I'm not sure where this goes as it's quite a complex issue. Mom is 80 and has some dementia. She's also been having chronic UTIs the last few years. Mom had to go to the hospital on New Year's Day with a bad UTI. Once released a week later, she went to rehab only to have another UTI. In the last 60 days, she's had four UTIs (or one they can't get rid of) and is now back in the hospital. The other issue is that she has a compression fracture in her lower spine causing her great pain. They found this by doing a MRI where she had to have anesthesia because she moved around too much when they tried it the day before. Since that time, she's been very lethargic. She sleeps most the time, has no appetite and crys a lot. We're now four days removed from the time she was on anesthesia for her MRI. The docs say her UTI is gone after three days of IV antibiotics. She was on morphine a few days due to the intensity of her back pain. She was taken off it three days ago. She hadn't eaten anything for five days until last night when she had a Ensure-like product and a popsicle. She still has no appetite. Can't talk (but babbles sometimes). She totally looks out of it for most of the time. We're not seeing improvement as fast as we thought we'd see. They won't put her in a back brace until she's more cognitive. She's got to eat more soon or they will use a feeding tube. She won't take her usual meds either (diabetes, cholesterol, blood pressure). Anyone have any thoughts on this? We're very worried.
Mom's situation isn't improving. She has constant back and stomach pain so is doing less and less rehab. She has mixed days mentally.
I had a great conversation with her on Friday—probably the best I've had in weeks. The next day, she was confused and not making any sense. I've learned to cherish the good days.
Her C-Diff continues. We were hopeful it would be gone by now. We assume the antibiotics used is part of her stomach issues. She continues to have diarrhea too though is eating and drinking well.
Her time in rehab ends mid-month. They're shift her to nurse care which is $7k a month. Her doctor mentioned hospice might be good at that point to help her manage her pain.
Does anyone have experience with hospice in a nursing home environment? Thanks.
She'll be isolated to her room for as long as it takes to get rid of it. We'll have to wear protective clothing to just visit her.
My LO fell and suffered a spine fracture in the AL, several years ago. Her doctors said she was not a candidate for the surgical procedures either. She was in a wheelchair, but, could walk a little and transfer, so we were afraid to give her anything too sedating. So, she took Tylenol and was also placed on Cymbalta at that time. Cymbalta is actually for anxiety and depression, but, ALSO FOR PAIN. It really helped her on so many levels, including the pain from the spine fracture. It never impaired her alertness at all.
MY LO's dementia kept her from engaging in physical therapy. She just wasn't able, but, she did heal and after a few months months, her pain did subside. She adjusted to her wheelchair just fine and scoots around on her own. It wasn't the spine injury that put her in the wheelchair. It was the dementia.
They prescribed a brace for her to wear during the day, but......I don't think they understand how a person with dementia isn't likely to keep on a brace or properly wear it. She didn't tolerate it at all. It was very uncomfortable and she couldn't rest in it. Plus, the AL staff had to constantly adjust it, since she would wiggle around in it. When, I explained it to the doctors, they said, don't worry with it. You would think they would be aware of these things in advance.....anyway. I hope your mom's works out better.
I'm not sure what lies in store for your mom, but, I would encourage the comfort care. If we had it to do again, I'd avoid the hospitals and adjust my expectations to my LO's abilities.
She was taken back to rehab on Monday only to go back to the hospital on Wednesday. The rehab told me they feared she was having a stroke (face droopy, very disoriented). She was rushed to the ER.
When I got there, I saw her state and I too thought she might have had a stroke. But, within an hour of being on an IV, she starts improving. Her tests come back showing she was dehydrated and has a slight UTI. She'd only been in rehab less than 48 hours after being on an IV in her previous hospital visit. The doc said dehydration does add to the severity of dementia but usually not to the levels we were seeing.
I call the Care Manager at the rehab and, sure enough, she'd been given a opioid for pain relief after I had spoken to her the day before saying that we needed to find alternative ways to relieve her pain as she had a reaction previously when given opioids.
Fast forward to now...
Mom is back in rehab. She is eating well. We have a lot of her favorite drinks now in her room. She was on Lasix (I think) because of swelling and we've removed her from that. We're treating the pain with Tylenol and another arthritis meds. Her primary care physician is supposed to meet with her rehab doc and a pharmacist to work out some pain relief options that agree with the long list of her other meds and Mom's reaction to opioids.
24 hours later back in rehab and all is good so far. I'll follow up once I get information on the pain meds they recommend. Thanks to all for the advice.
Mom wiggled so much during her first MRI they had to go with the anesthesia. I suspect there is no way she'd be still on her stomach for this procedure but it doesn't hurt to ask if options exist.
The first thing I plan on doing when Mom gets back to rehab is to ask for a care conference with palliative care the thing I am most concerned with now.
Mom had a slight UTI when going to the ER. She had three days of antibiotics and the urine test came back negative two days ago. The ER has missed UTIs before so will ask rehab to test as well.
Plumbing #2 seems all good according to the nurses.
I really encourage you to seek a palliative care consultation. I am a Nurse Anesthetist and I can tell you that even the kyphoplasty will require sedation and the positioning for it is extremely difficult and painful. Sometimes less is more. And the treatments are causing more harm. Comfort care can even get you more days together, interventions can hasten decline.
Best of luck
Margaret
My mother had some short term memory problems (but not any other issues) for about 4 years prior to having cataract surgery. Following the surgery, the short term memory issues became MUCH worse and she was eventually diagnosed with MCI (scored 26 of 30 on assessment with 27-30 being normal). Five years later, she's not any better or worse. Even though my mother had several prior surgeries without any issues, I think the propofol anesthesia was responsible for the sudden decline.
I hope your mother's situation is more like my grandmother's and she will just need more time to recover. Not only do older bodies take longer to recover from illness it also takes longer to flush medications out so the anesthesia (alone or combined with other medications she needs) could still be causing problems four days out for her.
Ask for a pain management specialist, there are lots of options besides morphine and toradol.
Mom still barely eats or drinks. An IV is keeping her hydrated but they want to send her back to rehab today.
Her compression fracture has been painful but they have fitted her with a back brace. They backed off the strong pain meds and are now using Toradol which, I understand, is more an anti-inflammatory. She's six days removed from the morphine. She's not a candidate for surgery.
We tested her again for a UTI and it came back negative. We're a week since the anesthesia used for her MRI (I don't know which one it was but will ask). She's still very confused and sometimes hallucinates but, at times, carries on a decent conversation. It's almost like you can see a light come on in her only to dim again in a few minutes. She does things like fold and refold her pillow cases and rearranges the little table beside her bed. Lots of mood swings. She gets very angry and frustrated at my sis and I only to smile at another visitor.
Mom has a living will which states she doesn't want a feeding tube.
I've been reading a lot about palliative care and hospice. I think our first goal is for Mom to be comfortable before looking to rehab her back. If she's hurting, I can't imagine she'd have the will to rehab. And rehab might just send her right back to the hospital. She's much worse now than when she went in 11 days ago.
I also saw some articles about the late stages of dementia and she has most of the symptoms. Thanks again for all the advice.
If she is babbling have they assessed her for stroke? When my dad was on a narcotic for pain after falling and surgery he also was out of it. We need a bit more info. But agree that care conference is needed assuming she’s still in rehab or skilled nursing.