Hospital delirium- help!

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My 85-year-old father has been in and out of the hospital and 2 different rehabs since Christmas Day. He had an infection in gallbladder and gallstones but they would not do surgery because he was too high risk at the time because of some kidney and heart issues so instead they placed a tube and drain. Moved to a terrible rehab (that's another post!) for 2 weeks where he continued to decline. I screamed and yelled something was wrong, no one listened even after 2 trips to 2 different doctors. Finally, last Weds, on the day it snowed 8" here in NC, I called my dad to check on him (also had daughter at home puking with stomach bug so between that and snow, I couldn't go see him) and he was slurring his words and severely confused. Also he'd been very lethargic, falling asleep mid-conversation and very weak, no appetite. Needless to say, the terrible rehab kept telling me he was fine but I listened to my instincts and had my husband go get him and take him to ER, where his BP was dangerously low and he was severely dehydrated. Turns out he was septic!!! So he spent several days in stepdown unit by ICU then moved to regular floor, total stay a week. Surgeon still refusing to do surgery (also another story for a separate post!) so kept tube in and have him on IV antibiotics - had to place picc line last night and finally we got him into a good rehab late last night, the one where he and my mom both were for several months after they both suffered strokes 2 weeks apart, 3 years ago. He's even in the same room and has one of his fave CNAs there. This is all good but the big problem is he has developed what the Dr. told me could be "hospital delirium." It is so, so bad. My dad is not my dad right now. It started on the first week hospital stay but was more confusion now it's full-blown delusions and argumentative behavior. He is convinced 5 people have been staying at his house and that he was there to see it and they are robbing it (my mom died a year ago and he lives alone), that the hospital rooms were his living room, it was his tv, that they did surgery and drilled holes into him, that he needs 8 blood transfusions. On and on crazy talk and he doesn't understand what the picc line is and what is happening to him. It is very distressing to witness and I don't know what to do. Please know before this initial hospital stay at Christmas he had NO dementia and no memory issues, very sharp, independent, driving, etc. I just had a p/t caregiver who cared for my mom thru cancer stay on and help him with things around the house, grocery shopping, meds etc. She is wonderful and this sudden cognitive change is distressing to her too. I have read it can get better but it may take weeks or may not get better till he gets home. But the dr also said sometimes it doesn't improve or it kicks off dementia that may have been underlying. My dad has Parkinson's (the kind that affects balance no shaking), Afib, T2 diabetes, previous stroke (he recovered completely from that), high BP, stage 3 kidney disease, so he has lots of issues but this latest episode has caused a severe decline and I am worried what will happen. I am worried this state of delirium won't get better. I am going to hire more caregivers for when he gets home but we'll run out of money for that in a year and he won't qualify for Medicaid b/c I didn't put his house in my name till 2.5 years ago. So worried about the future, if he makes it that long. And very worried about his quality of life, which for a month has been 0 and before this was wonderful. I am an only child btw and care for my dad just me and my p/t caregiver. Husband helps as he can but he has to help with my daughter when I am dealing with crises like this. It is taking its toll on me as well, I haven't slept a full night in weeks and I am stressed to the max. I am most worried about this delirium and if it will get better or what to do. Does anyone have any experience with their elder experiencing this type of delirium in the hospital? It happened very suddenly after the first few days and hasn't gotten better even though the sepsis is clearing and his WBC is back to normal. Any help is appreciated. Thank you.

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Another thought is to monitor his meds. What pain meds is he on? Mom started hallucinating and after treating 2 UTIs ( which is a huge cause of hallucination in the elderly) I read that 2 of her pain meds could interact and cause hallucinations. We took her off one of them and they stopped. In my opinion there is nothing worse than watching hallucinations.
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My FIL was 88 and had only the mildest signs of dementia (he was “forgetful”) when he needed his gallbladder removed because gallstones had caused pancreatitis and other problems. After surgery he went nuts. He saw people in his room, thought the TV and remote were his “work” and he had to fix them, people were stealing from him (he was in a hospital room, nothing to steal), the “girls” (the Get Well balloons were gave him) were dancing. And so on. He became mean and nasty, made threats... totally was not himself. The surgeon and a neurologist who was called in explained it as a consequence of him being elderly, in early dementia (until then we had not thought he had it), and a C. Dif infection.

They cleared the infection. He got less crazy, and he went home to his apartment. Someone saw him every day for a month. He eventually got better. The hallucinations had stopped before he left the hospital, but he still had more severe signs of dementia. Those did not go away entirely. After a year or so, the dementia began to get worse and we moved him into our house where all sorts of other problems arose. Again, this was still the dementia which he apparently had all along.

The surgery and hospitalization probably speeded up his decline. His brain just couldn’t compensate for the incredible changes and stress of those events: medical, physical, emotional, situational... everything was too much for him. If he hadn’t had the surgery, he would have died, so that needed to happen. But we had never guessed that he also had dementia. Looking back, we realize many signs were there. He was in early dementia going in. The hospitalization just brought it out more.

Your father may get better, maybe even completely, but he also might not recover completely. My FIL went on two more cruises with us (he stayed in our cabin) and we had a few more good years. I hope your father has a complete recovery and can continue living independently and happily for a long time.
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If it helps, my mom had in and out memory issues, due to a UTI at 85, as it cleared, and she was back in her home, her memory returned completely, so keep the Faith. .
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I am so sorry for what you are going through and understand the shock, fear and confusion when this happens to a parent. I never did get any straight answers as to what was going on! My Mom was 91 when she fell, broke her arm, and was hospitalized. She was formerly very independent and sharp though had quit driving and I did her shopping and cleaning for her. This fall changed everything. The third night in the hospital I received a call from the nurses saying she was very confused and had fallen out of bed but did not hurt herself. She was somewhat argumentative and different when I went to see her, then ok again. She was released to a rehab where she went into delirium and rushed once more to the hospital. A UTI. The delirium was frightening, thrashing and talking and pointing at the ceiling for 10 hours before she finally crashed and fell asleep for a day. They had given her halidol and had a camera on her to make sure she didn't try to climb out of the bed. I didn't understand what happened to my Mom as she was always so intelligent and logical. This was the start of a year and a half of in and out of delirium, and losing the ability to walk. When she snapped out of the delirium she would sleep for a day or two, then be completely normal again and not remember a thing! She had many issues with UTI's as her bladder was scarred from radiation she received 12 years before. I never got any straight answers as to what was happening to my poor Mom. I have lost faith in the medical profession.
I finally took her to my home on hospice after nearly a year of in and out of delirium and hospitals and rehabs. I would wake up several times each night and listen. It was so scary when she would tell me she saw men looking in the window, (impossible), that the doorbell rang at 3 am, and a woman sitting on the TV with her head rotating around. She would have episodes of scary hallucinations on and off a few times for 8 months before she began sleeping nearly all the time, eating little. I don't know what I would have done without the great hospice staff that came into our home. My Mom was in her 90's but some people in their 80's sometimes bounce back from delirium, and I am hoping this is the case for your Dad. Please remember to take care of yourself too at this time...even little things help keep you strong.
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Cdrive, I was hospitalized for about a week in November, and was mentally out of it the whole time. I was still foggy for a few days after they moved me to rehab. I'm 74. My family was very worried that I might not come all the way back, although the medical staff told them that "almost" all patients came out of it. (That "almost" scared them silly.) I'm still recovering random memories of the hospital stay and it has been nearly three months. Anyway, what I'm saying is that it can take a while to get back to normal. That being said, there's good advice in the letters above because each situation is different. My best wishes to you and your father.
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Cdriver,

First, let me say I’m sorry you and your Dad are dealing with this. I too am an only child, with no husband or other family to assist me. I was a primary caregiver for my Dad in my own home with some part-time caregivers. Take a deep breath, I got through this, and you can get through it too.

Overnight, my 72 yr old Dad went from being a hospital volunteer strong enough to help push people in wheelchairs - - to suddenly being a delirious patient.

He had been 100% independent with no known heart issues. That day he’d had a cold, so before bed he took Nyquil. An hour later, we were in the hospital where he was diagnosed with CHF.

He became delirious, and it was truly frightening as it was so unexpected. The hospital called it ICU delirium, and said can clear up once the patient’s brain chemistry improves and/or the patient goes home.

In this case, the delirium made him happy—he thought he was at a friend’s house for Thanksgiving. It so happened the hospital was serving turkey for dinner, which made him even happier. That made it a little more bearable for me to witness.

Thankfully, this first bout of delirium cleared up overnight, but he could no longer walk. They reviewed his few meds and said they were ok, forbid him from ever taking any kind of cold medicine, Advil, Aleve, or other NSAID pain reliever ever again (Tylenol ok), and gave him a staggering number of heart medicines to start on.

He recovered after months of home/outpatient PT, but a few months later suffered a stroke during an unrelated procedure. More delirium, and this time he wasn't happy and it did not clear up quickly.

The delirium eventually subsided, but not until he was back at home, where the surroundings were familiar. He went back to being himself, but now had memory/cognitive issues.

I am not a doctor, but I learned a lot about this, some of which echoes what others have said:

- As people age, people can function fine but the brain can start to shrink behind the scenes as a part of the aging process. Older people may do fine going to everyday places doing everyday things, but a sudden illness which takes them to unfamiliar surroundings can bring out age-diminished cognitive ability

- sepsis and other infections can contribute, as you already found out

-ICU delirium can take a while improve. If its not improving, keep digging for the reason (as you have been doing). Sometimes hospitals will see an older person and assume they were congitively impaired before. Keep telling them this is not normal for him, and get a neurologist involved to get a brain scan so you can better know what you are dealing with.

- if medically possible, bring him to his home or to a familiar place. The 2nd round, that helped pop my Dad out of it after a few weeks in the hospital. Eventually, I figured out ways to get him help at home from visiting nurses without going to hospitals...hospitals only sped his decline. 

- review all medicines with a doctor, many can contribute to delirium or memory issues. Cold meds, sleeping pills, melatonin were all off the list for my Dad. Some heart meds may require balancing the dosage.

-certain vitamin/mineral deficiencies can contribute to weakness and confusion considerably. Again, pay attention to what they are giving him and why.

At the risk of sounding like a Hallmark card, I have one parting thought: 
You seem like a very caring person who loves her Dad. Trust your instincts, and do the best you can for him. 
Yes it may get hard, the money may get tight, and you may not know the right thing to do. Just let your love for him continue to guide you, and you will find it helps you both. 
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Years ago my mother-in-law had  major delirium problems. A local psychiatrist friend came to the house and promptly threw away 14 of the 15 medications she was taking. The only one she was left was the digitalis that she was taking for her heart. A few days past, and there was no improvement. We were in the process of selecting a long term care facility when our daughter looked up digitalis in the pharmacopeia (Every physician and pharmacist has one) . Among the side effects was listed "delirium". Her primary care doctor had never heard of it. In any case, she was temporarily taken off the digitalis and in less than 24 hours her delirium was completely gone! Another MD she had seen told us that he had heard of "digitalis delirium" but had never before seen it. They were able to successfully substitute an alternative medication.

In the case of your Dad, I suggest you get the name of every medication he is taking or has been taking, and then go on line and look them up for yourself and see if you find anything that causes delirium.

If you find nothing there get the physician to temporarily take off one medication at a time and see if there is any improvement. One would think that that type of experiment would happen as a matter of course. Well, its not. You are the only hope your father has and you have to ride herd of them to see if that testing is being followed.

These days patients like your father have an almost impossible additional problem to contend with. In many facilities the staff is just not adequately equipped to handle English speaking patients. So when for father has a lucid period and something relevant to say, he is either misunderstood or ignored because that's much easier than trying to make sense out of words spoken in a language you don't always understand, by a sick old man, who doesn't really know what he's saying most of the time. As I say, its an additional problem most patients, particularly in rehab facilities, have to deal with.
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Delerium is frightening. My dad had moderate dementia and a little less than a year ago we finally talked him into assisted living. About 4 months ago he contracted a UTI & pneumonia and was hospitalized for 10 days before moving into rehab. Even in rehab he had boughts of severe delerium and the doctor told me how infections can wreak havoc in a compromised body. That's when I first heard the term "baseline". They told me that we'd have to see where his new "baseline" was after he recovered. He never really bounced back to where he was before and became increasingly unstable. Due to the fact he was no longer able to do his insulin injections (he's a diabetic) we had to find a long-term care facility and he has been in a memory unit for a couple months now. He's adjusting OK. He has good days and bad. It sounds like your dad was in pretty good shape before this set back, so my hope for you is that he recovers and can return home and have some more good years. Sending good thoughts and prayers out to you and your dad. Hang in there.
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So sorry for what you are all going through. My mom (92) was very mild first stage of dementia but doing well in independent living with a 2 hour/day caregiver, when she developed diverticulitis and needed a bowel resection almost 2 years ago. She definitely had "hospital fuzzies" from the anesthesia when she was discharged to rehab. We didn’t know how long it would last or if she would ever get back to normal. We were warned her dementia could progress from the hospital stay. They were correct. She couldn’t go back to her independent living apartment and was in rehab for 6 months, couldn’t walk good enough for assisted living, so now is in Long term care. I don’t mean to scare you, and your Dad may bounce back but you need to start to make plans in case he doesn’t. Line up more caregivers and perhaps start to at least investigate assisted living, memory care and long term care facilities in your area. I don’t believe having the house still in his name will preclude Medicaid, but there will be a spend down. That’s another investigation with Medicaid. Good luck. This is a process. My life changed 2 years ago, but I’m so fortunate to have supportive husband, and still a very appreciative mother.
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I think hospital is the worst thing for an eldery. Both o f my parents develop delirium and confusión while being at the hospital, and it´s truly frifhtening, besides it is unmanageable for the hospital staff. I have noticed that when my parents come back from hospital, they never recover totaly, their dementia goes increasing, besides they come back with some kind of trauma disorder.
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