Is disorientation after a hospital stay normal, or is my Gran just angling for more attention?

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Is disorientation after a hospital stay normal, or is my Gran just angling for more attention?

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Hi,

I have just joined the forum after visiting for many years!
Sorry in advance for my long message.

I am based in the UK and help care for my 88 y/o Gran.

She just had a week in hospital after a mild bout of pneumonia and a UTI.

We got her home last night but she didn’t seem to recognise her flat and also was expecting me to do everything, take her to the toilet, pull her trousers down, undress her for bed (although she was quite able to work the TV and check the messages on her phone?)

Prior to going into hospital she was doing these things for herself, but does have carers in two times a day to do meals for her, laundry and give her a shower etc.

This does sound awful but she has, for at least the last 20 years, been a very lazy person. My Grandfather did pretty much everything for her until he developed dementia 10 years ago (he died in 2016).
I lived with my Grandparents from age 11 to 19 after my mother died, hence I am more involved in capacity of a Daughter than Granddaughter.

Obviously being in the hospital she got used to the nurses doing everything for her, but she was only in a week, seems a short time for her to completely forget how her life was before hand?
She does not live in the home she shared with Grandad, she moved to a managed flat when he went into care although there are not staff there all the time. There are pull cords etc. in case she falls.

My Dad (65) also helps care for her, he takes her to appointments, deals with her finances. My involvement I mainly do food shopping, a bit of cleaning but really up until now I have only visited once a week to do these things but will mainly spend a few hours just as company for her, chatting.

There is a communal area in her building and she used to go down there herself to meet with the neighbours for coffee etc. but when the pandemic struck it closed for two years and when they reopened it this year she decided she wasn’t able to do that any more so spends all day at home. I think she is still able but just lost confidence. But try as I might I can’t convince her, even if I offer to walk down with her (she has a walker too which she can use well).

My view is that if she wants to continue living independently in the way she has been then she will need to start doing things for herself again as neither my Dad or I or her carers can be there 24 hours a day.

Maybe she will bounce back again, just wondered is this a normal thing after a stay in hospital or is this usually when the conversation about a nursing/care home needs to start?

I personally think she would enjoy a care home but has a mental block about it as my Grandad’s was a specialist unit for dementia and it was upsetting for her when we would visit.

Sorry for long message, just be nice to be able to chat to folks going through the same thing, as I don’t think people who aren’t currently in it appreciate how stressful it is and how much mental space it takes up for us.

Thank you,
Jennifer

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Hospital stays do change people. And don’t fool yourself they will never be the same. At this point you have to do what they want (not you) that makes their life happy. Realize they have taken one more step closer to the end.

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What? No, a grandchild should never be asked to forfeit their entire life to prop up the illusion of independence. Happiness comes from within, saying someone has to do everything to make another happy is outrageous.

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Hello Jen, I just want to say that I don’t think you are selfish at all for thinking she would be safer in a care facility. Almost no one WANTS to move out of their home but for someone who needs 24/7 care it’s necessary. You want your grandma to be safe and looked after, that’s nothing to feel bad about. Even if it’s not her preference.

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Hospitalizatipn can really take a toll on an elder's functioning; Anesthesia, pneumonia and UTI especially can reduce functioning. Shes not faking it, though it's consistent w her personality to be needy. She may just be reverting to what is her norm... or a new norm/what is safe for her. She's telling you she needs you... or someone right now. It may be temporary or permanent. Read about RETROGENISIS, decreasing function over time.

You are correct that if she wants to continue living in her current level of care, she will need to resume certain tasks for herself. That may help to motivate her. But she may not be ABLE to do so. Give 4-6 weeks to see if things improve. Then have an impartial carer assess. Together you may have to make a decision to move her to a higher level of care.
Good luck

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Most of the time when an elderly person leaves their home for a hospital or rehab stay they often get "delirium". Coupled with an UTI this makes it worse. It mimicks dementia and staff at the hospital may call it that as well. Give her some time to get used to being back home and encourage her in a nice way to do the things she used to do for herself (as long as she is able to). It may take a week or two for her to get back to normal.

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I only have to say, as others have: Yes, yes, yes. If it continues for longer than a couple of weeks, speak with your loved one's physician.

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UTI’s are notorious for causing cognitive disruption. Very very common. That is the first thing to check for when a normally functioning eldrrly adult woman becomes confused and disoriented. Add to that the life and routine disruption of a hospital stay and the assault on lung function that is pneumonia, it is no surprise that she has not been herself. Low oxygen to the brain as a result of pneumonia can also affect brain function.

Have her drink cranberry juice daily if she likes it. It is a natural UTI preventive. There should perhaps be a follow-up urinalysis to make sure the UTI has been eradicated. Getting an oximeter (cheap on Amazon) to check her oxygen blood levels as her lungs heal would be good.

Pneumonia is VERY depleting. I have had it 4 times so know what I am talking about! Encourage movement around the home. The fatigue can last weeks to months.

The next time she has bloodwork ask them to check her B12 levels as low B12 is common in elderly people.

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Note: REAL cranberry juice, not flavored water

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People not only as they age can become disoriented in hospital setting; but it can take a little bit to reorient after getting back to familiar places. Keep in mind as we age our bodies and minds take a little longer to rebound from physical assault and by that I mean illnesses. Then you mentioned she had a UTI which is notorious for causing altered mental status i.e. confusion. If that has not cleared all the way up she may still have some lingering confusion. While not knowing your Grandmother's history outside of what you have written; I would still say it's not stretch for her to still have some confusion. If it continues I would make an appointment with her primary to get a urinalysis to see if her infection has resolved and if not some type of oral antibiotics

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After my mom had surgery when she was in her early 80's, she was disoriented for a little while, while in the hospital. I asked the nurse if my mom 's cognition would return to normal, and she said, "Usually." (I wanted to hear, "Of course.") My mom was fine mentally within a day or so. I think with her, it was a combination of the physical and mental stress of the surgery, medication, anesthesia, etc. I think with your grandma and so many others in her situation and age bracket, Covid added insult to injury. They weren't able to socialize as much, they became more isolated, etc. I agree with others, in that if she can help herself a little, that's great. When my mom was back living with us, (about 5 years after she had this surgery), she developed Alzheimer's), I'd encourage her to do what she could. It might have taken her 1/2 an hour to write out 1 check, (and she had been an accountant, and could have written many checks in a minute when she was younger), but I wanted her to maintain as much cognition and independence as possible. (I hovered over her, to make sure that the check was written correctly.) I had to be careful though, in which arena she'd be able to exercise her independece. For example, I had to keep her out of the kitchen, as she once put frozen peppers in a cup, to make coffee. At that point, the kitchen was off limits to her. Since she didn't really like to cook, I'd just tell her, "I'll make your breakfast, lunch and dinner," and she was fine with that. Of course, each situation is different. I'm sorry to hear that your mom passed away. It's very nice that you and your dad are helping your grandma.

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Definitely yes my mom and dad were very confused and disorientated after both hospital and rehab stays. It took a good six weeks before they were more of their normal. In the meantime keep the sitters and check in often. Encourage her to do as much as she can but don't force it. It takes a lot out of them recovering from pneumonia and the UTI!
It will get better!

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Hello. I would give her time to get back to normal. Meanwhile hold her tight and love on her you only have one grandmother, even if she likes being waited on.

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It's normal for elders to behave that way after a hospital stay. It's also normal for some elders to behave that way when there's nothing wrong with them. Give her a few days to re-accliamate to being home and watch her behavior very carefully. If she can work the remote and listen to her phone messages, then the other stuff is her as you say, angling for attention. If you see that she is struggling with tasks, then it may be time for her to have a higher level of care.
You say she is a very lazy person for the last 20 years and your grandfather enabled her laziness until he became ill himself.
She is very likely looking to you to become her next enabler. Don't do it. Remind her that she is not an infant and you will not treat her as one.
I was an in-home caregiver mostly to elderly clients for almost 25 years. I will tell you that sometimes with the elderly they need a bit of tough love from their families and caregivers. You love and care about your grandmother. Do not enable her to become a useless invalid that has to have her pants pulled down to go to the bathroom and has to be put to bed and tucked in at night like a baby. You must refuse to do these things if she can still do them for herself. If she can no longer do for herself, she will need a higher level of care.
Elderly people have to hold on tight to whatever level of independence they still possess. Doing for themselves whenever possible must be strongly encouraged by family and caregivers and even demanded.
I've worked for too many families at the end of their ropes who just did everything for their elders because it was faster and easier than the elder doing for themselves when possible. These people turned their elderly loved ones into invalids then were upset because they were invalids. Your grandmother must be forced to do for herself where she is able to. It's the best thing for her and for her own good. Any level of independence is positive. Good luck.

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Please have her checked again. UTI’s can be tricky. I lost both in-laws earlier this year to persistent UTI’s which ravaged their systems.

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That’s horrible I’m sorry for your loss.

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Some very helpful and well-received ideas and responses in this posting. It was a pleasure just to read through the questions and suggestions.

I am envious of some of the "fully funded" services and re-enablement provisions described. Those would be very helpful.

I can only add my "vote" for giving Gran a little more time while tapering off some of the assistance she may need. If she cannot regain safe independence after a few weeks, it would be time to re-assess her living situation or amount of care needed.

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Good Morning,

Absolutely...with each hospitalization it's almost a setback for the elderly. For every day they are admitted it takes them so much longer to get back on their feet. Oftentimes you have to find out what their "baseline" is after a safe discharge.

Be patient, loving and kind as it is an ordeal for the elderly to be out of their environment, mostly with everyone wearing facemasks, they can't shower and there is constant noise and interruptions with blood draws. The Pandemic did a number on the elderly.

The fact that you are writing in you love your Grandmother. Hold their hand, tell them you love them and that they have a family who cares for them and there is nothing to worry about.

Amen...

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It's completely normal. Each time my mother returned from a hospital day, she was completed disoriented and sometimes extremely anxious. It will pass, be patient and kind and she will transition back to "herself" in a matter of days.

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DreamerJen, you give an excellent example of things going a bit wonky. It quite often happens that a client will wait for us to arrive before she begins her routine, thinking that it's the correct or anyway the polite thing to do; but there's no need to wait! If she's confident with some tasks, such as cleaning her teeth or making her toast, we'd encourage her to do as much as she can and then we'll support with completing the routine later on. They won't cancel her calls just because she's managed to get her own cardigan on (which is another reason people are sometimes afraid to forge ahead).

So, say your grandmother can manage to wash and dress her top half but struggles with getting socks on or her trousers over her feet - it's *fine* for her to get halfway and then just keep her dressing gown or pj bottoms on until they arrive. The workers should also be looking for and recommending tips or adjustments or gadgets that will help her manage more easily, too.

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Thank you countrymouse, I think you are right on the money and she is always keen to do the right thing so maybe just needs encouragement to remember what she can and can’t do nowadays.
We have started the ball rolling with the reablement, the manager of the care company we use is coming to assess her so we’ll see.
Thank you so much for your help and advice!

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"pneumonia and a UTI"

Both are very frequent causes of delerium in older people.

Hopefully as the infections clear, she will bounce back to herself.

Gran will be a much bigger falls risk if confused/disorientated, so more supervision from family or carers popping in (if possible) will be a good thing as well. Hopefully her set-up is quite suitable? Habbit of wearing sturdy shoes, good bathroom lighting, no rugs to trip on.

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Thank you Beatty!

She does have a pretty good set up and was good about wearing shoes in the house (after a few falls in the last few years she realised they helped steady her).

My Dad and I have been popping in more often since she got home but also want to encourage her to remember she is living alone again (which is her preference) so has to take a little bit of responsibility for herself.
Unless she wants to sit in her nightgown til the carers come to help her, which is fine if she’s happy to do that but she has been complaining that no one has helped her to dress which was something she did comfortably herself pre hospital stay.

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When my 90 y/o father was hospitalized for a week, he was acting exactly like your gran after being released. Including the Sundowning in the late afternoons which had nothing whatsoever to do with dementia, but with hospital delirium which is common in elders with hospital stays and/or going to rehab. My mother was seeing MICE crawling on the floor of the rehab, that's how bad she was! Practically incoherent and babbling.

Hold off on all premature diagnoses, neurological evaluations and jumping to conclusions until gran has been home at least a month or two. If she's still not back to her old self, then you can start worrying.

Good luck.

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Thank you, I appreciate the reply! I need to be patient and remember that just because she is out of hospital that doesn’t mean she still won’t be feeling the effects of her illness.

I just don’t want her to give up all her independence yet. That is probably just selfish of me!

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Jen, if the care is being fully funded it's possible she has already been referred for reablement without your (or her) realizing it :)

If so, get on board with the concept as well as you can. You have up to six weeks' service, which goes quicker than you'd believe, and there should be a folder or something like that in her house which will contain the support plan and the workers' daily notes.

Reablement as it should be done can be difficult to deliver because local authorities, although they're required to offer the service, can't afford and are not funded to pay for the time it takes. If you have 45 minutes to get somebody started off in the morning it's a lot quicker to do things for her than to help her do it herself and the temptation can be too much.

So the more positive you can be in encouraging your mother to use the service as it's intended to be used, the more likely she is to achieve the best possible outcome.

You can find out anything you want to know about how it's supposed to work from the Social Care Institute for Excellence - https://www.scie.org.uk/reablement/what-is/carers-family

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Countrymouse ~
Thanks so much for the education on benefits in the UK. I'm tucking the info away because you never know when it might just come in handy!

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I have always heard pnemonia itself will disorient people. At 88 it will take her longer to bounce back. Was she checked for a UTI while in the hospital?

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Jen, first thing tomorrow contact Adult Social Care, explain that your grandmother was just discharged from hospital and is finding it difficult to reorient herself, and ask if there is a Reablement service she can be referred to. Stress how independent she was before her hospital stay and how important it is to her to return to that.

Have the carers been started again?

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Oh countrymouse thank you so much. I did not know such a service existed. Will contact them asap.

Carers have started again but at the moment they were only really there for meal times but think we have the option to increase it to include more personal care like helping dressing etc.
seems to be all fully funded by the local authority which is a welcome surprise!

Gran has started using the toilet herself again which is a small but good step in the right direction.

She is not getting herself dressed yet and still seems a bit disorientated, when she wakes up particularly and is more keen to stay in bed whereas before she would always get dressed straight away and head to the living room.
I can totally understand it must be so confusing as time can lose all meaning when you’re in hospital.

Thanks again!

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Sounds like your grandmother is suffering from delirium, which is very common in the elderly after a hospital stay. It can take weeks even months to completely resolve in an older adult, and in some cases the person never recovers back to their prior normal.
So be patient with her, and know that it's the delirium and not her.

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Thank you for your reply. I am so shocked at how quickly it can cause a change in people. I have been reading up about delirium, thank you for the information,
I pray she will find her bearings again at home but will watch closely for the next few weeks.

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Disorientation and a change of personal habits in a 88 year old person recently treated for a medical condition, could be the first signs of a developing dementia. Many times, a medical condition is the trigger to make evident a preexisting dementia. The best way to evaluate for dementia is a neuro-psychological test done by a specialized psychologist.

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Thank you TChamp, she was evaluated recently and Dr said no sign of cognitive impairment.
However she does every now and then (maybe every few months) wakes up in the night and think she’s in the wrong house and will call my Dad to ask where she is.
He can usually talk her down from this state.
They told us that could be to do with very concentrated urine or also sundowning(? If that’s the right term).

I would prefer it if she was in a full time care place but feel selfish for that as that is not what she wants.
but worrying about her all the time is making me ill.

My Dad will say as long as we are doing our best for her then there is no use in worrying. Easier said than done!

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Thank you for your reply.
Wow after 1 day really I did not appreciate that!

I do hope she can bounce back being more independent as she was doing quite well before (although needy in the way many old folks are!).

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Jennifer, welcome!

Yes, it is common for some confusion after a hospital stay, especially for the elderly. It only takes 1 day of laying in bed for them to lose all stamina, she probably feels weak and wobbly.

Giving her prompts to do what needs done and helping when she runs into trouble will show if this is temporary and she has the physical ability to recover.

However, at 88 changes happen quickly and this could be her new normal.

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Is disorientation after a hospital stay normal, or is my Gran just angling for more attention?

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