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Hi there. Hoping for some advice on what to do. My dad (75) is in a LTC. He has been there for a few years after a fall. Since entering LTC, he developed memory and cognition issues. These issues were mild until about 3 months ago when they suddenly and abruptly worsened. In February, he was being treated for a UTI and stopped eating because he didn’t feel well. He was sent to the ER and we were told the UTI was gone. He was treated for low nutritional status and assessed with mild cognitive impairment. He was also placed on Wellbutrin by the hospital for depression.


A few weeks later, his cognitive issues rapidly and suddenly declined. He was in a state of delirium with hallucinations (he’d never been like this before). He was sent back to the ER and was found to have a UTI. He was diagnosed with “metabolic encephalopathy”. They treated the UTI and sent him back to LTC. He hasn’t been the same since. His cognitive function has been diminished. For the last week, he has complained of stomach pain. They did an x-ray and sent him to ER. The ER ran tests and cleared him, sending him back to LTC. Since then, he’s stopped eating again and complains of nausea, lack of appetite and feeling of fullness in his stomach.


We are so confused. He has never been diagnosed with Alzheimer’s, though he is referred to as having dementia. He has had numerous CT scans and brain MRIs, all unremarkable. He saw a neurologist, but missed his last follow-up after a previous LTC failed to set up transport. His next appointment is in June. We moved him to the best LTC in our area a few weeks ago, but still not much is done. The ER/hospital doesn’t help and efforts to get him into specialty care have failed.


How do we know if/when his dementia has worsened? How do we know if his current symptoms are related to dementia or if it caused by infection or something else? Any suggestions?


Thank you very much.

Constipation? fecal impaction? Stercoral colitis? Is the facility managing his elimination schedule with a bowel regimen? Sometimes a don’t ask and don’t tell situation. Not fair to the old person in their care. Facility staff, nurses and CNA should be monitoring this.
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Reply to Beethoven13
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I am not a nurse, but my husband's Hospice nurse described symptoms that would indicate a bowel blockage: nausea, stomach pain, feeling full, no hunger. The one thing you didn't mention was not having a bowel movement in quite some time.
Please have the docs check for blockages.
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Reply to JanPeck123
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One small thing to add to the discussion. You mentioned low nutritional status. I got repeated utis for years. Doc recommended ester-c, a special type of vitamin c to "help bump up my immune system". It is calcium ascorbate and is advertised as gentle and non-acidic. I took it occasionally and it seemed to work in preventing them.
I noticed when my Mom was in care, beside the issue of needing someone to remind her to drink water, she ate fewer fresh foods. In addition to the other suggestions offered here, you might see about adding the vit c if his physician doesn't think it would hurt anything.
My Mom did not have great reactions to a lot of drugs and it seemed like the more she got the more problems there were. (just wondering about the Welbutrin).
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Reply to Pjdela
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Dementia declines in steps. I watched my mother take a step down in her cognition every so often, and it seemed sudden.

None of her brain scans were abnormal. She had vascular dementia brought on by small strokes and TIAs. Alzheimer's is only one type of many forms of dementia.

Cancer would likely show up as an abnormal blood test reading at the hospital to alert the doctor to do more tests. My D-Dimer reading was off the charts, for instance, meaning I either had a blood clot or cancer. It was the latter, as evidenced by a full body CT scan.

My mother took max dose Wellbutrin for 7+ years. It kept her relatively civilixpzed instead of so depressed she'd be crying constantly or hiding out from being seen. Obviously, folks react differently to drugs. So a new medication is always suspect if symptoms appear out of nowhere.

My father started getting constant UTIs when he was at end of life. His body could no longer fight off infection, even when antibiotics were given and his urine was cultured.

Failure to thrive looks like a bad appetite, lots of infections, hospitalizations, worsening symptoms and more sleeping than usual.

Your dad may have a stomach condition going on....was he seen by a gastroenterologist at the hospital? Was his stool tested? If he doesn't improve, I'd send him back to the ER accompanied by you as his voice. I'd ask for an endoscopy to be done to look at his stomach. It can be anything from ulcers to a parasite to nothing serious. They'll sedate him for the endoscopy, so no worries. After 75 a colonoscopy is potentially more dangerous than helpful.

Best of luck.
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Reply to lealonnie1
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Pjdela May 14, 2025
Yes, my Mom did very well with an endoscopy in her late 80s with some propofol. Didn't take long for them to have a look-see.
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My mom had dementia and UTIs that exarcebated her cognitive issues. She was successfully treated for the UTIs, but finally was complaining about intestinal pain. At the hospital, they decided that she probably had cancer, but could only verify by doing a colonoscopy. The hospital said it wasn't really necessary to do a colonoscopy because due to mom's age they wouldn't treat the cancer even if it was confirmed. Mom was 96 and was moved to hospice for her last days. The point of this story is that intestinal cancer can easily be missed because insurance normally quits paying for colonoscopies after age 75, so they aren't done unless there is some significant reason that indicates one is needed. I would be asking about possible cancer as a reason for your dad's abdominal pain. Good luck getting him some relief.
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Reply to WilliamBillA1
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My 96-year-old mother has had constant UTIs for over seven years. She was living with my dad until he passed six years ago, and the UTI went undiagnosed while he was alive. I really do not understand why physicals do not require U/As after a certain age, but she and my dad covered up the mental problems that she had. It took us a long time after dad died to figure out that something was not right with mother, and by then she was truly unable to take care of herself. We did not live near them, so we had to bring her here. Eventually the UTI was diagnosed, but it took her a long time to get to a state where she could function in an AL setting okay. She still has constant UTIs, in spite of culturing, cranberry pills, probiotics, and instructions on how to clean herself properly (I use the same instructions she used to give my sister and I, but that she has now forgotten). Nothing has worked, but constant vigilance and - so far - intervention with antibiotics have helped. I will say that with each time a UTI has caused her mental problems, a little more of "herself" slips away and she does not really come back to where she was before. We have steeled ourselves to these horrible UTI situations and that someday nothing we do will help. Life can be good and can be hard. We, the family caregivers, can try to be experts in everything, but we will not succeed any better than the experts we pay to be experts. All we can do is try our best and love our loved ones while they are with us. Try not to be too hard on yourselves (easier said than done, I know very well), but I am 75 and my and my husband's health have declined, too, and some of it has been because of the stress of trying to keep my mother happy and healthy, even though that seems to be an impossible task. I hope you can find a happy medium with living your own lives and taking care of your dad's needs, too. I guess my point is, you seem to be doing what you can; but, ultimately, we have to accept that most things are going to be out of our control.
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Reply to asfastas1can
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My dad has "seizures" that are not really - just extreme shivers when he is cold, his BP rises into the extreme range until we get him warm. I have asked the caregivers to put a blanket on him when serving dinner - over the arm that doesn't work and both shoulders, regardless of temp in the house to prevent his body's extreme reaction to cold (never can be warm enough LOL 75 in the house). New habit takes time and he has four caregivers 24/7 at his home and I am there 2 weeks out of the month with the caregivers making adjustments and taking care of house business.
My mom's reaction to having flu was falling/working her way out of bed twice, another time collapsing while trying to use walker and seizure like behavior and increased memory issues.
My point is that the elderly body's reaction to "simple" things like dehydration can look like something much bigger. Not liking to drink water? put a favorite flavoring in it - but if a "no sugar", watch for reactions to an alcohol sugar.
When my dad was in LTC after his stroke and I was in town, I visited twice a day every day and listened for what was NOT said by dad and staff. Some were unkind, most just doing a job/task, he was alone with the TV most of the day -- it was the latter part of the pandemic and he couldn't ambulate at all. He survived because he knew he would be home in a month or two after we redid the bathroom. The same place is now different - staff have more compassion, more "visits" to rooms where everything is needed, more friendly regardless of elderly reaction.
Observe what he is being offered, is kindness part of the diet? or mostly left alone? These situations are really hard and if he has decided to exit rather than endure anymore, that's what will happen sooner rather than later. ANYTHING that he likes - eyes get big like a child's does when mentioned - is a good thing to do - an ice cream sandwich always worked for my mother, until it didn't and she was gone in three days and I was there with Hospice help those last three days.
Applesauce with cinnamon, feeding him yourself, anything that seems appropriate to YOUR situation. That's the part we can't help with - follow your heart in the ideas that are NOT medically minded because the medical often does not know and our mental state is a BIG part of "thriving" - the will to live and continue is a big part of staying here.
And more than anything else...take care of YOU and be sure others that will be affected by Dad's passing are taking care of themselves too. Do they need to see Dad before he passes? You aren't saying it will be soon, but if they need to see him, then now is the time to be sure they don't miss the opportunity. AND it could make Dad realize he is NOT forgotten. That people still love and miss him. You may also find out what he does and doesn't remember and therefore be better informed how his brain is handling life.
My family gathered for Christmas and all who needed to see our parents saw them. My mom (mainly memory issues) passed in January and we've been working on my dad's "thriving" mechanisms since and so far so good. He has UTI issues which are treated "immediately" with the help of a nurse that visits the home, but my dad is ambulatory and eating so I won't say more.
I'm getting prepared for my Dad not to be with us - and making sure my sisters are on board with what happens next. God bless us all!
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Reply to RainbowHeart
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Idkanything May 15, 2025
What a compassionate and informative response!
Thank You!, and yes, God Bless Us All 🙏
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My father went into hospital for a gallbladder infection
he went in fit of sound mind
in there they postponed his procedure - he stopped eating and drinking and gave him medication which gave him symptoms of delirium- I actually thought Alzheimer’s had set in
I got him removed from hospital. We noticed lack of water brought on delirium and Alzheimer’s symptoms-as soon as he drank we returned to normal
tbe co codamol pain tablets also made him ‘ not there’ and gave severe constipation but did they stop or change it-no!
as I say I insisted he have his procedure and I was removing him from their death hospital
that seemed to get people making an effort
he was put in a drip for water/ whatever they put in the water and he came back alive
His decline was thru pure neglect
and that of other patient’s waiting for them to go basically !!
I think it’s prudent to investigate how much water being taken - get them into a meal liquid supplement
we have a compact one do even less to drink
and look at the tablets - if they have changed
after that it was clear fir my dad that the hospital environment was not a positive place and he was going into depression
which he never suffered from
now he’s home
He’s been persuaded to eat and drink again
foods that didnt require chewing or were put in a mini liquidiser
And now he takes foods that he will chew

along with this to point out when someone looses weight if they wear dentures - the dentures could become loose because the mouth shrinks also. If anyone wearing dentures is affected you can buy a denture fix ( glue) to keep the denture in place otherwise they could move while eating and cause pain to chew
and you won’t know that’s the reason someone’s not eating that the dentures are moving rubbing causing ulcers
and need a mouth ulcer cream
best wishes
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Reply to Jenny10
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When my father went into hospital he had a rapid decline
he was having delirium and not eating/drinking
it steadily got worse so I insisted he be released
it was plain neglect - main issue was dehydration which gives off symptoms that look like other decline issues
we also noticed poor reactions to sone tablets
eg co codamol - everytime he took it he had delirium and constipation- the. There was the constipation liquid making him throw up
all in all the place was speeding up the process for old people to go
i think you need to look at his medication
how much water he’s having if not enough then a temp drip and watch the difference
My dad has recovered from the hospital in that he’s eating and drinking and no delirium anymore but it still weakened his body
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Reply to Jenny10
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Hi QueenBee,

I'm sorry that your dad's situation has become much worse.

If your dad's cognitive decline was caused by an infection, there would likely be other indicators, such as an increased temperature. It is concerning that your dad is having more frequent infections, though. That could indicate a failure to thrive.

Alzheimer's is only one type of dementia. I think the key point is that your dad's brain is affected by dementia and that its function will not improve, whatever type he has. Unfortunately, ill health seems to have brought on a sudden and irreversible deterioration.

Do you know what tests the hospital did for your dad's gastrointestinal issues? I wonder whether they have ruled out all issues which could be treatable. However, if your dad did have something very nasty, like cancer, do you think that he would be strong enough or aware enough to deal with aggressive treatment?

When my mum had a stroke, which caused dementia, the part of her brain that controls appetite and eating was affected. She stopped eating, saying that she either felt full or nauseous. She lost all appetite. For a few years, Mum had some good but mostly bad days, until there were only bad days.
Mum was kept alive through drinking the meal supplement drinks (like Ensure), but her weight fell below 6 stone. And lower.
The lack of nutrients and energy meant that Mum was very weak and couldn't fight infection.
It's so hard watching a loved one starve themselves to death. I've been going through it again recently, but this is with someone who doesn't have dementia. It's so frustrating and it hurts like hell.

Please learn acceptance. You cannot do everything. You cannot fix everything. You cannot make someone eat who really doesn't want to.

This may be your dad's time. If so, make his comfort your priority.

Don't wear yourself out trying to get your dad to do something he can't. If he had quality of life, I might not say this: don't push your dad to eat if it distresses him. Give him peace. That way you will also find peace.
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Reply to MiaMoor
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Idkanything May 15, 2025
Bless You 🙏 for going thru this twice and for sharing your compassion and experiences with the rest of us so that we can learn.
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Just a question to consider in consultation with his doctors. Welbutrin is considered to be a drug with anticholinergic effects: https://www.rxfiles.ca/RxFiles/uploads/documents/Psyc-anticholinergic-Ref%20List%20SPDP-complete.pdf.

The effects probably vary from person to person, and may be more intense in the elderly, who process drugs differently. There is research looking into connections with dementia, e.g., https://www.health.harvard.edu/mind-and-mood/two-types-of-drugs-you-may-want-to-avoid-for-the-sake-of-your-brain

The new prescription for Welbutrin may be entirely coincidental. My mom has cognitive difficulties that seem much worse lately, without any new drugs. So I wouldn’t jump the conclusion that Welbutrin is associated with the cognitive changes.

But it might be worth discussing with the doctors. Maybe it would be worth slowly tapering off the Welbutrin, to see if there is any improvement. Maybe not. Depends on his complete health situation and his doctor’s advice. Would also take time to see improvement (tapering + a stabilization period after tapering).

I also think the other suggestions are worth investigating. This is just one speculation among many, about what might be going on. Aging and changes in disease status may be the more likely culprits. I hope you will get a clearer picture of what is going on soon!
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Reply to UpstateNY
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My sister was having cognitive issues 3 years ago along with other symptoms . They went from thinking it was ALS , to Parkinson’s . But both were ruled out . They said they did not know what was wrong with her .

2 years ago she had sepsis and metabolic encephalopathy following a bout of bronchitis . She almost died . She never returned to her baseline .

She has subsequently been diagnosed with Lewy Body and vascular dementia after finally having the proper scans , and MRI . Originally they had done scans and MRI without contrast .
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Reply to waytomisery
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MiaMoor May 5, 2025
Yes, it's so important to do the scans properly.
Mum had an MRI, CT with contrast, as well as an EEG. This was in the spring of 2020. It was eerie going into what seemed like an empty hospital, without all the visitors milling about.
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What you need to find out is, if they are doing a culture when Dad has his UTI. Or are they just giving a broad spectrum antibiotic. A culture will tell exactly what dacteria is causing the problem. He should be on IV for a couple of days in the hospital. What are they doing to prevent the UTI from coming back? My Mom was on cranberry tablets and a probiotic daily. In her last year of life, she had no UTIs.
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Reply to JoAnn29
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asfastas1can May 8, 2025
My mother has constant - and I mean monthly - UTIs. She, too, is on cranberry tablets, and a probiotic. Unfortunately, nothing seems to stop the UTIs from recurring. They culture them, too, to make sure the antibiotic matches what infection to fight. The last time we had to take her to the hospital because of the mental confusion caused by the UTI was too much for the AL to handle, and she was in the hospital for four days with an IV. Sometimes, the UTIs are just going to be the problem that she and we have to put up with. We, the family caregivers, are trying our best to be experts at everything, even though the medical experts have run out of ideas. It sounds as if you, too, did everything within your power to help your mom, and I am glad she was free of UTIs in her last year.
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I am assuming you are the POA?
I am assuming Dad is currently living in your area?
Other than the followup with the doctors, I don't see really what help we can be. He is currently being hospitalized and tested. It sounds like there is definitely a worsening of his dementia, but there have in the recent past been some reasons for it. Now it seems like it is a constant, no matter the status of his physical health.

This is a matter of getting a good gerontologist and a good neuro-psyc MD working together. How do you do that? In this day and age that's a real good question. I can only wish you luck.
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Reply to AlvaDeer
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Dementia isn't typically related to "nausea, lack of appetite and feeling of fullness in his stomach" so to me it sounds like your dad has more than one issue going on right now.
The only way you can find out exactly what is going on is to have him taken back to the hospital and insisting that he not be able to leave until you have the answers as to what is going on with him. You will have to put your foot down and not let the hospital dictate what will be done or not done.
Your dad deserves to be treated properly for his issues.
And depending on what the findings are, it may also be time to get hospice involved. His doctors can help you with that.
I wish you well in getting the much needed answers you and your dad deserve.
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Reply to funkygrandma59
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