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Well, finally got Mom to sign an Assisted Living lease, did the assessments etc. Only agreed to try for a couple of months, but we felt that would do the trick. Family made plan to get furniture moved and everything set up.


But, life happened. To help discuss and plan move and get me a little respite, my adult daughter offerred to invite granny over to her house for a few hours after a family birthday party. Everyone wins, granny gets an outing, I get a break and a dinner with hubby. My Mom unfortunately later that afternoon missed the last step coming down stair with my daughter and took a hard fall. We came and got her took to ER and she has a broken bone in right hand, a broken cheekbone, and bruising all over face. They kept her in observation area at ER overnight, and sent us home in morning, with instructions to follow up in 2 weeks. Thankfully no surgery required.
But afternoons and evenings have been horrible. Last night she was practically hysterical telling me she had to go home, becuase of her child, who is 5. ( no 51), Could not break her out if it, not even talking to my sister multiple times or even calling a friend helped.
Shes argumentative, keeps pushing back on regular meds. Waked me up multiple times in the last few evenings talking about things and people not there. This is a significant change, she was always a little more confused in the evening, but not to this degree.
Add to this the cast is on dominant hand, and she is not supposed to blow nose (and a lot if crying going in right now with the confusion), its a mess.
Will this settle down, should I take her to doctor, maybe they missed something (she had CAT scan in ER)?

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I would get her seen by a doctor that is not a hospitalist.

I have had no good luck with them and it is truly no wonder that medical errors are the 3rd leading cause of death in the USA.

Something has obviously happened for all of this sudden mental decline. She could even have a UTI, or it could be something else, but it should be checked into.

I am so sorry that your mom fell. That is enough to shake anyone to the core. Hugs to both of you.
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Reply to Isthisrealyreal
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Gracie61 Feb 13, 2020
Thanks, I think I will call her neurologist who is here in town. unfortunately her regular PCP is 200 miles away, since she is staying with me right now. I know the hospital did do a urine test, so I dont think UTI. She's pretty normal for her daytime.
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A neurological evaluation would be indicated. When she fell, she sustained a head injury (broken cheekbone, bruises.) A CT scan at the time of the ER evaluation may not have showed anything significant. However, you mention a change in behavior since this incident with worsening "sundowning." It may be that there is something going on in the brain such as a slow brain bleed. That may not have been present in the ER but may be present now. The neurologist is expert in evaluating such issues. He may order repeat testing and further treatment.

Unfortunately, given her current sundowning behavior, she may be beyond AL and need Memory Care. Sundowning symptoms are very difficult to manage, and as a daughter whose mother in memory care suffers from that, I leave it to the staff to handle since they are arms length and are trained/used to dealing with that. We do not take mom out or visit later in the afternoon, it's just not good for her.
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You have been given some good medical advice here, which I am sure you will follow up. The slow brain bleed is worth careful investigation. On a practical level, here are a few suggestions:
1. To prevent falls when with someone with dementia, it is good practice not to talk to them while they are on the stairs. That way that will focus more on the stairs and not on the conversation. However, some people with dementia could find it helpful to hear your encouragement while they are negotiating the stairs, so there is no single answer here. Staying close enough to prevent a fall (if that is possible) is also a good approach.
2. Avoiding stairs if at all possible is a good idea. This might mean turning a downstairs room into a bedroom, but the inconvenience is much easier to handle than a serious fall. You can get a chair lift, but they are expensive and their resale value is very low. Some people also will not use them. I would check carefully if the person with dementia is safe to sit in it and is willing to use it. I would be doubtful on both counts if this is a solution.
3. You are probably right that the lack of carpet on the bottom stair was the cause of the fall. Check carefully on carpet locations and colors to see if any changes need to be made.
4. "Sundowning" is a challenge and needs to be considered in planning the daily routine. There is some evidence that getting enough sleep helps those with dementia to deal with the plaques and tangles in the brain. Sleep doesn't remove them, but it does seem to help the person with dementia recover from their effects. Try to see what pattern of sleep and activity works best. If the person with dementia is getting very confused in the late afternoon, see if different bedtimes or naps in either the morning or afternoon are helpful.
5. Check carefully that the person with dementia is getting enough liquids in order to avoid dehydration.

Prayers and the hope of helpful remedies in a challenging situation
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I’d support the suggestion that the fall may have caused a slow brain bleed that didn’t show up immediately. My mother in her 60s had a fall, hospital checked and sent home, drove two days to see my sister, and three weeks later had to be brought back by the Flying Doctor. Bi-lateral sub-dural haematoma. Worth a check!
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Is she "fine" during the day, or is she agitated then as well?

One of my mother's doctors instructed me "a change in mental status is a medical event and needs to be reported to the doctor right away".

I wonder if perhaps the fall was precipitated by a TIA or stroke? Sometimes they dont show up in the ER.

I would call mom's doc right away and ask for her to be seen today. 2 weeks is too long to wait.
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Gracie61 Feb 13, 2020
I think the fall was a perception issue. My daughter's stairs are carpeted, except the last step. Its wood and blends in with the wood floor. My daughter feels terrible she stepped away to make sure her little dog didn't get in the way, and my mom thought she was already down and just missed the last step and went flying and hit floor and slid into cabinet in kitchen.
She doesn't have a PCP in town yet.
She's a little more confused during the day, but mostly the same. But evenings have been turned up to 11
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If you haven't done so already, please get your mom medical attention immediately. The same thing happened to my father-in-law, though he had not been diagnosed with Alzheimer's at the time. He'd had several falls, but didn't think anything of them until he suddenly had odd spells of being unable to speak or walk, and a spontaneous lack of bladder control, at which point my husband flew out to see him and got him to the ER. He was hospitalized and declined rapidly. It turned out to be a subdural hematoma, which was surgically repaired, and the surgeon advised that the bleeding was from a very old injury that had most likely occurred several weeks prior to the onset of symptoms.
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I agree with the others that she needs a recheck - ERs generally stabilize, but expect further treatment to be elsewhere. Although they said recheck in 2 weeks, that was given she was stable at the time of discharge! Neurologist is probably better for this recheck than any regular doc. Stress to them when calling to schedule that she's had severe issues since discharge, to highlight the need to get her in sooner rather than later!

It can't hurt to recheck for UTI. Sometimes it requires a culture test, not just the dip stick test. Our mother had some odd OCD behavior which started just before she went to bed (was living alone and we had some cameras in place) and became a nightly marathon (1-1.5 hours of checking the door lock, side lights, dishwasher and LR.) This was most likely her "version" of sun-downing. She really didn't exhibit any issues like this after the move to MC, until she had her first UTI there. THEN she was out of control late every afternoon/early evening. Fine the next morning.

When I first joined this site (before the move and UTI) I was skeptical of the UTI comments, until this happened! In addition to the antibiotics, she was given Lorazepam (anti-anxiety) in the afternoon, minimal dose. It was just enough to take the "edge" off, and was only used during the UTI treatment (in your case she might need it every day, if she was already sun-downing and non-medical interventions don't work.) After mom's UTI, we kept it on hand "as needed" only, mainly because her "trip" happened on a Friday night and we had to wait until Monday to get this checked! For the most part we haven't needed it since.

Although I prefer not to medicate, this medication was great as it doesn't take time to build up and can be discontinued when not needed (worked first time/every time we needed it and no withdrawals.) Not all medications work for everyone, so it could take trying others. Since this did work quickly for our mother, it shouldn't take more than a dose or 2 to determine if it works for your mother - then something else could be tried if it doesn't work. Two subsequent UTIs our mother had presented as night-time bed wetting, big time!

As for stairs, best to avoid them if possible. In a situation like your daughter's, it might help to have some bright colored tape on that last step, to make it more obvious. It is easy to miss steps, even when not older or impaired with dementia!
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Reply to disgustedtoo
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Beyond the other reasonable advice here, just in case this might be helpful, when she is bringing up things that make no sense or gives you the "I want to go home" or I have to go home lines, rather than being truthful or rational or argumentative with the reality, remember you have permission to lie. A sitter is with the child; ok, we'll get you home in the morning...(by which time she likely forgets). On my parents last trip to FL to see my sister, we didn't realize mom was getting on the path already...she was quite distressed to learn they'd be there 10 days...oh no, she had bills to pay...my sister repeatedly showed her the calendar. THEN she just happened to tell her she was going home "the day after tomorrow". It did the trick. It was soon enough to satisfy her and then she'd forget or couldn't process the concept...It was my last staycation.
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How to cope:

As JTFW1924 suggested, you have to "go with the flow."

Learn all you can about sun-downing, redirecting focus, how to deal with various behaviors, etc. Sometimes simple adjustments such as lighting can help. Be agreeable to anything she says/does (so long as there's no safety concerns.) Don't argue with or try to correct her. You will only frustrate yourselves and her more, and ramp up her anger/anxiety. Fibbing to assuage her will come in handy (use it to defer going home, perhaps tomorrow, make plausible excuses for missing child, such as having a sleep over with friend, etc.) Try to get her focus onto something else, cup of tea, snack, some activity, etc. Since it appears to be afternoon, DO consider an anti-anxiety medication. The lowest dose should be enough to take the "edge" off and won't "dope" her up. For our mother, it didn't take time to build up in her system (worked first time, every time) and there's no withdrawal issue if/when it isn't used anymore.

For the talking/repetition, just be agreeable, go along with whatever (exception is the child/fear - find an excuse why the child isn't there.) Response to questions should be kept as simple as possible - no details. Why am I here? Just for a visit, dinner, to help with something, whatever might work. When can I go home? Soon, a little later, tomorrow, or whatever works. No long detailed explanations, no long winded responses. No reminding her she agreed to the move(s) - she doesn't remember it and you won't get her to acknowledge that now!

I do understand how the constant barrage gets under your skin. I didn't live with mom, but a 30 minute phone call that was a repetition of the same 3 things over and over... augh! Just yesterday I stopped by. She kept saying she'd like these shoes in the sale flyer, over and over, and they're only $29! I show her similar ones at WM on my phone, only $10. Annnnd repeat... Once they get fixated on something, it can just go on and on. You have to get informed and skilled at changing the subject, changing her focus. I liken it to a scratch on a record, which keeps skipping and playing the same thing over and over. A little nudge and it moves on (sometimes to the next scratch, but at least it is different and can be nudged again!)

Although I already posted it, I can't stress enough that you should get a urine test/culture. IF it turns out she has a UTI and it gets treated, all the above will just be learning how to deal with it in the future - the current should go back to near "normal" (from before the fall.)
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Reply to disgustedtoo
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Does she get more lucid (more her regular self) during the day? Was she prescribed pain meds other than over the counter NSAIDs? IS she getting less sleep than usual? If any are yes, than we have our answers - narcotics can cause some confusion, less sleep can cause more confusion, more pain can cause her to be more agitated. If she is more like her usual self for some part of the day... this will pass once her injuries heal. She may have a slight concussion (brain bruise) that should resolve on it's own.

Does she remain confused throughout the day? Is she on any blood thinners or medications that tend to thin the blood? Have you noticed weakness on a side of the body or mouth (ask her to smile and stick out her tongue)? Are symptoms worsening? Headache, especially with light sensitivity or nausea/vomiting? If yes, then you want to follow up sooner with a doctor. She could develop a brain bleed (stroke) from a slowly leaking area. These may require more treatments than a wait and see approach.

Realize it takes older bodies longer to heal than younger ones. If she was on medications that thin the blood, she will have more bruising and swelling than other folks,,, which will take a little longer to heal.
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