Concerned about elderly Mom sleeping most of the day. Any advice?

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Hi all, my mother had a stroke in October of 2010 which left her with short term memory issues and poor balance. She can walk with a walker. She is 89. She refused to do physical therapy or leave the house and as a consequence sits all day and is extremely inactive. Her condition has slowly deteriorated and this past December she contracted shingles and has since recovered, but just hasn't seemed to be able to bounce back. In the past 2 weeks she is sleeping almost constantly. She wakes up during the night and dozes in the chair. She is groggy for the short periods of time she is awake. She lives with my brother but I spend 2 nights a week at her house to help out and give him a break. On this last visit she slept the entire day and into the late evening both days I was there. I had to wake her for meals. She seems to have a semi-alert period from about 9 to 12 at night, and then starts to fall asleep again. In addition to this, she has swelling in her feet and legs, and one leg is worse. I also suspect she that she might have a urinary tract infection because she frequently has the urge to go but doesn't actually have to. Her appetite has also decreased a little. She seems to have become more frail and weak in the past few weeks. She was at the doctor last month (was doing better then compared to now) and at that time everything was within normal limits . She doesn't have any health issues. She takes Aggronox, vesicare, synthroid, and folic acid. I am shocked she is doing this badly, because other than the stroke she hasn't had any other health problems. She has been taking Lexapro for about a month and a half and it seems to have improved her mood. The problem is she can't stay awake long enough to be in a good mood!

She has a doctor's appointment on Monday but I am very afraid she will not be awake enough to make it. In addition, I fear the doctor might want to hospitalize her and he has privileges at a hospital that I feel is of poor quality and that I dread going to. She was there for 2 days after her stroke and it was a nightmare.
I think I would prefer to take her to the emergency room of another hospital that is closer and in my opinion of a higher caliber. We could take her at night during her semi-alert period. I am thinking that she might be admitted to that hospital because I can't help but think further tests are going to need to be done to determine what is going on with her. Is this acceptable? Will it be an issue if we break rank with her primary care doctor? Frankly, I have not been that happy with this doctor and think it might be better if we get another medical opinion of her condition. Thank you very much for reading this and I will greatly appreciate any thoughts, opinions, and advice that any of you have to offer as to what could be causing this excessive sleeping and the correct thing to do to get her medical care. Oh, another concern I have is what to do if she refuses to leave the house to get medical treatment.

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I don't know what state you live in but Medicare has revamped it's care and is asking people to choose a primary care doctor that is within their program. This greatly reduces share of cost should that apply and is oftentimes fully funded by Medicare. You can follow your plan to take her in to the ER but if it's by ambulance, plan to receive a hefty bill. They will take her most probably immediately however. If you bring her in yourself, plan on a long wait. Our hospital here it seems the ER is always packed 24/7. I'm not much of a fan of pharmaceutical drugs. They fix one thing but make problems with something else and could be interacting with other drugs to produce a negative reaction. Maybe the sleep is her way of winding down her life. I would just let her sleep but you must have her looked after. Maybe it's time for assisted living for your mom where she will be monitored at all times.
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I would insist the hospital run tests for sepsis. My mother got sent home from an evaluation on a Friday, after getting a little hydration fluid, feeling pretty good. The following Monday was rushed to the ER with a temp of 102. She had an infected Parotid gland, they missed with bloodwork, CT scan and chest xrays. By that Friday, her kidneys couldn't keep up with all the fluids they were giving her, it backed up into her lungs and I lost her.
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I would insist the hospital run tests for sepsis. My mother got sent home from an evaluation on a Friday, after getting a little hydration fluid, feeling pretty good. The following Monday was rushed to the ER with a temp of 102. She had an infected Parotid gland, they missed with bloodwork, CT scan and chest xrays. By that Friday, her kidneys couldn't keep up with all the fluids they were giving her, it backed up into her lungs and I lost her.
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And Jayne, you are thinking this is overwhelming now, and it has not begun yet. Wait until it does. If she comes home it will become very overwhelming to say nothing of increased difficulty much more to find appropriate placement.
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Jayne, because of insurance, she should be admitted, not under observation. I do not understand the impacts but maybe someone else here does. They may be doing that because she was just in last week.

If you cannot handle her, this is the time to tell people at hospital that you are not able to provide the care she needs. STAND YOUR GROUND! They will have to find placement for her.

If you think your brother will not be able to handle it, you are probably right, you know him very well.
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Thank you all - LearningCurve, thanks for the tips, been pushing the fluids luckily she likes cranberry juice.

Thanks Cyn111 - yes, I believe my mother qualifies for this because she's been prescribed oxygen.

Crazy time here - my mother declined each day she was home - by yesterday she couldn't stay awake for any length of time - extremely weak and unresponsive. Can't walk. My poor brother still managed to get some food and liquids in her, bless his heart. He had to feed her. She's so weak she can't do anything for herself. I arrived at her house this morning and she was so unresponsive we called an ambulance. Did a bunch of tests and there's nothing physically wrong with her. Not even evidence of a UTI. We're shocked - we thought she'd be doing better after getting treatment for the infection. I think the hospital was going to send us home. I have no idea how we would even manage that right now. Now they're going to keep her overnight for observation. But bottom-line is we are going to have to take her home, and it is overwhelming. My brother is willing to care for her, with me coming two times a week, but it just seems like too much for one person. We're thinking a hospital bed for the living room, and using a bedpan. But how are we going to bathe her? Obviously we are going to have to have help come in. I can't believe this, it's such a mess.
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Jayne30: It takes 2 days (48 hours) for a proper culture to develop and determine a UTI. The UTI your mom had may not have completely gone away and has resurfaced.
I have heard that a low dose antibiotic for an extended amount of time works well with UTIs that will not go away but doctors are reluctant to use this cure because they and the Hospitals don't make money on it.
Regarding hydration: Try a straw....my mom has trouble holding onto a cup/glass and is embarrassed by it. When we use a straw her pride doesn't keep her from drinking fluids. Of course my mom likes being babied too and your mom may be offended, so ask her if she would like a straw/if it might make it easier for her.
Cranberry and tomato juices have uric acids to keep the bladder clean so push those.
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Ask your Mom's doctor for a visit from a home care nurse for an evaluation of needs that can be met at home… my Mom had eval after I called Mom's primary care dr and spoke with her triage nurse… he got ball rolling so fast! Home care orders for eval signed by dr that morning and nurse in our home for eval 2 days later (had to wait over weekend as talked to triage nurse Friday morning)… Mom qualified for nurse visits 2x week for eval of her… home health aide 1x week to help with bath… physical therapy 2x week to help with balance and other issues… speech therapist 2x week for swallowing issues… social worker 4 visits to help identify other needs… ALL for up to 16 weeks paid by Medicare as they termed my Mom as "house-bound" temporarily… all this was a HUGE help as I was at wits end and badly burned out… and all it took was phonevcall and tears with the right NURSE… have been a nurse for 25 years and have set up same for other families… nurses are great resource as they have a bit more time with patient/family and doctor's ear… good luck!
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Thank you all!

Loridtabbycat, I agree, people on the site really know their stuff! Good luck, hope your mother's recovery goes smoothly.

Thanks blannie - I've noticed that my mother definitely perks up even just riding in the car - I have tried for years to get her to out and she just refuses. Right now she is still so tired and weak I don't think it's an option. In fact, I'm supposed to take her to her PCP on Monday and am nervous about getting her there. I feel like I'm back to square one. I agree, it's amazing how elderly people can "turn on" when they are around other people. Thanks for the link on the cameras, am checking it out.

Bamboo, you are probably right, she probably just can't generate enough energy on her own.

Not sure what to do here, she's very weak, groggy, and sleepy - not sure how we're going to manage bathing and just basic daily functions. Quick question - is it possible she's recovering from the uti and that's causing this weakness and sleepiness, and she'll feel better once it's completely cleared up? Not sure what's causing it - dehydration, the uti, a combination, or something else. Should she be doing better at this point? We're getting her to drink as much fluids as possible. I don't know, I have a feeling we're going to be heading back to the er. But I'm afraid the same pattern will just repeat itself.

Is at home intravenous fluids an option for us?

Also, anyone use a bed alarm or have recommendations for a good one?

A major THANK YOU to all!
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My grandma who suffered from Parkinson's is going through similar situation. She's very weak and sleeps most of the day. One day my mom took her to hospital where she got fluid with drugs and nutrient, she found her energy back for the next 2 or 3 days then fell back to the long sleeping pattern again. I think the fluid and oxygen was probably the reason why your mom felt so energetic the next day. Unfortunately, her body can not produce enough energy itself. It's sad but I think it's how it's gonna be when people get older
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