I hadn't (even temporarily) lost my mind! This surgery went well and I recovered as clear-headed as usual.
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Reply to Dosmo13
S7Catherine Nov 19, 2021
This is also a concern for my husband and mother. PLEASE PLEASE tell us which anesthesia is bad for seniors and which ones are OK. Thank you so much.
Every hospitalization without exception with my elderly dad brought with it a new, lower level of function. A change in routine, not moving around, less social interaction, med changes, the list is long, all can contribute to a marked decline, and it really doesn’t take long. I’ve come to view many hospitalizations to be the enemy of older seniors, but our medical community is geared to treat everything even conditions that won’t improve. I’m sorry you’re dealing with this and hope things look up
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Reply to Daughterof1930

1) I would immediately contact the social worker connected with your dad's case at the rehab center. Every facility (should) have one. Explain exactly what you've shared here on the website. Establishing communication with staff is essential and you may have to put in extra effort in this regard. The social worker can be a very helpful liaison among the patient, the family, and the physician. Another helpful person to establish yourself with is the "charge nurse" or "nursing supervisor". Also, there is actually something called the "Patients Bill of Rights" which states you have the right to have conference time with those people providing care for your father. You have a right to explain your concerns, give information that might not be in your dad's medical chart, AND to receive an answer that addresses or resolves all the issues you bring up. Be sure to go to the rehab's admission department, social work department etc. and immediately request a copy of the facility's "Patients Bill of Rights".
2) In terms of any advise you're receiving from folks on this website regarding changing medication, please keep in mind that (probably) they do NOT have an academic background in medicine. There advise is probably based on their own personal experiences (anecdotal evidence). Any changes in your father's medication should not be undertaken without the physician's input. When certain drugs are immediately stopped, there can be catastrophic results---even death. Doctors would be able to advise you in this regard. Also, those of us on the website do not have access to your father's health history and we don't know what medication he is taking and why. So please, take advise or suggestions about medication given here as "something to look into and learn about" but NOT "something to do ASAP".
3) There is an actual condition called "ICU Psychosis", which is frequently seen in patients (especially elderly ones) who have spent extended time in the ICU or similar hospital classification. It is a stress reaction to the environment. I would bring this up with social worker and/or physician and ask for their input on it.

Lastly, keep referring to this website! It is so helpful and can keep YOU feeling sane during a stressful and difficult time in your life as well. For me, its been a Godsend.
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Reply to JoanZP
DadIsFine Nov 15, 2021
👏🏾👏🏾👏🏾 Great response!
Your Dad could have been in early stages of Dementia. The move to the AL, hospital visit and now Rehab could cause a further decline. People suffering from a Dementia like familiarity. Your Dad has had a lot of changes. There is something called "hospital delirium". Dad may have that.

You need to get the doctors to listen to you. Keep saying this is new. Ask for a Neurological consult.
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Reply to JoAnn29

UPDATE: My Dad's primary doctor went to go see him in the rehab and she too was concerned by how far he was from his baseline. She talked to all his caregivers to explain what he's capable of, got him an appointment with a psychologist because of his anxiety and depression, and is taking over what medications he's being given (she thinks they are over medicating him because he's getting so upset and I agree)
So glad he has a great doctor in his corner! She says it can take time but she believes he will "come back" especially once he can get back to his AL.
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Reply to DoingMyBest73
AimeeB Nov 15, 2021
It might also help to know that hospital delirium is "common, serious, and often missed by hospital staff,"

My husband developed hospital delirium after being in ICU for several days, and it was ongoing for the remainder of his stay (about 2 weeks). He had no prior history with dementia or other cognitive or neurological conditions.

He had mostly returned to his usual self after a few days back home, though some confusion and anxiety (especially at night) lingered for another couple of weeks.

The neurologist he saw shortly before his release from the hospital (and continued seeing for another 2 months, just to monitor) told us about hospital delirium when she checked him out in the hospital & confirmed it at later appointments. Like the author of the article I linked to above, she lamented the fact that hospital staff don't seem to be aware of the prevalence or seriousness of this condition, much less how to help patients who develop it.

I'm glad things are moving forward for your dad in a positive direction, just thought I'd mention this condition since it was a huge relief to me when I learned about it 😊

Good wishes!!
Anesthesia can often produce what doctors call "delirium." It looks like what lay people call agitated dementia. This occurs so often after heart surgery, in which the patient is temporarily put on a heart-lung machine, that there's even a special term for it: "Pump Head Syndrome."
The delirium is usually very temporary, lasting perhaps a couple of days, but sometimes it lasts for weeks before resolving, especially if the person has a history of a stroke or milder TIAs. (Basically, a damaged brain has a harder time getting over it.) In some very unfortunate cases, the delirium lasts longer and can even be permanent.
Do check to see what medications your dad has received. Check the dosages, and potential interactions. Ask if he was put under light anesthesia for any tests, or if he had general anesthesia during surgery. Knowing this information will help you research the possible side effects. You need to stay on top of this, because in his current state, your dad can't be an advocate for himself. Be patient, and hopefully by the time you read this, the problem will have resolved and your dad will be back to his usual self.
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Reply to craftslady1

My Mom's primary doctor used to advise me to keep her out of the hospital as much as I could, because the elderly decline from those stays. I followed that advice as much as I could but the two times she needed to be hospitalized, she became fearful , anxious, and depressed. Thank God it was temporary. It may be for your Dad also.
It's a bunch of things, could be the side effects of the drugs or anesthesia, sundowning, being out of their home and in a totally non-familiar environment with total strangers. It's upsetting for anyone.
Have a talk with your Dad when he is calm and listen to his fears. Stand your ground with the doctors. Find out if he is taking drugs that contribute to his agitation. Listen to your gut - you know your father best. Many times hospitals push for a rehab center, but please consider rehab at home. If that is an option, pull him out and do that. Last and most of all, reassure your Dad that you will always protect him and are working out the best plan for him to come home ASAP.
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Reply to NYCmama

We are currently dealing with this very thing with my FIL. He was just discharged from the hospital (after 6 weeks) on Friday evening. He was suffering delirium from both anaesthesia and medications they were giving him for his agitation (Halidol and Seraquil). We explained so many times to nurses, case workers, social workers and doctors that this was far from his baseline. We were dismissed. He was supposed to go to skilled nursing but because he was so out of it none would take him. Their answer was to try and put it on us. We insisted on an evaluation and that delayed his release from the hospital (every day gave him more of a chance to recover a tiny bit).
After so much fighting they decided that even delirious he was able to make his own decisions and was transported back home alone. He was not given any medications and left to his own devices. They did take his driving privileges so we made the drive while he was in the hospital to take his car and keep people safe.
We didn't know he was going to be released until that morning and were left scrambling. Weekend and nobody was in offices for home care providers.
So now it's Monday and we are trying to get things lined up for him to at least be a level of safe. I am confused why someone who is a fall risk, can't remember anything longer than 10 minutes, and in no way able to take care of his basic needs was sent home that way.
This was done knowing we have medical and durable POA. The two things we can't do even with POA in our state is take his driving privileges and tell him where he is going to live. He is fiercely independent and refuses to go anywhere.
We are arranging for people to come and check on him for a couple hours daily and he is resisting even that. He wants to be left alone.
This is so stressful!
I spoke repeatedly to his PCP who was willing to evaluate him if the hospital wouldn't but he needed to do it via Telehealth as the hospital he was in was not in the PCP's privileges. The hospital refused repeatedly.
It is beyond hard when you are trying to take care of someone but are fighting the health care system on top of it.
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Reply to ladeegodiva

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