Hello, I know that this topic has been explored in previous discussions, but I wanted to see if I get some concrete suggestions, tools, devices, etc., that may help a LO who is experiencing Delirium on top of Dementia in a Rehabilitation facility. Three weeks ago, my mother (78 y/o) experienced a heart attack at her ALF. She was subsequently airlifted to a larger hospital with a 24-hour cardiac unit. There, they discovered that she also had pneumonia. After many tests and procedure (catheterization), they noticed various things related to her heart. After speaking to the doctor, my mother decided to opt for an internal ICD. Last Friday, she was sent to a rehab facility. Since then, I have pulled two all-nighters and my partner pulling an all-nighter to ensure that she knows where she's at and to ensure that she doesn't get out of bed (PT had to clear her first). Since she was bedridden for three weeks, she has lost some strength. She is able to sit in a wheelchair but not walk. So, here's the thing: my mother is scared, confused, and lost. Besides placing creature comforts in her room, what are some other strategies, tools, or devices that are helpful in this kind of situation? I know that Rehab is generally not a comfortable situation, but I also don't want her to fall, which will probably send her back to the hospital. Ideally, we are trying to get her back to ALF since this is where she is most comfortable.
She was not accepted back into her apartment at the ALF, however, b/c her dementia had worsened along with her new mobility issues being wheelchair bound. They would only accept her in their Memory Care bldg, so that's where she went. Just a head's up.........when the nurse comes by the rehab to do an evaluation on your mother when her stint is up, she may or may not qualify to go back to the ALF. You need to prepare yourself for the possibility that she won't and have Plan B lined up! I hate being blindsided, and I'm sure you don't want to be either.
That said, I'm not sure what all you can do to prevent your mother from falling; it's somewhat inevitable with these elders who are in a compromised mobility and mental state. If the PT is working with her to regain her core strength, that should help somewhat. If I knew what to do to prevent these falls, I would have done it already to ward off the 34 falls my mother's taken in the past 24 months she's been in Memory Care. Sigh. No injuries, believe it or not........just fall after fall after fall, even with bed and chair alarms in place, signs to Please Pull The String Before Getting Up and all sorts of other safety cues too numerous to mention. Dementia prevents the person from understanding cues or processing what 'danger' or 'safety' really means. THAT is the trouble. Short of you and your SO living with her in the rehab facility, I don't know what you can do other than to ask the staff to keep an eye on her. It's really a no-win situation, isn't it? Mixing dementia in with rehab is a recipe for disaster.
Wishing you good luck and Godspeed with a difficult situation. I pray your mom makes a full and speedy recovery with no falls during her stint in rehab.
"Short of you and your SO living with her in the rehab facility.."
To be picky, even if the OP & SO could live there, she could still fall. Maybe stop her from falling out of bed some of the time, but not from leaping out of chairs/wheelchairs. Mine have done this right in front of me. Just up - lose balance - down.
Understand her situation. I work as an RN and hospitals are NOT places to get good rest. Staff are always coming and going in the effort of healing. Most likely your mom has some serious sleep deprivation that needs to be addressed. Then, she had 2 serious health issues - cardiac and respiratory compromise. Micro clots can be thrown from her catherization that could cause micro-strokes in her brain and cause some confusion. Also, her pneumonia can cause confusion from poor oxygenation as well as the toxins from her infection.
Treatment options. Make sure her vital signs are healthy (ask the nurse, not the aide) to check her vital signs a couple of times each day and give you the results. If her blood pressure is too high or too low - notify the doctor. If her temperature is too high (over 100.5) - notify the doctor. If her oxygenation (pulse oximeter reading) is less than 95% - notify her doctor. Make sure she gets some solid sleep - at least 8 hours - at night and get an order for sleep medication if needed. If her confusion does not resolve in a week or 2, ask the doctor for a neurology consult.
Consistent routine. Most folks thrive in residential facilities with consistent routines and environment, Your mom should have a consistent bedtime, wake up time, meal times, and bath times. Help her to stay on a schedule. In a couple of weeks, she should accept the schedule and do better.
Anxiety. Many older folks that have dementia are scared in new situations. She may be anxious and that ends up in her being agitated or even combative. If this is the problem, keep reinforcing the routine and ask her doctor for an anti-anxiety medication. The medication should only be for a few weeks and should be tapered off. Be aware that anti-anxiety medications can make people a bit sleepy.
When are they going to start the PT. My Mom was hospitalized for 4 days for a UTI and rehab was suggested sort of. I was "told" she was going to rehab but you do have the option. She was going to get her strength back. Well. she had her PT in the morning and maybe OT in the afternoon and the rest of the time she sat in a wheelchair confused and unhappy. I was told at a care meeting 2 weeks in she would never walk without assistance. She was discharged after 18 days. Took her back to the AL and within 24 hrs was walking all over with her walker.
Now my Mom had not gone thru what your Mom has. Pnemonia alone does a number on you. I agree that being back at her AL maybe better for her. Its familiar. I would wonder if you could get PT to come to her AL. It should be covered by Medicare. If one of you could be there when PT is there you could learn how to do her exercises and help her when PT in not there. You would be able to walk her around. From my experience I did not once see an aide walking my Mom. For her, I think having PT coming into her AL would have accomplished as much or more than PT in the rehab.
My mom had severe reactions to all cephalosporin antibiotics - she still has small reactions or confusion moments with other antibiotics and isn’t fully herself until she has completed them. Once finished she has a much easier time regaining her strengths. If she is still being treated and finishing out antibiotics this could be some of the cause of why she is still having difficulties. It’s very difficult to find base level when they are being treated for infections all the while on the crunch time and pressure of meeting “goals” - because it’s not a true assessment of their capabilities while they are on medications - it such a hard and stressful time. If she is still on medications try to keep her there until they are finished to get a “true” assessment and I would also suggest checking for UTI and electrolytes.
Good luck.
Things that help with delirium: things from home , a familiar blanket, pictures on the wall, cards from family, telling family stories, saying what time it is and what day it is every morning and throughout the day, talking about the weather. From what I have experienced, anxiety fuels the delierium so anything you can do to reduce it helps. Reassure her over and over where she is and why and that you understand she is confused. Quiet, favourite tv shows and movies, ..The best thing for my dad was coming home but if she can't just do everything you can to make things seem familiar and safe. If you can make her laugh that really helps! Oh and a clock on the wall.
The best place is for her to be home with family at least while she recoops and if she can't continue to stay with family after she recoops, she'll have to go back to where she was.
Anone in a Rehab or Hospital really need an advocate with them during their stay, especially when they don't have their mind and aren't able to tell you things that are a problem.
If she has to stay where she is, make she she gets visited every day and at different times so the staff know that she gets visited. It's worse on Patients who have no visitors because there's no one to check up on them to see that they're doing what they're suppose to be doing. They don't take the time to feed you because they are understaffed.
My Dad with dementia has to depend on everything as he can't eat by himself, he had to be told to eat, to chew, to Swallow.
He is forTulare to be able to live at his own home with 24 hr Caregivers and I have cameras installed in his house to make sure the Caregivers are treating him right.
He wouldn't survive a week in a place.
He doesn't eat much and has to be offered something to drink every 20-30 minutes so he doesn't dehydrate because he just takes sips from a straw. He stays up a lot at night asking what do I do now or saying he's hungry. Since he doesn't eat much. Like a baby he is hungry every 2-3 hrs and will get a bite or two of apple sauce, yogurt, Ensure or some other breakfast drink, ect ect. Dementia people are very demanding and can drive you crazy because of all their talking and mumbling about things.
If he were in a home, they would have him on all kinds of pills to how they would put it to calm him but they would be sedating him so they don't hear him and keep him like a zombie til he withers away and dies or tries to get out of bed when no one comes to help him go to the bathroom then he would end up falling and breaking his hip and die because he's 97 and too old for surgery.
I thought about a Live In but after staying with my Dad a couple weeks, I knew it wouldn't be safe for a Live In because my Dad is high maintenance and takes little naps on and off all day so he's up at night when someone would need to sleep.
So it's a little better having 12 hr Caregiver Shifts.
And even using that, I can see Caregivers being short with him because he can't remember 5 minutes and will talk and ask the same questions over and over and over again.
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