Elderly mother in hospital now mentally confused

carolinabirichina

Sorry if I have put this in the wrong section - please move it if necessary.
The basic facts are as follows: my 86 year old mum has been in hospital for nearly 3 weeks - she went in due to a chest infection - and her mental state was fine when she was admitted.
She was given antibiotics for the first week and she appeared to be doing well, she was eating and drinking reasonably well and things were improving.
Then the course of antib's finished and the hospital spent the next week testing to see if the infection had gone and if she was ok to come home.
That's when everything started to go wrong - she still had the infection and it caused her mental state to deteriorate dramatically. She started to refuse medication (nebuliser treatments and tablets for a heart problem) and food and drink so she is now dehydrated and that is making the mental confusion even worse.
The hospital want to start her on more antib's but she won't take them and she won't allow the docs to put a cannula in her arm to have them by IV.
The docs say that she is not mentally incompetent (!) so when she says no they have to abide by what she says.
We (me and my 90 year old Dad) feel so helpless because we want her to have the treatment she needs but the hospital is saying that their hands are tied.
The situation as of today is that she has refused to let the nurses wash her for several days, she has hardly eaten more than a few mouthfuls of food and had just sips of drinks, she has refused tablets for 2 to 3 days and is being stubborn and disruptive.
I have nothing but praise and admiration for the docs and nurses - they have been so patient with her - they have tried and tried to coax her to have tablets/food etc.to no avail. We have tried as well but we cannot reason with her - nothing we say gets through to her and we just end up in tears after every visit.
I wonder if any of you have had a similar problem and have any advice to offer on how we can get her to have the treatment she needs - she is so obviously not in her right mind what can we do?
Thanks

Georgiegirl256

Just wanted to say so sorry to hear about your Mum, I can imagine it must be so upsetting to see her like that.

I assume the doctors and nurses will have tested her for anything they think could be causing the confusion, but have they tested her for a urine infection? My Granda had one, and he was awfully confused, as did a friends Mam, and she was too.

I hope your Mum makes a swift and full recovery very soon, and all the best to you and your Dad, it must be so hard for the both of you.

charlies-aunt

A very difficult situation.


Do you think that she is in her normal mental state or confused?


Are there any underlying factors that might be influencing her decision making? She is aware of an undisclosed condition that she hasn't shared with her nearest and dearest for fear of upsetting them?

HOWMUCH

Please try and get your mum to drink, when I was in hospital once a lady in the bay didn't drink much and got so confused. I kept encouraging her to drink and her confusion went away. Good luck with your mum.

LondonDiva

Ask that the ward manager contact the hospital's safeguarding lead as you and your dad feel that she is not currently competent and that her behaviour at the moment is not what you would recognise as having capacity given her usual behaviour.

Ask that they carry out a full formal capacity assessment and that you want this included in her notes and for the Independent Mental Capacity Advocate (IMCA) service to be contacted as part of the process.

meritaten

If you think her current mental state is caused by dehydration - then how can she be mentally competent? speak to the doctors again to ensure this is their diagnosis, and then tell them that you are going to the solicitors to ask for advice.

Errata

meritaten wrote: »

If you think her current mental state is caused by dehydration - then how can she be mentally competent? speak to the doctors again to ensure this is their diagnosis, and then tell them that you are going to the solicitors to ask for advice.

How on earth do you think that would help when it will only serve to delay matters even further?

LondonDiva's suggestions are the correct way to progress things.

Mr_Toad

It may be dementia.

My father was 84 and in the very early stages of dementia, if you didn't know him you would never have guessed. He was mildly forgetful but not as bad as some people half his age can be in normal life. He knew people but if he hadn't seen them for a while it would take him a moment to remember their name, that sort of thing.

I visited my parents one Tuesday, mum was out shopping so just me and Dad. He was absolutely fine, made us a drink and we chatted about all sorts of things. He was in his workshop servicing the ride on mower ready for a lawn cut session.

On Wednesday he started feeling poorly and by Thursday it was obvious that he had a nasty chest infection. His GP came and had him admitted to hospital. It took three weeks to clear up the infections, chest and urine but when they'd done that he was a different man. He didn't recognise any of his family, didn't know who he was or where he was.

It seems the infection triggered a massive advance of the dementia and he never came home. He was transferred from hospital into a care home and he never spoke to me or mum again.

That was almost exactly two years ago and he passed away peacefully in his sleep on Tuesday night.

Was your mum a little forgetful before she went in?

It can be hard to spot as people are very good at covering the early stages up because they are still generally fine and they know that they should know something but rather than say they can't remember they develop strategies for covering it up.

Dad was helped by Mum, she would be sure to say the persons name, rather than simply saying hello, haven't seen you for a while she would say hello Bob, haven't seen you for a while so that my Dad didn't have to struggle with the name.

As LondonDiva has already said, you need to request a mental capacity test and take things from there.

Good luck.

frippit

Hi Carolina, I really feel for you as this is a very difficult situation and it makes you feel very helpless.
All I can say is based on a similar experience I had with my own mum. Looking back I think that the nurses could only try to encourage my mum so far. However, we as her nearest and dearest can be firmer and push a bit more.
I talked to my mum about how she had to eat/take meds so as to be able to leave hospital and play with her grandchildren. I tried every trick I could think of - distraction, little white lies, fed her myself, bribery, etc. what ever works for you, after all you and your dad know her best.
Hope this helps, frippit

Gavin83

Is she actually confused or is the only sign of confusion her refusal of treatment? Can you hold a conversation with her for example?

A refusal of treatment alone is not a sign of mental incapacity, there could be other reasons. After all the doctors seem to be of the opinion she is still sound of mind and they would be skilled enough to spot signs of this.

Mojisola

carolinabirichina wrote: »

That's when everything started to go wrong - she still had the infection and it caused her mental state to deteriorate dramatically. She started to refuse medication (nebuliser treatments and tablets for a heart problem) and food and drink so she is now dehydrated and that is making the mental confusion even worse.

The hospital want to start her on more antib's but she won't take them and she won't allow the docs to put a cannula in her arm to have them by IV.

The docs say that she is not mentally incompetent (!) so when she says no they have to abide by what she says.

I wonder if any of you have had a similar problem and have any advice to offer on how we can get her to have the treatment she needs - she is so obviously not in her right mind what can we do?

One issue that cropped up with my Mum and Dad is that medics who didn't know them judged their competence by their idea of the "average 80+ year old" while people who knew Mum and Dad could see that they weren't their usual selves.

I phoned for an ambulance once for my Dad because I could see how poorly he was (confused and bewildered because of urine infection). Fortunately a paramedic who had been to the house before arrived first. When the ambulance arrived, they didn't want to take him in because they just saw a 90 year old man being a bit vague. The paramedic took one of them into the other room and I heard him saying that he had been to the house recently and Dad had been chatting and joking with him and was fully compos mentis and that something was very definitely wrong with him now. Dad ended up being in hospital for several months.