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I took my mom for an assessment on her walking on Monday at the ER, per her Dr.'s orders. She was admitted that night for PT assessment on Tuesday. She was cognitive, very aware and ate well. Wednesday I got a call saying my mom was in ICU. As she was getting her breakfast the nurse said her head dropped and she was incoherent. They did an MRI because they thought she had a stroke. That was negative. They have done CT Scans and an EEG. They're still looking over the EEG, and tomorrow they might do a lumbar puncture. Her numbers are perfect. Her doctors are "baffled." The ICU doctor is trying to persuade me to sign a DNR. I will not do this until I get an answer why this suddenly happened. She did know who me and my brother, sister in law and husband were. She was able to say our names, but everything else was gibberish. But she would continually make noises and turn her head back and forth. I am so confused and broken hearted. Has anyone else experienced such a thing. I am POA.

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You might want to ask the hospital for a list of medications your mother has been given since she was admitted. It is not unusual for hospitals, nursing homes, assisted living facilities and Hospice agencies to calm agitated patients with dementia through the use of antipsychotic medications, also known as neuroleptics. The practice is ongoing, despite a stern warning from the FDA in 2008 informing practitioners of the causal relationship between neuroleptics, stroke and death in the geriatric population with dementia.

One side that antipsychotics can cause is dysphagia (difficulty swallowing, and even talking). I would want to leave no stone unturned. Definitely check the possibility of a UTI.

Among common antipsychotics are risperdal, haldol (the decanoate form is the most dangerous), and seroquel. Please be advised that this is not an exhaustive list.
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Was there something else going other than walking because "a walking assesment per her doctor" isn't deemed a medical emergency.  ER's are used for medical emergencies. That seems odd that the doctor wouldn't send her to a specialist, such as a vascular specialist.
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Oh, Ambly02, I am praying for you and your mom. I am very sorry to hear about the rapidly growing mass. This must be so difficult for you! Thank you for caring so much and taking such good care of her.
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Thank you for the update Ambly. I’m so sorry the outcome isn’t the best. Please don’t hesitate to post where when you need to express your frustrations or grief. This site was a tremendous support to me during the 3 months my MIL was on hospice.
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Thank you! Thank you! Everyone!! My mother "woke up" Friday morning. The nurse in ICU said she opened her eyes and was following other nurses on the floor with her eyes. She was still somewhat confused and didn't talk much. Saturday they moved her to a regular room and put her on a Mechanical Diet. She was much more cognizant and talking. her Primary Dr. said he couldn't believe it! The change in her. Marymerry, they did give her Ativan on Wednesday to do an MRI. This may have done it. The Dr.'s did not find out what happened. All tests came back negative and her labs were good. She has a mass on her right kidney which is rapidly growing. My mom signed the DNR and does not want a biopsy or anything invasive. Therefore, she is now with hospice and will be coming home, to my house, tomorrow. Her Primary feels that this mass is affecting her other body systems, even though there are no lesions anywhere else and nothing shows in her bloodwork. This is so hard for me accept. All of her equipment came today. Please pray for her and everyone else going through their trials and suffering. I will do the same! God bless!!!
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Dear Ambly,
I am so sorry that this is happening to you & your mom. I just got back from spending 5 days & nights at the hospital for my mom who had chest pains & a cough. I would definitely check on what medications & what they have been doing with her. If she is alone at the hospital anything could have happened. It is strange that they kept her overnight for a PT eval., while I was at the hospital with my mom I had to stop the nurse from giving her the wrong meds, stop the doctor from giving her a blood transfusion to pep her up, she was given every lab test under the sun with med techs taking blood every 6 hours even at 2:30 in the morning & trying to take blood while she was sleeping. Her roommate kept yelling all day & night & died expectantly after one of the blood transfusions & the daughter was so upset that they wouldn't do anything because of the DNR. My advice is if possible bring in another doctor, check the meds ( on another occasion my mother was given morphine without my knowing it because she said that she hurt from head to toe- she ended up in Intensive Care & it took a day or two for her to respond- when I asked the nurse that I wanted to know what drugs she had been given - the pharmacist came & talked to me about how she shouldn't have been given morphine because of her age etc. Check about the UTI & even think about changing hospitals. Giving a lumbar puncture, etc. seems like they are on a fishing expedition, talk to your physician or bring in one from another hospital to review her records before doing anything extreme. I once made an appointment with an Orthopedic Surgeon to discuss her case & he actually went to the hospital for free to review her case. I will keep you and your family in my prayers. Hope she is better!
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You need a second opinion. Unfortunately, mother's health had a major cognitive change I won't hold out for why at this time. You need to focus on your mother's advanced directive for healthcare and abide by her wishes. If she doesn't have one, you need to reflect how she has told you what she wanted as treatment when her health changed radically. Because the decision is about her, not you.

I'm curious where you are located? Doing a physical therapy evaluation as an inpatient? The rest of us would have it in the home or in living facility. PS If this admission is for an inpatient stay in order for mom to qualify for skilled nursing care which requires a three day hospital stay, be sure her status hasn't been changed to observation. If the stay is less than 3 days or for "observation " rather than an admission, Medicare won't pay for skilled nursing facility care for rehab etc. Check it out before she is moved.
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Hi Ambaly

I am sure you are as frustrated as your mother. I have to thoughts on this situation. In all my years of working with seniors, I have never heard of the POA signing this document. I would say contact your local Area Aging on Aging (county office) or contacting National Senior Citizen Legal Services, (NSCLS)www.justiceinaging.com. Both can help without charging. I have no idea where you live but I am sure either of these can help. Next, did your Mom have any surgery or care that would require her to be sedated. My experience has found a common drug for sedation in older people is Versad. I am not a medical doctor and not pretending to be. I have several clients over the last few years in which this drug was used for older people. The outcome was not good initially, for some reason this drug causes much of what you have described in senior citizens. Finally I got a doctor to tell me that for unknown reasons 'Versad does this to many older people'. The good news all of my clients did improve back to baseline, although it was a lengthy process.
I hope this will help a little. I know you are looking for answers, perhaps this has helped.
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My husband has vascular dementia, emphysema, has had aggressive form of prostate cancer (had prostatectomy, radiation, hormone therapy), aortic stenosis, enlarged left ventricle, 2 heart surgeries...etc. and he's 73. He has had pneumonia with sepsis twice and suffered respiratory failure both times. Th last time this happened in January, he had a seizure in the vehicle when we were coming back to Texas from Arizona. He stopped breathing and turned purple as I was driving madly to get to an ER. He began raspy breathing shortly before I reached the hospital, but again suffered respiratory failure. The ER staff worked on him an hour trying to get him to breathe on his own...I had refused to allow intubation because he has a DNR and I was afraid that he would be significantly deteriorated and stuck on a ventilator. Eventually, I allowed the intubation because he could not be air transported from a tiny country ER to Austin without the procedure.
When I arrived in Austin 3 hours later, he was in ICU and breathing on his own! I expected to arrive and find him on a ventilator and have to make the decision to disconnect him. The pulmonologist explained to me that intubation is recommended to the elderly if there is NOT a cardiac event. The DNR is for a cardiac event and resuscinating an elderly person...especially a frail person with the problems my husband has...generally results in significant loss of mental abilities because there is a lack of oxygen to the brain. If there is no loss of heart beat in a respiratory failure, the brain is continuing to receive oxygen and, therefore, the intubation can result in a good outcome.
It did turn out to be the "right" thing to do for my husband. Although he was very ill and developed heart failure and pulmonary hypertension during his 3 week hospitalization, he is "almost" back to his pre-illness status. It was a difficult battle getting him back, but I'm glad he is here. He still has the ability to dress himself...some times he needs reminders; he remembers who I am; he still has "old" memories we share (short term memory very bad); he feeds himself, brushes his teeth and showers (with a small amount of help). So, he still has a quality of life.
When he was in the hospital, he was very confused and disoriented...after months of recovery, he knows he is at home and finds his way to the bathroom, bedroom, living room and kitchen.
I hope this information on my husband's experience will help you as you struggle with your mom's situation. I hope she is recovering and all is well for her now.
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My mother experienced seizures, loss of consciousness, and odd side to side movements and even tongue thrusting at one point due to a relatively simple antidepressant (Zoloft) In her case, the side effects didn't show up immediately but took a few weeks to "surface." She had been given it to improve her appetite. She was also very sensitive to opioids that could cause her blood pressure to drop precipitously, making her a serious fall risk and also causing difficulties in communicating. I'm not sure if she knew me during those episodes. That side effect was immediate. On top of all of that, she developed orthostatic hypotension which despite various treatments became progressively worse and eventually was the reason for her passing. As time went on, her level of tolerance became more restricted. The few medications available didn't seem to help and eventually just sitting up for a few minutes could cause her to pass out. Know, too, that this condition affected her memory. My advice to you is to ask for a medication list and research the side effects of those medications including things like causing sodium levels to drop in the body. Low sodium can be a side effect of medications and that can cause the symptoms that your mom is experiencing. Perhaps, ask for an evaluation from an endocrinologist as my unprofessional opinion is that the adrenals can be part of this picture (sort of like Addison's Disease). As far as the DNR is concerned, I would sign it, particularly if your mom has other conditions that complicate a recovery. CPR methods are brutal to the patient. It's possible to save an elderly patient from a heart attack only to have them die from pneumonia from the trauma (broken ribs) of CPR (painful) a week or so later. This is such a difficult time for your mom and you, and having just been through a year + of this with my mom, I know how hard it is. I focussed on making the quality of mom's life the best it could be and made every effort that her medical treatment did no harm. You have a big responsibility in her care and by asking questions, I can see that you are doing a great job. Aging isn't for the faint of heart, therefore, caregiving for the aging isn't either. Last advice is to know your mom and ask her if you can what she wants and if she isn't able to answer, ask yourself metaphorically what she would want. Look at the decisions she has made over a lifetime, and it can inform you enough to soothe your heart as you make your way through this difficult time.
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My mother suffered a very similar situation. Initially the NH Doctor thought that she had developed pneumonia and she was given antibiotics and IV fluids. The following day she was still unresponsive and I insisted that she be sent to the hospital ER. She was there for 20 days with tests after tests, but remained incoherent. She had to have a feeding tube inserted to go back to the NH. Upon release and shortly afterwards, she pasted away, never recovering. I think it poly pharmacy that killed her.
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It is not usual nor appropriate for medical/nursing personnel to recommend ER for a PT evaluation. My guess is that your mom experienced a change in condition, and being unable to walk was one of the symptoms. Medical issues must be assessed before it can be determined if your mom is able to participate in PT. Whatever caused this change could be the underlying cause of the change in her mental condition. Sometimes it takes many tests to determine the cause of decline. I would like to add that just because the cause has not been found yet does not mean it is medical malpractice, as someone mentioned.

I hope all will be well for your mom, and for you. I know it is very difficult.
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Did you find out what meds they may have given her overnight? As someone else said, a med for sleep could be suspect, or yes! Check for the UTI!
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Also make sure she isn't dehydrated. My mom was at Thanksgiving dinner with my friends when she suddenly went limp and eyes rolled back in head. Ambulance came and it was dehydration. They admitted her for a few hours with IV fluids and then we went home and she was back. Also could be a TIA. The paralysis usually goes away quickly but they still want to run all kinds of tests which at that point usually come up negative.
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My mil went to hospital for broken hip. While she did have mild Alzheimer’s - suddenly within 24 hours she was totally delirious and yelling all night for her mommy. Huge change! They said hospital stays just make them more confused but this was TOO big a change too fast. We did our research and found out Dad had told them her prescriptions and there was one ‘he never used’ but they gave him once for her for ‘occasional use’ when she gets ‘mad at me for no reason’. It was Haloperidal and they didn’t understand so they gave it to her in her drop line!!! We asked that it be stopped immediately! After it’s half-life expired, she was back to her normal, sweet, docile self and not so confused. The nursing staff were flabbergasted cuz they even dent Lu hadn’t believed us that this just was not her. We were right. Something they had accidentally done had caused this huge change. Get mom home as soon as possible and research and monitor any new meds they have put her on (of course after they rule out a UTI). Ask lots of questions and if it’s a possible side effect of a new drug - see if there is an alternative you can try.
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My dad was sent to a geriatric psychiatry unit for a "medication assessment." When he returned to the nursing home he was virtually catatonic due to the overly high dose of Haldol he'd been prescribed. (He was very combative so they basically drugged him into a submission--it's called a "chemical restraint"). Once we moved him out of that bad NH and into a better facility the first suggestion the doctor at the new place made was to cut way back on the Haldol. It worked and he started talking again. Good luck.
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Amjoy02:


Please get a consult from a medical malpractice attorney. They all give a free consult and they may take the case on a contingency basis.   Contingency means you pay not money unless the attorney wins.

My own father had a similar situation. It turned out after hiring a malpractice attorney who was able to get his records, that they had given him a strong medication that interacted with other medications that he was on.

This is clearly malpractice. My attorney prevailed and was able to win a $3 million lawsuit.

My dad recovered but was further disabled due to this error.   His last year of life was miserable because of this error.

Some drugs can also cause a stroke if administered improperly.

If more people would file lawsuits, all doctors and nurses would be more careful before administering drugs.

Do not feel greedy for suing.  If you sue, you will be doing many other patients a favor because the entire staff of the hospital will finally be exposed to outside scrutiny

If they did nothing wrong that will also be a relief to you.
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UTI is a great thought! My mom had been home from Acute rehab for a couple of weeks when she had a sudden change we noticed (because we knew her), it was subtle but clear to us and all cognitive stuff. We took her to her primary for a UTI test which came out negative. The next day she went in for pre-op work up (she was having her heart surgery) and we got a call that afternoon from the surgeons nurse putting her on antibiotics, she tested positive for UTI. Mind you she never had or at least expressed any usual symptoms in her urinary track area, it never developed enough for that I guess. We had just been aware enough to notice the speech and cognitive differences (her stroke left her with aphasia) so early on that either the infection wasn't registering on the test yet or the test the Primary ran wasn't as sensitive as the one the hospital did, IDK maybe the result was just wrong but my point is UTI's can be slippery and they can cause havoc! Absolutely be persistent about this possibility and have her retested if the first one comes back negative. Medications given and taken away in the hospital are also very good points as is the advice to have someone that knows and loves her with her as much of the time as humanly possible while she is in the hospital. We learned that with my grandmother who had a TIA while in the hospital after heart surgery. No one in the hospital knew until I walked in for a visit and knew immediately that she was not behaving or speaking like herself. Can't blame the hospital staff, they didn't know her and she was behaving/speaking like many of the elderly heart patients they see but the difference was so significant to me and then her children who responded to my call we spoke up and they ran test's that told them she had had a TIA and were able then to prevent a major stroke.
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A friend of mine hand the same story and found out the common drugs Haldol and Ativan had caused the problem. Once those drugs wore off, the LO was fine.
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Be sure they have checked for UTI!!! always the first thing I think of when a patient has a sudden cognitive or functional drop.
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Another comment about this...
If this came on suddenly...
If she was not "tagged" as a "Fall Risk" and she got up herself it is possible that she had a fall in the hospital and it is a head injury.
Was she able to get out of the bed on her own?
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First I am so sorry for what your going through, last year my mum who has vascular dementia got a really bad UTI and was so bad we as a family thought we were going to loose her, she did not know anyone was so frightened and confused. When the doctors told us it was a UTI causing all the issues we were gonna smacked. My mum spent 1 week in hospital and 6 weeks in respite until she fully recovered.
I pray all works out positively for your mom.
Patrick
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Look up hospital delirium online. What caregivers should know and do. It is very common and not just to dementia patients. Good luck.
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I haven't read through the answers here so maybe someone has suggested this already but I wanted to asap since I just got this in my email feed (or whatever it's called) and you didn't ask today.

Sounds to me very plausible that she had a fall or hit her head somehow and has a brain injury. If this isn't a stroke I'm not sure why they wouldn't investigate that immediately next but it sure sounds like she's behaving that way. She was in for walking or motor evaluation meaning they had her up and doing various things and there is some problem with it that made her doctor order this in the first place, maybe she hit her head on the steps or some other PT tool they use for assessment and either the elevator didn't see it happen or didn't report it not thinking there was an injury.

I am curious about why she would be admitted to a hospital at all never mind a couple of days for walking evaluation though, are there other medical issues that make this necessary and could be contributing? I don't think that would be possible in CT, is it an acute rehab facility that's in the hospital and did she have a condition or trauma that created the need? I'm just curious but trauma sure sounds like good possibility here and it could be trauma from days or even weeks before. Make sure they are asking and you are providing all info about anything like that even if it seems insignificant and you are just remembering something because your thinking about it.
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I agree with BarbBrooklyn. Why did she go to the ER for a PT assessment? What else was going on? What other symptoms? Ask for a UA, urinalysis, and a list of medications your mom was given. And I am with you; I would want answers before thinking of a DNR. If it is a UTI, it's easily treatable. But if left untreated, it can become septic quickly. 
Oh, and please let us know how she is!
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The more current document is a POLST
The POLST has several different levels of care that are spelled out in the document so you can elect what course of action to take.
A personal comment tough...CPR does not work all the time. If it does when done properly the patient will have broken ribs possibly a broken sternum. Would your Mom be able to recover from that? Or would she be able to deal with the pain from the injuries sustained in attempting CPR?
I think CPR works great on a younger, healthy person but not sure about an older, frail person with many other health issues.
I know none of these comments help your decision now but it is a good conversation to have with your siblings now. It is a great conversation to have about yourself. It is a great conversation to have with your Mom when this episode comes to an end.
As several have pointed out it is possible that it is a UTI. Unbelievable what crazy symptoms a UTI can cause.

Another side note it is odd that she would be admitted to a hospital for a PT assessment. And also odd that after the assessment she would remain in the hospital another night.
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My Dad was 86 and paramedics tried to rescusitate him with shock etc. To be quite honest I don't think Dad would like to have come round, he was depressed about his health, numerous tests and appointments nearly every day, his life revolved around them and I was told that if he did come round he wouldn't be the same. It depends what age she is and what is going on. My Mum went into hospital for a UTI and was in there for 2 weeks, she went downhill, wasn't talking properly, just lying there, not eating or drinking. Nurses just left fluids out of reach, she spilt hot tea down her dressing gown, dry old sandwich left out of reach, wasn't taken to the toilet just slapped a nappy on her and left her in bed. I was fuming, took us months when she got home and fighting the care company who said she wouldn't get better, she did get better but not quite as strong as before. She wasn't incontinent before but after two weeks of having to wee in her nappy made her rely on her nappy. Is her thyroid result good and that is importantly including her T3!! They refused to give Mum her t3 medication in hospital and I am sure that was the problem. Hope she gets better, don't lose hope, TLC is the best medicine.
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You need to educate yourself on what happens to an Elderly person when they do CPR on them. Most times it breaks their ribs and cracks their sternum for starters. Then those things puncture their lungs. Research it. Not trying to be mean here, just stating the truth.
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20Eagle16 you are sooooo CORRECT. We had to stay with my mother 24/7 in hospital when she was under a geriatrician...couldnt trust anyone in the hospital.
They love giving the elderly antiphycotics through the night to "calm them down"...these drugs can definietly cause the symptoms. Also if she has been tested for a uti get them to do it again....sometimes the first test comes back inconclusive which alot of the time they dont test again on the elderly...pls insist on this and insist on knowing what medication they are giving her.
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My mom had these similar symptoms appearing like a possible stroke, delusions and it was a UTI. They also did an MRA I think it was called similar to a MRI but shows more.
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