Follow
Share

Short background update: June 28 FIL (89) died. He was in Hospital 2 weeks (surgery for hernia) , NH 1 week for rehab, moved to hospice 1 week before death. THEN MIL (80) had COPD flare up & Critically low sodium levels twice in August, 1st time she was fully alert, aware, etc. Transferred to NH for rehab. Three days later 2nd time critically low sodium & also had a UTI and was TOTALLY out of her mind but she remembered her husband had died. Total hospital stay was about 13 days.


NOW: She’s home after 8 weeks rehab for physical therapy. She also had a very mild case of Shingles while in rehab, not requiring any meds for that now. She doesn’t remember even being in the hospital, despite being fully cognizant her 1st hospital stay. Therefore she didn’t understand why she was in rehab. She was asking if her husband died at home or the hospital (he wasn’t even Sick when he was home). She thought the picture hanging in a very prominent place (by her phone & calendar) on her wall was new, but my daughter painted it & gave it to her months before. She also wanted to know if I had given her my microwave, as-she didn’t remember going with my hubby to get a new one because Her old one was peeling on the inside (it was her idea). Also, when returning home she didn’t remember how to use her nebulizer despite having used it several times a day for several years before rehab. That REALLY scares me, but I do realize this is a LOT for someone to go through. We hadn’t noticed any memory probs prior to this, and we saw them several times a week as they live on our road. They totally functioned/handled all business by themselves.


My husband thinks she just needs time to recover, but I’m concerned this is the beginning of dementia. Oh, the NH has told us all those “breathing spells” she was having are actually panic attacks, but she also does have “severe” COPD per her pulmonologist, but he didn’t tell us what stage. She is now on Buspar for anxiety, and their thinking that the Zoloft she was given when my FIL died caused the low sodium. (Sorry so long!)


Thoughts/opinions/advice please.


PS we must find a new Dr. The one she has is nice but terrible with seniors, or at least her.

This question has been closed for answers. Ask a New Question.
Sorry for your loss. Just an FYI - I recently learned that the older we get the worse our response is to anesthesia. It can contribute to dementia.
For your MIL - UTI's can contribute to dementia as well. I've also been told that for every day on your back you need 3 days to recuperate. If she becomes cognizant to make daily decisions to get up and get after her rehab then she is headed in the right direction.
I have documented abrupt changes in my husband's behavior but sometimes he goes back to "normal" after a few days.
Take care as you figure this out. We are all so different.
Helpful Answer (0)
Report

Yes she has been through a lot but either hubby or yourself is right - probably too early to tell - now is the time to hope for the best but plan for the worst

So start with:
1 - what if she recovers but needs help? what steps do you need to do?
2 - what if she has dementia? where will she live? who will take care of her?
3 - what if the COPD makes impossible to live alone? does she need a NH?

Get all your facts & write them in a notebook along with dr's # etc - make space for appointment diary - then basically you have done as much as you can except observing her to see if the confusion is short term or permanent -

The fact that it all comes to light after her living arrangements changed sharply could mean your dad could have been either covering up for her or unconciously been helping her automatically & the situation may be longer term than you realize
Helpful Answer (1)
Report

It's a combination of many things---loss of her spouse, severe COPD, "not wanting to bother you"-so she doesn't tell you the whole picture of her health or perhaps she is unaware of its status, medications, et al. Best to get her checked out by her neurologist.
Helpful Answer (1)
Report

When the summarized version of your question arrived in my inbox, all I saw was "my husband thinks Mom just needs time to recover from an 8 week stay in rehab", which I thought was intended to mean that the rehab facility was the source of her problems. So, I came here to address that because my research shows it IS a very common issue for elderly to receive subpar care in rehab facilities, or attention is given by staff to one or two needs while neglecting all others, and thereby creating new health issues.
But, I see that's not really your question.
From what I"ve read, being disoriented is common and you may end up going to multiple docs and having numerous tests conclude nothing, and then she just gets better on her own....or she doesn't, but it's all despite the many doctors. I"m not suggesting that you avoid docs, but sometimes just a good diet and lack of stress makes a huge difference with time.
That said, the stress of her grief will be impossible for you to determine or remedy, though distractions can help.
Best of luck to you.
Helpful Answer (2)
Report

Possibly both. She certainly is in deep grief right now and she has severe COPD. I think you are right to be concerned about dementia; however, personally I would give her a more time to process her grief before having her further tested. Then if you still have concerns I would arrange for testing by a geriatric psychiatrist. By all means give her all the support you can and, very importantly, keep on top of treatment for her medical conditions. Hope things go well. Poor lady. She has a lot to contend with.
Helpful Answer (1)
Report

I would have her primary care doctor look over all of her medications. She may have some which are causing her confusion. Oxygen therapy can be u seful too in some of these cases.
Helpful Answer (2)
Report

I agree with the other replies, all well said. Just an encouraging addition - my mom has been very confused several times, and even combative from UTIs and a terrible disease - autoimmune encephalitis. We never dreamed she would recover mentally, but she is sharp as can be at 88 years. I just hung up from speaking with her and what a testimony to how amazing the brain is! Just have faith and don't give up yet. Do as much as you can to engage her and if possible help her escape from her confining environment from time to time to reconnect with the outside world - even if it is a short drive. There is also an inexpensive digital clock on Amazon that shows the time, date, and day of the week. She and my 94-year-old dad love it and have stopped forgetting (and asking over and over) what day it is. Another caregiver on this site mentioned electrolytes a few weeks ago, so I added Pedialyte to my parent's daily intake. Honestly, it seems to my siblings and I, that has helped reduce my dad's confusion as much as anything else. A heartfelt "thank you" to whomever shared that information! You might give it a try.
Helpful Answer (3)
Report
skyelav Oct 20, 2018
You might switch to ionized minerals..can be found on Amazon or EIdon.com.. Just a suggestion. Good luck and good for you.
(1)
Report
You've been given a lot of good answers as to what could be going on. Finding a geriatrician for a PCP would be excellent. Or consult a geriatric psychiatrist for the immediate issues.

I want to focus on just one factor contributing to MIL's current state: grief. MIL lost her husband less than 4 months ago. He'd lived a long life, and he apparently was reasonably healthy in his old age. His death was sudden and unexpected. What a shock to his wife! Under normal circumstances we would expect this recent widow still to be in a deep state of grief.

I was surprised to learn that grief can present itself cognitively. I was not shocked when my husband died -- we were both expecting it. But I was, of course, deeply grieved. I was prepared for emotional outbursts or very sad periods. That didn't happen. Instead I had brain fog and memory lapses. I tried to buy my groceries with my library card. I was becoming quite concerned. But two psychiatrists and a psychologist (I was seeing them for different reasons) assured me that while cognitive (instead of emotional) mourning is not typical, it is not abnormal. This was just part of my grieving and it would pass. It was and it did. (You might look up bereavement or grief or mourning if you are interested in this concept.)

It has been less than 4 months since MIL had that life-altering loss. In the "old days" she would still be wearing black, to remind folks that she was fragile at this time. The loss alone could account for unusual behaviors.

But she did not have only the loss to contend with. She had major assaults by disturbing infections. She had flareups of her chronic conditions. She had changes in her environment not once but twice and now she is back home.

I think it would be surprising if she didn't have drastic reactions to all of this. And I would think it would take a long time to recover. (She will never "recover" from the loss of her husband, but her behavior will become more rational as time passes.)

Could she also have dementia? Certainly. According to the National Institute of Health, 25% of people her age have dementia. That statistic is a little lower for men and a little higher for women. Keep in mind that dementia can develop in the brain for years before it becomes obvious. It is not likely that all these other events caused dementia (if she has it) but that they may have been a factor in triggering the dementia to show itself now.

Time will help sort out what is going on with MIL.
1) Try to get her appointments with a geriatrician for her PCP, and also to get a referral to a specialist -- a geriatric psychiatrist, or perhaps a behavioral neurologist who has extensive experience with dementia.
2) Be gentle with her. She is in mourning!
3) Begin learning about dementia. It is very possible she doesn't have it, but considering the statistics you will know other people who develop dementia, and you learning will not be wasted!
4) If feasible, I think I would try to make it safe for her to remain where she is now, until her condition stabilizes. She may eventually need a care center, but the poor dear has been through more environment changes than she can handle right now. It would be good if she can be supported where she is, in my opinion.

Keep in touch here. We care!
Helpful Answer (6)
Report

Look at TEEPA SNOW's Positive Approach to Care website or call them; Teepa is one of the leading experts on dementia. I do her webinars - over the last two years and read monthly newsletters - and more. There is a lot of educational offerings available.
Helpful Answer (3)
Report

It is a lot for someone to go through! A lot for your poor MIL of course, but a lot for you and DH to get your heads round, too. And all on top of bereavement. Hugs and sympathy.

If your MIL has only just got home it seems reasonable to hope she may improve once she's had a chance to settle, but as you say I would look seriously for a doctor who's a better fit.

I'm frowning over one point - the NH said her 'breathing spells' are panic attacks? Treating anxiety may be helpful anyway, but on the other hand if you couldn't breathe, you'd panic too! And the lady has severe COPD. So, what matters is how you should manage any further spells/attacks/episodes - I'd be seeking urgent advice on that.
Helpful Answer (5)
Report

Here are my opinions. It's probably everything. My mom (93) is on Buspar and zoloft and I do give her a potassium booster.

My mom has dementia. I never let her get sent to the rehab hospitals. I just have the rehab come to her in home. That cuts down the rehab effect. They always (100%) want to send them to rehab after a hospital stay. I just tell them no. It was bad for my dad and my mom. I just have caregivers and PT at home.

I think the more you have physical contact with her (lean against her...hold her hand, etc.) and have meaningful discussions...you can draw her back faster. Afternoon naps can help with sundowners too. Standing and walking helps.

Being in the house with her and making yourself busy around her is not nearly as good as the contact and the talking.

Good luck.
Helpful Answer (3)
Report

Mol. Delerium is well known in medical events and can last for a few months including depression. Hold on a little longer. The medication issue is more troubling. If family is not available to help, you may want to hire a caregiver service to help with ensuring she self medicates. Or would she be able to do so if you call her at certain times?
Helpful Answer (1)
Report

Make sure she doesn't have a lingering infection. It might not have completely cleared up 100% or still be in another part of her body.
Helpful Answer (0)
Report
Spankiedoodle Oct 20, 2018
Yes, including a UTI---those often cause signs of dementia.
(1)
Report
It is gradually being accepted that drugs of certain types can cause memory loss or further exacerbate it. Look up the Beers List. My friends in Winter Park, FL, have agreed to stop taking Lipitor and similar drugs saying they would rather die of a heart issue than dementia. I occasionally work with an Integrative Medicine MD who tells of a rigorous protocol for reversing memory loss having to do with diet change and detox regimins etc. MDs are trained to treat with drugs or surgery and are usually no help at all.
Helpful Answer (3)
Report

My suggestion, from my experience with my dad, is to start with a neurologist. From there, they can send you for a “full neuropsychological exam” (it’s about 3 hours)which details what is normal for the patient based on their personality, living situation, recent trauma, med history, etc. and then recommends a treatment plan that’s individualized.
Sounds like a whole host of issues contributed to this sudden decline in cognitive function...
hopefully a neurologist can begin to reveal what caused the condition to deteriorate so rapidly.
Helpful Answer (0)
Report
MargaretMcKen Oct 20, 2018
Perhaps give her time before putting her through all this?
(2)
Report
Many elderly become delusional from a UTI or a move to a new place (especially a hospital or rehab facility). It takes a week or two for this to work itself out, but could take longer. I would suggest you buy a pill organizer and that YOU put them in the organizer so you can see what she does and does not take - any medication foul up will cause more problems with her mental state. It sounds like she lives alone which may not be the safest environment for her in her current state. One factor of dementia is that the patient can remember things from long ago yet cannot remember more recent things.
My 94 year old Mom started to display dementia 2 years ago and was in and out of hospitals and rehabs. I brought her to my home which was very stressful for everyone and exacerbated her dementia (new environment). In retrospect, it might have been better to hire someone to live with her part or full time or to have her in an assisted living facility ..... as difficult as that would be. She started to display severe anxiety and kept trying to escape my home. She ate and drank little and no coercing helped. She ended up in the hospital from dehydration, continuous falls, and high blood pressure. I started researching assisted living facilities for her release from the hospital when they told me she qualified for a hospice facility nearby. They had to medicate her heavily due to her anxiety level and she basically slept for a week and died there.
Good luck - it sounds like you are in for a long difficult journey - hope for the best but be prepared for the worst.
Helpful Answer (2)
Report

Oh...and one more thing...first of all older people metabolize meds very differently than younger people. The buspar and zoloft could be a source of trouble...i.e. maybe they are contributing to some of what's going on...all to say you need to get a new MD in the picture ASAP who will be able to assess things and wean her off if necessary or use something else. And what background were those people who decided the breathing issues were panic? Of course it might have been...but maybe in addition to the COPD if that is accurately diagnosed...
Helpful Answer (1)
Report

Grandma above is a wise woman:-) I agree with her. Initially I expected to read that maybe there was a surgery and anesthesia after effects may be playing a role. But that doesn't seem to be the case...but the number of emotional blows and transitions would overwhelm people half her age. It's possible she might have had a little stroke as in my mother has "mixed dementia". There is a program called Saito (sp) which works with people one on one with cognitive training and brings people back from what appears to be dementia, but I'm not sure it would be the answer in your case. In our case looking back, mom had signs prior, but then had to have an emergency appendectomy and during the hospital stay things progressed. She fooled the MD who was clueless until I contacted him and gave him examples and then when he tested her he was shocked. Definitely get a new MD. I'd get some names or look on the board of directors of your local Alzheimer's Assn to get some leads. Or go to one of their support group meetings if only once and ask people who they are happy with. The meds situation is going to be a problem. If she's this confused, she most likely doesn't know what day it is. They make clocks I hear are helpful that say "this is tuesday afternoon" but even that..with meds...I'd check out the self opening pill boxes unless you want to dole the pills out daily. It is a major drag. Even living with my folks I can't tell you the number of times I'll get in bed and go "oh sh!t. I forgot to put her pills out". They are otherwise hidden and the pill bottle stash is with me. I fill her and my dad's boxes weekly and then hide hers. Your mom is not going to remember the instructions most likely. Short term memory may be gone. Good luck and remember you're not alone...
Helpful Answer (1)
Report

A lot of things going on here.

First, find a doctor who specializes in geriatrics and get her an appointment as soon as possible.
Or go to immediate care and report these changes since they’re new and impacting her safety (if she can’t manage her meds, she could take them incorrectly, overdose or under dose). She needs consistent supervision for her safety until you get some definitive information from a doctor regarding her cognitive functioning and her health issues.

Medically, the severity of her COPD has to be determined. She could need oxygen at times during the day or night. She should also be re-evaluated for UTI. It could have recurred.

This is a lot going on - losing her husband, the hospital stays and changes of location. It can be difficult for our elderly to make the transition without some confusion. In addition, UTIs can really do a number on an elderly person’s cognition. That said, she may have been having problems before your FIL died but they were able to cover for the deficits. Now that he is no longer here, she’s not able to manage those things he did for her.

Did anyone do a cognitive evaluation in rehab? You said she had physical therapy - did she have occupational or speech therapy? If so, what did they report about her functioning? It seems that with 8 weeks of rehab, she would have had at least occupational therapy in addition to the physical therapy. What did the rehab facility report at family conference(s) about discharge recommendations?

This is is a hard situation, but taking the first steps will help determine where this might be going.
Helpful Answer (1)
Report

Short answer..Yes.
She could be recovering from hospital stay and rehab stay. She may also have a type of dementia.
She is also dealing with the death of a spouse one of the high point items for stress, (along with moving and if you consider a stay in the hospital and a stay in rehab that is sort of like moving).
And yes it sounds like you need to change doctors, I would look for one that specializes in geriatrics. And you might also want to look for a neurologist. Or there are neuropsychologists that work with neurologists and between the two disciplines they are better able to get a good idea what is going on.
Side note..as for the picture. It is sort of new...and if she has been in the hospital and then it may not have been there long enough to make a permanent spot in her mind. We often "see" things but not "see" them. We will see that there is a picture, we know it is a picture because it is in a frame, it is hanging on the wall but we may not see the whole picture then when we really look at it and realize it is a picture of a farm field in the setting sun. I drive by the same buildings day after day then one day I drive by and a building is gone and they are putting up a new one. Well the old one did not disappear over night it took a few days to tear it down and clean up the site. We see things but they often do not register. How many times do you drive to work, then half way there you look around and wonder how you got to that intersection without realizing you were at that point in your trip? We go on auto pilot thinking about other things.
Helpful Answer (4)
Report

Update: She just called and asked me to come sort her medicine and tell her when she’s supposed to take it. I showed her the two new ones yesterday and gave her their instructions. The other meds she’s been on for years and only takes once a day in the mornings.
Helpful Answer (0)
Report

This question has been closed for answers. Ask a New Question.

Ask a Question

Subscribe to
Our Newsletter