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She was in rehab for 2 weeks after surgery and at her home for 1 month during home health PT. We took her to our home for 1 week, then took her back to her house. She is not recognizing her home as her own, she says something is not right. She can function fine in her home and is oriented but insists she is still at our house. She has not been diagnosed with dementia or any cognitive decline, she did have some trouble with time of day after naps prior to surgery. What can be happening?

Thank you all for the insight and suggestions. My grandmother-in-law had several tests done last week. We are going in tomorrow for test results. I'm just uncertain as to her reaction and what comes next. Its been so slow trying to get agency's and health providers on the ball with things during this time....but I'd rather her be safe then rushed into a rash decision.
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Reply to Katriggs
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Definitely run this by her doctor(s). It is well known that anesthesia in the elderly can cause this kind of condition, which sometimes will resolve, sometimes partially resolves and other times one gets back to the pre-surgery normal. It can be compounded if one is already in the early stages of dementia.

It is also well known that UTIs can cause dementia-like symptoms as well (I was a skeptic when I joined this forum, but after witnessing severe sun-downing with her first UTI in MC, and bed-wetting episodes in subsequent UTIs, I am a believer! Best to test and rule it out.)

Your profile indicates she has dementia/AD, which if true will also impact how well she recovers from the anesthesia and/or UTIs. Moving can also cause disorientation in those with dementia, even early stages, as short term memory is generally what goes first (depends on the type of dementia.) There are many factors at play here, so you need to rule out each one, starting with the simplest.

Since a UTI test is simple and quick, this might be one place to start, even before she can be seen by a doctor. Home test can be taken, but she should still have a regular UTI test, maybe even a urine culture, as UTIs can be sneaky (plus a culture can help fine tune the correct antibiotic to use.)

Meanwhile, have a checkup scheduled no matter what the UTI results are and ensure she has someone to supervise her (you aren't local - someone needs to be close at hand, to help her AND be able to make observations!) It doesn't sound like she should be alone at this point. Depending on the cause of the disorientation, it may improve enough to allow her to live alone again, at least for a while, but be proactive anyway - dementia can sneak up on us when we are not there to see it in action. It can even blindside those who live with the person, but is more common to miss the signs when only random visits/checks are done, as in the early stages they can appear to be okay, just a little slower maybe, but it can be deceiving.

When I became aware of mom's early dementia signs, one of the things we did was install some cameras (she lived alone, and was about 1.5 hrs away from me.) While some signs were clear, not being there all the time resulted in missing some other issues, like realizing she was not cooking anymore. She was relying on microwave dinners and boxed crap, letting meat remain in the freezer and fresh veggies to shrivel up in the fridge! It also revealed OCD behavior just before bed, checking several places over and over again, for up to 1.5 hours! We wouldn't know this without the cameras (I think this was her "version" of sun-downing.) Then seeing her wear the same clothes over and over again, up to 6 days in a row, even though some were stained with food - this was NOT my mother, she had SO many clothes, with a different outfit for every day and every occasion! There were other issues that couldn't be observed by camera, and only being there would reveal - some of it only became apparent after we moved her to MC and started to clear out and clean/repair the place.
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Reply to disgustedtoo
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I hope you have talked to her doctor today at least. Hopefully she has an appointment.
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Reply to MAYDAY
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Blood flow to the brain is important...
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Reply to MAYDAY
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Easy thing... Have her carotid artery checked... Is she getting enough blood flow to the brain? It is a simple test...Not invasive..

Do not forget to bring the medications she is taking..
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Reply to MAYDAY
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one month 2 weeks... and she is not normal... Get her back in and have a brain scan.. Seriously.. HAVE HER BRAIN CHECKED...
Did she have a stroke in that time frame? Seizure? or are there more signs of dementia from this operation?
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Reply to MAYDAY
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yes, anesthesia can be very hard on the body and brain..

Get another analysis on her behavior... Get a 'NEW BASE LINE" for her memory/brain function. You need to get her evaluated. Sometimes it takes awhile for the body/brain to become clear again...
Get her evaluated... And ask questions.. why? how long was she under? Was there any signs of seizures or strokes while she was under? WEhat can be expected at this time? And how much longer until full functions and memory are back to "normal"? hence... the new base line...
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Reply to MAYDAY
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Imho, anesthesia COULD be the reason for her disorientation.
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Reply to Llamalover47
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It could be that the stress of the surgery along with the anaesthesia has affected your grandmother's cognitive status. Plus she was moved to different locations along the way. I would give her a little time for her to adjust in her own home to see if the situation improves. If it does not improve, I would suggest a cognitive evaluation by a neuropsychologist or a geriatric psychiatrist. Good luck.
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Reply to Peanuts56
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My husband had lithotripsy in 2006 and again in 2007. He did not come out of the anesthesia "right" in either case. He was never the same again. I noticed it immediately, but thought time would take care of it. It didn't. Nobody seemed to notice but me. By 2008 he couldn't pass a simple memory test. He was 62 years old at the time. I took care of him until five months ago. He's now 73, in a memory facility, and is in acute end-stage Alzheimer's with a brain that swells. He is now aggressive, dangerous, and attacks the staff. There is no doubt in my mind the anesthesia caused it. Prior to the anesthesia, he had NO issues of any kind.
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Reply to sister46
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But they can recover out of that with time.

https://www.everydayhealth.com/alzheimers-disease/anesthesia-linked-to-increased-dementia-risk-in-seniors-6759.aspx
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Reply to Manson
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DO NOT GUESS. DO NOT TAKE ANYBODY'S ADVICE EXCEPT THIS.. Take her to the Emergency Room for they can scan her brain for a possible clot. For changes you need to know the cause and is beyond the scope of this forum to answer this. she may need a neurologist consult.
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Reply to cetude
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How recent was the surgery? Many people even young people go through a period as long as a week after any surgery with a lot of anesthesia followed by narcotics in a serious brain fog. This usually gradually dissipates. However, in older people , if the narcotic is continued for about 2 weeks after surgery, they do not seem to fully recover mentally until the narcotic is ceased.Both anesthesia and or narcotics have a much stronger and longer lasting effect on an older person.Hopefully the pain will diminish so the narcotic can be stopped.Then, after no narcotic for about a week, a mentally normal state may return.If narcotics are continued even in small doses, the patient may never recover completely mentally. It is a difficult challenge controlling pain without doing mental damage.I was very blessed to have a wise, caring, and competent surgeon for my knee replacements at age 78. I was in a brain fog untill about 2 weeks after my surgery. I gradually recovered completely. However, I was able to quit vicodin onlt 6 days after surgery.I also was blessed with a wonderful therapist who guided me carefully throughcarefully planned and pain free activities every other day for 4 weekd.I am so very grateful to have been healed mentally and physically. We all need to stay away from vicodin and or any other brain altering substances. However,they are necessary for serious surgery.I am now 86, happy, healthy, pain free, and med free. i pray your loved one will recover completely.
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Reply to BobbieSena
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cetude May 4, 2020
everybody is different. Others' outcomes are not so rosy.
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Please get her evaluated by her doctor. She may have thrown a blood clot to the brain causing a "pin stroke".
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Reply to Taarna
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There is the possibility of anesthesia induced Amnesia or dementia. Frequently this is a temporary situation but you need to immediately speak with her doctor and or the surgeon who did the hip replacement. Good luck
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Reply to geddyupgo
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I would definitely check with her Dr's ASAP. IT could be the meds they had her on or she's on now.
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Reply to bevthegreat
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We now are starting to understand the relationship between gut health and the brain. Her friendly gut bacteria may have been killed by antibiotics. Maybe she would improve if her gut bacteria were restored. Consider giving her some fermented vegetables, such as sauerkraut, kimchi, or yoghurt. Not all have bacteria in them--you have to read the label. The health food section of a grocery store might have them. (There are also tutorials on how to make sauerkraut on YouTube, which would have the friendly bacteria.)
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Reply to Lilacalani
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Have her checked for Urinary Infection and rule that out first. Check meds for side effects. If nothing shows up with these, there is also a chance her body has not completely recovered from anesthesia -- however -- you said there were a couple of issues prior to surgery.
Maybe watch and wait. It may well be a true mental decline and important to watch for things such as leaving pots on stove to burn to identify if she needs additional help in the house or someone to be with her in the home.
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Reply to my2cents
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Anesthesia commonly effects cognition in the elderly. Sometimes they do not recover, in my mom's case she continued to decline. In her husband's case he was loopy for a couple of months and fully recovered.

Check out this article

https://www.agingcare.com/articles/how-general-anesthesia-affects-elders-mind-160100.htm
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Reply to gladimhere
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Delirium.

Here's one google definition but please get proper medical advice.

'Delirium is a term meaning “sudden confusion.” It refers to a sudden change in mental function. ... Post-operative delirium is delirium that happens after an older adult has an operation (surgery) and is the most commonpost-operative complication in older adults'.

After hip surgery in elderly patients it is VERY common. Your Grandmother will need supervision until it passes. Can last weeks & be off & on.
Sometimes if there was some mild cognitive decline, this may become the 'new normal'. Keep her supervised, either at your home or someone moves in to hers (if possible). She will be a huge falls risk among other dangers.

I'm glad she has recovered physically but you will have to watch & wait I'm afraid. Good luck.
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Reply to Beatty
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Katriggs,
It's very common in our elderly LOs to suffer mental decline with something as simple as a urinary tract infection.
If you haven't already, you need to talk to her Doctor.
Does she have someone in her home caring for her?
Sometimes they don't mentally recover from these things.
Hang in there!!
God bless!!
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Reply to xrayjodib
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Your profile says grandmom has dementia. Then u say she hasn't been diagnosed. Did you see signs of decline before the surgery?

Breaking a hip is very serious in the elderly. The anesthesia can cause Dementia type symptoms. If you have Dementia, it can cause further decline. Being in the hospital and then rehab can cause some confusion. There's a name for it, just can't remember it.
It can tak the anesthesia a while to wear off. She could also have a UTI that causes confusion.You need to bring up this change to her PCP.
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Reply to JoAnn29
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gdaughter May 4, 2020
There is also a program in some areas called SAIDO (hope I spelled it correctly) that helps those experiencing some of this post surgery/hospitalization/anesthesia type decline regain their abilities to some extent. Might be worth checking into.
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Katriggs, at 91 what can be happening is she is in cognitive decline. I strongly recommend she has all her legal ducks in a row, and it would be fantastic if you could find out if she does. If she has not assigned anyone as her durable PoA, it will make legally helping her needlessly more difficult. She needs to get this into place before she has an actual cognitive exam, before it gets into her medical records, if at all possible. A PoA signed after a dementia diagnosis can be contested.

Your husband's reality now is that gramma can't be alone. We were trying to care for my MIL in her home until we discovered she wasn't remembering to eat. Food was rotting in her fridge. She couldn't remember how to use the microwave. We'd call her every day and ask what she ate and she'd give us a detailed account, only to go to her house the next day and find no dirty dishes, no food containers in the trash. She had to go to AL to keep her protected and socially engaged.

Right now you and your husband only have seen the tip of her cognitive iceberg. You and he should make a trip up there to have a discussion with her. Start there and see where it goes. It needs to be gentle and compassionate. She may resist any change or help but this doesn't mean she is ok. You cannot be expected to keep making a 5-hr drive because she won't leave her house (you know, the one she no longer recognizes). Do not take her into your home to care for her (please read some of the thousands of posts on this forum under Caregiver Burnout). I wish you and your family great success in helping her in a compassionate, realistic way!
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