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My dad has Alzheimer's and fell. He went to the hospital where they gave him Dilaudid for pain and he hasnt been the same since. Its been days and now they dont seem to know why his dementia has gotten so much worse. They are now saying that they want to take him the psych ward. My sister fears it is to evaluate him that his decline was normal not due to the heavy drug side effects.. Is this a scary place for an alzheimers patient?

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Your dad could have hospital psychosis or delirium. I've read about and actually think my dad had a little of it when he had heart surgery. His cleared up in a few days, though some lasted for several weeks. I'd ask the doctor about this being a possibility. Of course, it could be something else too, like a reaction to medication, infection, etc.

I bet you get some other responses to this from those who know much more about it.
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The purpose of the psych ward is to alleviate his agitation. That's not easy to do when he is also on pain meds. They will attempt to medicate his fear and pain simultaneously.
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Is he still on this pain medication? There are several possibilities here that may have caused an increase in his confusion. Opiate drugs are certainly one as are some other drugs. Another is whatever caused him to fall. Did he have an infection, a TIA or stroke, etc or did he just trip? Having some mild dementia already and being taken out of his usual environment and routine is yet another. And finally, did he require a general anaesthetic as that most certainly can increase confusion. Going to the psych ward may or may not be a good thing. Sometimes they are good and will do a good evaluation for all the causes of increased confusion and seek to alleviate them before doing a proper psych assessment. Others are not so good. If there are disruption and distressing elements about the ward eg. other distressed and loud patients this may make things worse. Staff who feel that doping him up to shut him up is another problem. Of course if he is a danger to himself or others in his confusion it may be necessary to dope him up a little for awhile, however, I would be cautious. Sometimes all that is needed is a couple of days with anti anxiety medication such as diazepam although that is only for very short term use in most circumstances. Just some thoughts. I hope it helps. X
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The geriatric psych assessment is only to help your dad. They will figure it out.
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Not any scarier than the real "normal" world. Trust me, I'd rather be in a psych ward where he can get some rest and hopefully evaluated where they will take him off all drugs to see how his dementia is progressing. I had surgery yesterday and one Percocet and the anesthesia has made me so confused, and I don't have dementia. Give his body time to adjust and calm yourself. Your excitation will further his anxieties. Best wishes!
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My husband was put on meds for myasthenia gravis which greatly exacerbated his dementia. He became aggressive, agitated and I could not control him. They put him in psych ward and adjusted his meds with observation and constant bloodwork. He came home 2 weeks later with a medication plan and greatly improved. Let him go to the geropsych ward and get leveled out. It is the best thing you can do for him.
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Sometimes you have to start over or go backwards to go forward. And be is advocate and be present for as much as you can in order to alleviate your fears.
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Dilaudid has awful effects on my mom who also has dementia. In my opinion, this drug really makes the dementia worse. I would request an alternative drug or a minimal dosage. I'm not an MD but this is what we do after seeing the impact of dialaudid on my mom. I think hospitals want to subdue patients to minimize their care. I.e. if you are zoned out and immobile then they do not need to keep an eye on you. If you are in the hospital with you dad and you are watching him then you can ask that he not be administered this drug.

In my mom's case, she had had a knee replacement. She was doing great, participating with PT etc. until one of the nighttime nurses gave her dialaudid. She was so zoned out and floppy like a rag doll. She could not sit up on her own. She could not do the PT. A one time administration of dialaudid kept her in the hospital for an extra three days.
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like bechwin indicated, many things need to be addressed.
As his advocate find out the following:

- why did he fall? ( infection, stroke, decreased heart rate and dizziness, tripping or poor balance, dehydration)
- did he hit his head?
- why did they put him on Dilaudid ( pretty heavy med)
- Get Pain Management team involved to evaluate his pain and treat it.
- Only have you Dad see a geriatric psych practitioner or a geriatrician. These practitioners know these situations best and will deal with them with more experience.
- medications and anesthesia can cause ( increased) delirium in people over 65.

Yes, being hospitalized or doing anything out of the norm is difficult for anyone. It is impossible for a demented person to deal with until he feels that this is his " new normal" Your father needs to feel reassured that he is safe, and that he will be well cared for. You may need to let him know this many many times a day.

In any case, a logical step by step procedure of finding out the cause of the fall, and correcting that cause will lead to remedying everything else. Just let the most competent Nurse Practitioner, MD or D.O. who has experience with dementia patients be his primary care provider.

Take care of of yourself too
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My dad was given drugs after surgery that had a horrible effect on his mental health. He became extremely paranoid among other things. I agree with the others on the thread. Work with the doctors to try to find a different drug for his pain. Older people don't generally have a large tolerance for side effects so it doesn't take a lot to have a big effect on their mental health or cognition.

We're with you on this. Take care,
Carol
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Most of these answers are good but, pay close attention to what bectwin1as written. Especially about what may have caused the fall. Another good response is by sunnygirl1. Hospital psychosis. BE PRESENT AS MUCH AS IS POSSIBLE! Good luck and God bless you!
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Long before my mother developed dementia from her Parkinson's she was given Dilatid after surgery. It was scary. She was throwing things, fighting the nurses, pulling her IV out, cursing everyone in the family and as others on the thread mentioned extremely paranoid. She thought everyone was trying to kill her and was hallucinating that the hospital was on fire and everyone was being taken outside except her. The good thing was she certainly had no pain. They brought in a psychiatrist to have her evaluation. It is sad the number of medical professionals who have no idea that things impact the elderly differently than others. Keep fighting for your loved one!
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They didn't know what my wife's dementia was, so they gave her the commonly used drugs for Alzheimers. Immediately 2 of them doubled her over on the 1st dose and she was bumping into walls and drooling. There was no change in her agitation, that the drugs were supposed to help. We could not straighten her up. It was if her spine no longer supported her. After the drugs should have been out of her system she has remained a little hunched over for no physical reason. That was 2014. In 2016, she bumped her head and straightened up completely for a week, so we know that it is not physical. Occasionaly now, she will stand and sit straight.
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Have him tested for a UTI. Encourage water, cranberry juice, and d-mannose is good for that. Stay away from grains and sugary things. It is amazing how a urinary tract infection / dehydration can morph into a psychotic episode!
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Good morning, I had this same thing happen to my Mom. Dilaudid (hydromorphone)...horrible for older people. 3 surgeries in 9 months &
I thought my Mom had dementia/alzheimers. Nurse comes in after I've
been restraining her cause she tried to pull out IV & cathera - nurse gave
her liquid Norco thru drip & she changed back to mostly normal. She thought
she could get out the bed with a broken leg by herself & go to the bathroom.
After her 3rd surgery, the surgery nurse actually somewhat bragged that they
had given her dilaudid - I was really upset. This happened before as well with
my Dad, which I lost during all these surgeries my Mom had. The nursing home during PT stay lied about reducing her meds especially ativan, zoloft, tramadol,
zanaflex & a couple others which I can't remember right now. Mom left wheelchair bound from the NH & they thought that she had met all her goals. I
moved her to assisted living for a short time. The PT guy came 2-3 times a week & we dropped some meds & she was walking in a couple months & her mind was better. Also, after she fell at the NH (34th day - 2nd leg break), I hired 24/7 sitters to be with her even though this was supposedly a really good NH. Ratings
have dropped since that time. After 9 months in assisted living, I did move her home with 24/7 companions & she is still a fall risk but she is more lucid but has
slight dementia & is taking the meds for that. She is off pain meds but is still on Ativan & Zoloft. It is very expense to have 24/7 companions but for us it is the only way I could go home. I also got her a jitterbug cell phone instead of the other monitor systems (works out to be about same cost to have). It has a red Alarm button that even if she pushes it accidentally we pay for the service-if she doesn't answer they call me next. This is what I've learned over a 2 year period- Trust No One & check & visit as often as you can. Hope this helps.
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my Mom had delrium after her incisional hernia and her partial hip replacement. She has since been diagnosed with alzheimers.
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My first question would be, Why did they put him on Dilaudid when they have other pain medicine available that is not so strong, and they are suppose to ask permission to the family member whether or not he has been given Dilaudid in the past and if he is allergic to it. They gave me Dilaudid one night when I had to go to the ER, and I did not know I was allergic to it. But they told me that I started talking out of my mind and seeing things that were not there, and my heart rate went up and I don't remember any of it. So it wasn't until the next day that I was told what happen and that I tried to fight them so that had to counter act what the Dilaudid did and then try to level me off and I told them that I did not know anything about Dilaudid or that I was allergic to it. So now I am allergic to Dilaudid. But they have other medicines for pain that is not so bad on people. Make sure that whenever your dad is in the hospital , that before they give him anything they need to know that they need to check with you as to the medicine if any that needs to be given. They could give him a medicine that may be too strong for him, and it could be an overdose so Please let the hospital know that they are suppose to approve anything through you, and the sooner that they know that, then the better his care will get. I know that this could damage him to some point, but I am Thankful that my situation did not get worse but that I have no after effects from my stint in the hospital. The doctor who attended me got to me right away, and knew that I must have been allergic to the medicine but didn't know it. If there is any thing that you need , just ask. We will always be here.
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I feel so bad for you to see the effects of that particular narcotic and the change it creates. If you can get him off it, you may be fortunate and find he will return to his prior state. I lost my husband to cancer, and swore if I never saw or heard of that particular medication, it would be too soon. I hope you can get them to stop giving him that medication.
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Thank you all for your comments! My dad was taken off all drugs and is not back home with us. We see a major decline in his dementia since he was in the hospital but we are hoping he will get better with a bit more time. We have since made it very clear that no pills or medication will be given to him without asking us first.
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Razzleberry, you are soooo right about the terrible effects of dilaudid. My mom had that when the hospital screwed up her surgery (she was a malpractice case) and I think they gave it to her to kill her, literally. Yes, they gave it to her to minimize caring for her. It did keep her very immobile to the point of developing a bed sore that never healed and eventually caused her death. My aunt, her sister, was a nurse who thankfully came to help initially and told the staff to stop giving it to my mom. Of course they didn't like it. But we have to be tough and advocate for our elderly since they sometimes can't speak for themselves. It wouldn't surprise me that this horrible drug made CarinMiller's dad's dementia worse. Getting a non hospital doctor as a second opinion is probably worth a shot too. I'm not a doctor either but what I went through with my mom and this drug I wouldn't wish it on anyone.
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Carin Miller: I used to have the same problem with my mother when she was in the hospital. She was 88. God rest her soul, I lost her own October 1 this year. I know what pain you're going through I have been there many times with my mom in and out of the hospital. Anytime they gave her any kind of pain medication her dementia worsened. It was delirium. The medications made it worse. Elderly patients can be very sensitive to pain meds. I would talk to the doctor about switching it to something different and perhaps lighter dosage. I know it's a scary thing when they say the psych ward and honestly If any of the doctors would have suggested the same thing to me for my mother I would have told them no. But I am in no means a professional to tell you that. I only can share what I went through with my mother. Once your Dad gets back home, you will probably see an improvement. It can take several days to even a week for them to get back to their baseline. But keep in mind sometimes they don't go back to that baseline. I noticed that with my mother each time she came home from the hospital she would just be set back a little bit each time. I always tried to keep my mom out of the hospital as much as possible but honestly sometimes you just don't have a choice. Unfortunately there are a lot of nurses on the floor that are not experienced in caring for older people with dementia or Alzheimer's. If you're lucky to get a nurse that's skilled in that area then you've got a good nurse for your dad. When my mom used to go to this one particular hospital they would always have to re-strain her. That's a horrible thing and it made it worse. Her last hospitalization she Went to a different hospital and they never ever had to use restraints on her. I really think it was just because the level of care was so much better and I ended up with a couple of nurses that had worked in nursing homes previously to working in the hospital. They have a much better understanding of how to give care. Sometimes they get scared because they're alone and they don't recognize anyone. If you're able to stay there with your dad is much is possible it would probably make things much better for him. But I know that that's not always possible. I hope everything works out with your dad.
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CarinMiller; Is your dad back home with you or not? I hope that he does gets better. Just let him take his time and maybe the effects of the drug will wear off and won't cause any major damage. We are praying for you and your family and we all know what you are going through. So stay positive, and take each day as it comes, and know that God is watching over your dad, and he knows what to do. And your dad is going to struggle some, but be there for him and ask him what he wants, what he likes, and he will come around and he will let you know what he wants and what he likes whatever that may be. I will be praying for you and in the days and weeks ahead. And if you need any support, just ask we are here for you.
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I once had to go to the Psych court and have my mom committed at the advice of the psychiatrist on call at the hospital she was in. She was on Dilaudid as well as methadone. She is dependent on hydrocodone so it takes a stronger medication to alleviate acute pain. Her behavior declined to the extent I was asked to commit her (she did not want to go and I did not have a Medical POA).

The geriatric psych ward at the hospital was wonderful! They worked on the medication withdrawals as well as had group and individual therapy. It was a hard thing to do, but I'm glad I did it.
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Dilaudid, aka, Hydromorphine, is VERY POWERFUL! USE WITH CAUTION!
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Correction--hydromorphone
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My husband has been in a nursing home for three months now and recently they started giving him too much seizure meds and he's so doped up that all he does is sleep. He wont eat, drink or get up. When he was admitted, he used a walker and now a wheelchair. He has dementia but he has suddenly taken a turn for the worst since he's been there and on too many meds. Im afraid I will lose him if I don't do something quick. Should I have him transported immediately to a hospital? I had planned to bring him home but there are things I have to set up for his care.
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Pondering9Rosy: You cannot bring your husband home. How do you think that you are equipped to handle his care at home? Talk to the NH.
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We have had bad experiences with dialaudid as well. I now have it on my mom's "allergy" medication list to ensure they will never give it to her again.

I do believe that it can wear off - and in response to Pondering9Rosy above, it is possible that when you get your husband out of that facility that he could return to the way he was when he arrived there. You definitely (in my opinion) need to get him out of there.

Back to our situation, my mom came back to being "herself" after a knee replacement when a hospital (night shift) nurse doped up with dialauded. After that single dose, I flat out REFUSED to allow them to give her any additional.

The night shift hospital nurse that gave her the dialauded received a negative report from me to hospital management. That extra dose resulted in an extra three day hospital stay because my mom had to be able to get through her PT before she could be dismissed. After the dialauded my mom was basically completely unable to phrase a single sentence, combative, and limp. It was absolutely horrible. She will NEVER return to that hospital.

Happy to report that she is now at our house and doing well. Effects of dialauded are well in the past (and staying there).
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Demerol is another one to watch out for - it did crazy things to my mom when she was in the hospital even before dementia - then to top if off they gave her ambien and didn't start an IV and put her into renal failure - and then shipped her to a rehab facility
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My dad fell and hit his head. Had a brain bleed, make sure they checked that out, can effect their personality also.
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