Husband with dementia had pneumonia and sepsis, ended up in the hospital, and now his dementia is worse! Will it improve?

Any interruption in routine can exacerbate dementia especially a stay in the hospital. In a hospital there is no day, no night, no time frame and strange faces coming and going. It's very difficult on a person.

It's impossible to say if your husband will bounce back or not. That's probably a question for his doctor.

Everyone is different but I doubt there will be much improvement. Once my mom was hospitalized for pneumonia she had full blown dementia come on immediately. She has only declined since and rapidly. She had been driving, living independently and managing her own finances till then, once hospitalized she couldn't done any of that on her own. She had to be hospitalized again a couple of months later to have a breast removed and it worsened again. Now she is in an assisted living facility and she still knows most of her family but not much else and it gets worse day by day.

Good luck with getting any answers from doctors - they really don't have any clue either. Everyone is so different and what their other medical conditions are - so many things impact people differently but I hate to say that once the decline begins it's rare if not impossible to see improvements. So in my opinion it is best not to expect it and if it does improve feel blessed but anticipate the worst and you won't have such a hard time coping with something you didn't see coming. We all prefer denial but reality is harsh and swift.

I’d be more concerned about what his sepsis status is.
Did his physicians at all mention “MODS” or his going into “cascading” of care needs? Sepsis is pretty serious to deal with even if you were previously healthy and get really bad pneumonia and then get something else - like a bad infection - elsewhere and get septic.
I’d suggest you contact his MD to see if any of the changes are symptoms of his going into MODS phase. My MIL was septic & went into MODS. She went into a free standing hospice facility post hospitalization rather than going back to her NH; and it was covered by Medicare. imo MODS needs a care team and beyond what a spouse on their own can do at home or a NH can do.
Please call his MD to discuss what’s happening.

As posted before, doctors can’t be much help. It’s a ‘wait and see’ situation - people are different and react/respond/recuperate differently. I have cared for my father with Lewy body dementia (at home for 14 years and going on two years in a facility) and have witnessed these changes; general anesthesia is an enemy to someone with dementia and it takes them much longer to regroup. My father has bounced back some after a total hip replacement, the move from home to memory care, and even changes to his medicine. But dementia is a progressive disease, and decline is inevitable - that’s our ‘normal’ now, unfortunately. I am sorry to say that you are in for a lot of ‘firsts’. I rejoice on the days that he knows who I am! My only regret is that I did not find this site sooner to help me through those first dozen years - you have many friends here that have experienced multitudes of situations and will be happy to share their experiences with you to help you in any way they can. My thoughts, prayers, and hugs are with you and your family as you go through this journey.

Read up on something called “ICU delirium.” That’s what happened to my mom; it’s taken about a year for her to come out of it.

I am replying based on experience with my mother. In her case, yes, she did improve but it took time. We all thought she was near the end, but she wasn't. Her doctors did not give us helpful insight at all. Perhaps everyone is different so no doctor can say for sure. We took it one day at a time, and she slowly got close to her baseline prior to hospitalization. Maybe if your husband is recovering from pneumonia and sepsis and if new meds were introduced to treat it, those factors could be impacting his current status and ability to rebound. Once he fully recovers from those conditions, you may get a better picture of where he is at. I know this is hard. Prayers to you.

Pneumonia will have that effect on Dementia people even people without it. Just read that Sepsis was probably caused by the Pneumonia. But it is very serious.

Great answers/advice given.  Based on my own experiences;  it may improve - or maybe it won't - time will tell.  When my Dad was hospitalized with the flu, it changed his life.  He regained his cognition for the most part, but he hasn't driven or walked without a walker, since.  My Mother had a traumatic event that landed her in the hospital and I thought she would never be the same.  Not so.  I am thankful to say that about two weeks later, she was back to herself.  (She has advance dementia).  I pray that things improve for you and your husband - One day at a time ....

Yes having pneumonia compromises the oxygenation of the blood, thus less “fresh” blood to Major organs like the brain. It will take some time to get back to his baseline or where he was prior to his hospitalization.

The pneumonia is putting even more pressure on his already compromised body. Mom's a zombie if she doesn't get a good night's sleep for example.

What's his BP and pulse ox?

It might get better.... and it might not. Talk with his doctor to piece together a game plan. Then take it from there. Good luck.

He will probably not get back to the point he was prior to the illness. And with each illness or hospitalization he will not recover to the "starting" point.
He will improve. It may take weeks or months depending on how severe the illness was and how long he was in the hospital.
Side note this is a problem with ostomy's, feeding tubes and IV's people with dementia will pull them out. "they just don't belong" to their body and they do not understand that it is something that may be needed. (I will not get in to feeding tubes or other procedures that may not be wise)
Keep things as "normal" as possible, get him back on whatever schedule he was on before. If you have him in Day Care get him back as soon as possible. A routine is important and the sooner he can get back on track the better.

If this was a pneumonia caused by aspiration this may happen again. If it does happen again you might want to discuss with the doctor about thickening liquids so it will be easier for him. At some point the body/brain does not recognize liquids and will not close off the way to the lungs. This will lead to more bouts of aspiration.

Pneumonia used to be called the "old people's friend," as it caused a relatively peaceful death before the person lived on to develop lots of worse conditions--dementia being among them, in my opinion. My great grandmother had dementia in pre-Medicare/Medicaid times. She lived with my grandparents who never took her to a doctor (although I don't know if she had any conditions that would require medical care these days). When she quit eating, they didn't try to feed her and so she died. It sounds cruel, but she didn't drain time and money from my grandparents (who were busy during day with their flower shop) and my mom, who took care of her during the day. My family lived with my grandparents as well, they had big old house. If I develop dementia, my kids are under strict instructions not to call the MD to treat any life-threatening illness--pneumonia, heart attack, cancer--but to let me die. Why our society values life over quality of life is beyond me!

After 2 taking care of 2 parents...they always seem to decline a lot when they go into the hospital. If there was infection, that seems to compound things. I've had them regain like 95% if not all. Hydrate...get him moving around...read to him 1-1 directly engage him. Read the newspaper. Makes a big difference. Smooth diet. It does not have to be the beginning of the end, especially if this was his first big episode.

My opinion. More you engage, hold his hand, etc. the better.

John

Oh my gosh...so sorry to hear what you are coping with. Hospitals really need to do so much more in protecting the cognition of all older patients but especially one with dementia. Being hospitalized is traumatic in itself. I think there is always hope for improvement, especially once back home...you might want to check into SAIDO (I think that is how you spell it). It is a program that works with people one on one regularly to help regain function, but of course I wouldn't know if this would be helpful or not.

Yes ! Keep the faith but also keep the routine. He wont get better just lying in bed. And it will take time. But yes. He might not get 100% back but 95%. Pneumonia @ hospitalization does a # in all seniors, cognitive impairment or not. Is he getting any home therapy? He could possibly benefit from OT/PT/SLP. Try to resume his routines & rhythms as much as possible. He struggled to make coffee? Did he do it though? Was he Independent with ostomy care before? Dont sweat/stress the b’day info go for routines he had. Trust me they are fairly hard wired & need activating with patience & cues. When did he get up ho to bed change bag etc before? Whats most imp to you for him to do? What does he care about. Constancy & routine are keys here. Let him do things — take the standby cues role... hard contain your own emotions - but breathe & relieve them elsewhere. the standby give him time see if he figures it out & cue & positive reinforce the correct stuff. Get up go to bed eat meals etc same time every day. Pick 1 or 2 things like ostomycare & make coffee . Build from there. What’s imp to him? break the steps give him time to do it. Can he follow simple directions? Write them done & let him follow in his iwn time. Home OT & SLP can help with this . Im an OT & Ive seen it happen. I wrnt through this with my father & he went in hospital cognitively intact & reached a point where he couldnt fig out what a toilet was for &but using the aforementioned he did come back ... takes timez get dupport for you.

My mom was the same way right after the epidural shots on her back. Then, after she broke her arm, and leg, Mom’s dementia kept getting worse for a little while. After being in the facility, and was taking therapy, she was improving until she had pneumonia, and many health problems. 'Weird that on her birthday, I think she had the 'rally', and she made me think that she was going to get better. However, about three days later, her doctor called me to tell me my mom was not doing too well, and that she was eating well because of the pneumonia. Then, she died a week later.

When my mother had pneumonia, I thought she had lost her mind and she wouldn't come back. In the hospital, she had elaborate hallucinations and weird paranoia. But as the antibiotics began to work and she got over the pneumonia, she recovered her clarity of mind and was pretty much herself again.

One suggestion -- manage the screens in his life. Visual and sound input. Play some music softly in the background. If he's home, make sure he's seeing things he is familiar with, his favorite shows, listening to stories on tape (RBDigital is available from your library probably), even home movies. hospitals and visiting therapists often have the tv on regardless of what's coming at him. he's very sensitive to input right now. At a rehab facility, no matter how much I asked and pleaded that my mother's screens be carefully chosen, she would be in tears thinking crime dramas were real news and warning me there was a rash of murders in the neighborhood. (If somebody wants a viable business idea -- make a Eldercare cable station, of happy Lawrence Welk shows, Fred Astaire dancing...movies guaranteed not to have any death, murder or angst in them and NO ADS EITHER, because sheesh, I would put it on PBS or nature shows, and next thing there would be a bloody dead body advertising the upcoming murder mystery. Couldn't win for losing.)

Hi,
im sorry you’re going through this. I too went through this with my husband last July. The dementia WILL subside. It takes some time ALOT of patience and love. It is frustrating and yes you feel loss. Finding balance is hard and most family and peers don’t understand. You have to think for both of you right now and that is scary. Play card games, board games. Get your husband thinking. Remind him to make lists. Give him small tasks. Reintroduce him back to life in small chunks. Socializing is a big part. Keep it positive.

Thinking of you
Michele

I am so sorry you are dealing with this. My own experience is all too similar. My husband with advanced Parkinson's was hospitalized just before the holidays for a week with pneumonia and a urinary infection that became sepsis. This happened twice before, two years ago. The good news is that each time he has returned to his previous condition, though very gradually after several months and sometimes longer. I hope that is also true for your husband. Being in bed in the hospital can leave someone, especially someone older or sick, very weak, and also confused, or in my case even more confused. It's been a big relief for both of us to have his old self back. The bad news is that it has taken so long. Also, after the first hospitalization, he became so weakened and his balance so poor that he can no longer go up or down stairs, and has had to sleep on the first floor. But it's hard to,distinguish between his hospitalization and its causes, and the inevitable progression of his Parkinson's. I do know that sometimes elderly patients get something called "hospital-induced delirium," especially after a stay in the ICU, and that it can be long-lasting or even permanent. That doesn't surprise me, given all the disorientation, sleep interruptions, bright lights, loud noises, constant beeping alarms, and just unfamiliarity of a hospital environment. I wish your husband a full recovery. And I think I would follow up with his primary doc to check him out just to be sure.

Joycee1, I really sympathize and identify with your exhaustion and burnout. I have been in much the same place, several times (just not today) and have even found myself wishing, briefly, that he would die soon. I feel horrible saying that, and even for feeling it. But I've heard it's common. And so I forgiven myself. In any case, I've always known afterward that those are the points where I need to realize that I need more help at home with him. And so each time I've eventually hired more caregiving help. It is expensive and practically bankrupting us, since he doesn't have long-term-care insurance, but that seems better than ruining my own health, physical and mental, which has started several times to happen. I have to say that has helped a lot. Often I've thought I should be able to handle it all myself (and my husband wishes I would!) but I can't. No one can. I tried. Two years ago he came home from the hospital totally incontinent and demented, and overnight he would climb out of bed and fall, sometimes injuring himself seriously. I went four months without more than an hour of uninterrupted sleep and my health collapsed. So I hired caregivers overnight till this improved. Please don't let it get that far. What would happen to him if you totally burn out like that or get really sick? You sound as though you are showing the signs of being overwhelmed, and I hope you can find some respite or ongoing help with him. As his caregiver, you also need to care for yourself.

Every situation is different, but I can tell you an encouraging story. After a week in the hospital and a month in rehab, my husband (also with dementia) was so much worse that he could do none of the five ADL's when he came home. The OT at the rehab said he'd never get back to baseline. But he did!

Luckily my sister was visiting at the time and helped me tremendously. We had a visiting NP, and soon got PT and OT as well. Being away from home made him quite crazy with hallucinations. He gradually returned to his merely forgetful, slow-moving self.

Be attentive and patient, and ask for all the help you can get. If you can get an aide in for the afternoon, take a break and go to the movies.
It's tough, but can definitely get better. I wish you the best of luck.

When a patient has been septic with an infection it can take days / weeks to recuperate. Was he on IV antibiotics or oral medication? Has he had follow up bloodwork to see what his levels are for Whiteblood cell count? Follow up chest X-ray? It could be possible that the antibiotics may have interacted with any dementia medication he is taking.

Monitor the sepsis and the pneumonia carefully.

I don’t have the answer for the ostomy bag, but I do know the feeling as I deal with my poor guy who just lets go wherever. I’m looking for mops that I can attach to my socks to dry the floor, as I follow my cleaning oceder mop around. I’m gonna see if I can invent something to help myself. Coming back from the hospital stay, I think, try to take control like the staff did there. “We’re going to do this now” and “your schedule is this and this”, I’m still looking for that firmness of voice that gets your loved one to co-operate but every time it does work I give myself a hug and say I’ll get through this.

Check his blood work to ensure other functions are in balance. Were medications added during his hospital stay? Read about proper dosages and study all medications together (as a whole). Look for drug interactions and side effects. Make sure he isn’t over medicated. Give him lots of love and ease him into a normal sleep schedule.

This is one of the least discussed side effects of dementia and Alz! Health problems (like urinary tract infections) can wreck havoc with the dementia brain. Anesthesia can plunge an MCI patient into deep dementia. Sometimes they come out of it, sometimes not. With my husband, middle-stage Vascular Alz, he had BIZARRE hallucinations for two weeks (almost always at 4 am) following a steroid shot in his spine for severe stenosis. The doc knew he had Alz, but never told us this might happen.

I have since learned to be wary of all medical procedures when it comes to my husband. Especially anything involving anesthetics.

Now, my husband uses medical marijuana for pain relief and agitation. Works great. But, start small. Less is more.

It did not with my dad. He was much worse and declined rapidly afterwards. The Fluoroquinolones Antibiotics they usually use for these infections cause terrible side effects and worsen and cause dementia. I know for a fact it caused my dads dimentia. He came home with after treatment for a bladder infection and was never the same.