I haven't been on for a while. A son who was diagnosed with colorectal cancer, and my aging spouse, who is now approaching 96 in December.
She recently had a UTI, was having some thoughts that were a little confusing, went to urgent care, UTI diagnosed, placed on meds, repeat urinalyis/ culture around 2 weeks ago that was negative. Several days ago, she has become preoccupied with living on the "top" floor of our condo building. This preoccupation seems to happen after the following events: a. long day working on word puzzles (Wordscape on her IPad), napping, then waking up sort of in a fog. She describes it as feeling like she is dreaming. She is very clear during the day, engages in her own personal ADL, helps with laundry (folds clothes, etc), washes dishes, works on this puzzle sometimes for 4 hours, takes a nap, wakes up in the evening, and the confusion about place and belonging sets in. I am at my wits end and she seems to know that she is caught between the past (where she grew up on the top floor) and where she is. She told me that she needed space to get her 'brain together'. This is tough as I almost do not look forward to the evening after such beautiful days.
I contacted her doctor and he suggested taking her to urgent care or call his office to see if they could work her in tomorrow. This has persisted over the last 4-5 evenings.
Her lips were very dry and cracked. He ordered some blood tests and the phlebotomist could hardly get 3 small tubes of blood. I have been hydrating her. She loves coconut water.
The doctor put her on melatonin and stressed the importance of her continuing the Wordscape, lots of morning sunshine, going out more often. Her lips are more moist. We have not had an episode in a week. I wonder if this is the tail end of the UTI or a combination of residual UTI and dehydration. The melatonin is creating deep and restful sleep for her. She wakes up rested and ready to tackle her day.
Yesterday we went to lunch at a Thai restaurant with a friend, returned home, and she was on Wordscape until dinner. And, yes, she is really progressing in the game.
My former RN background is still wondering what happened.
Keep her safe. Reassure her if she become agitated. If the agitation becomes more than can easily be managed talk to her doctor about medications. Do keep in mind a medication that can help may also make her a fall risk.
Keep windows covered, either curtains, drapes, blinds. This can cut down on reflections at night that can be confusing. Increase lighting to eliminate shadows.
It sounds as though she is "sundowning", although the recent UTI incident could be an added complication. I think if her doctor recommended taking her to urgent care or going to his office ASAP, then I would start there.
See if you can get the doctor to prescribe some anti-anxiety medication.
There are many ways to address sundowning. I can give you some that I remember here. You could do an online search and get some helpful information.
Honestly, asking the doctor about how to manage sundowning is probably not going to give you the information you could get from nurses and experts who have experience in behavior management associated with diminished cognitive function.
Here are some tips I learned for managing Sundowning;
1) Close the curtains before sundown and make sure the lights are on in the house, including the hallway and any visible adjacent rooms. Distant Dark spaces can cause anxiety and confusion for someone with diminished cognitive function.
2) Follow a consistent daily routine. Around this time is especially important.
3) Try and prevent her becoming over-tired. Too much stimulation (mental stimulation, sound, activity) will be very taxing for her brain.
4) Since the afternoon napping and waking in the evening seems to bring on her confusion and brain fog, I wonder if you could encourage a shorter nap earlier in the day, or try and keep her awake until an early bedtime. Waking up to find that it is not morning, but evening can be confusing.
5) Give her the space to get her brain together! Keep something familiar nearby, whether it's her IPad, or the TV on (low-volume), or just avoid talking to her for a half hour or however long it takes her to wake up from her brain fog.
Your wife waking up confused is not such a surprising thing, especially that she's had a UTI and also takes Memantine. Giving her MORE drugs is likely not a good idea because she doesn't sound agitated or upset, per se. As the brain approaches 100, cognitive changes are to be expected.
Get her tested again for the UTI, that's my suggestion, because they can persist in the elderly.
Take care.
Does she get any sunshine during the day? If you can get her out first thing in the morning for 15 or 20 min in the morning sun it will help regulate her circadian rhythm which affects how well she will rest at night. Then give her the D3 and B vitamins with a meal in the morning.
Keeping a regular sleep pattern is also helpful. Up at the same time and to bed at the same time each day. Even one night of poor sleep can take a toll. Be careful if giving sleep aids. She may sleep but not get the type of sleep needed. If she was given an antibiotic for the UTI, her microbiome will benefit from the B Complex. This affects the gut and brain.
I have no idea that these will help with sundowning but a restful night makes the world more pleasant. When we get the right stages of sleep, the brain does healing and cleansing. If she can take a little walk instead of staying so long on the tablet it might help her stay more alert. Four hours is a long time to spend sitting staring at a screen.
Best not to have long naps in the day.
At almost 96 she sounds like she is going well but I know regardless if her age if she is stressed then you are stressed. Take care of yourself. You matter too.
I’m sorry about your sons cancer.
There aren't medications that address Sundowning. Best solution is preemptive.
https://www.agingcare.com/topics/19/sundowners-syndrome