SUDDEN INCREASED DEMENTIA CAUSED BY INFECTION

Her mom was diagnosed with mild dementia, but now she has significantly increased dementia. And it has happened so suddenly. From being able to walk independently around her neighborhood, handling her own finances and even helping with her granddaughter. To suddenly not only was all of that gone, but now she is unable to speak, only babbling incoherent sentences. Mom is now total care with all of her needs from dressing to toileting and eating.

The first sentence she wrote me said it all, Mom is 88 years old and has had a urinary infection. At her advanced age, and with already a diagnosis of mild dementia, it is no surprise that she has had an increase in her dementia since being sick. The urinary tract infection was resistant to several antibiotics and after the 5th try her blood still shows a low grade infection.

Once the elderly person has a decline in cognitive function due to infection, the person even after the infection is resolved never returns to their previous level of function. And this mom just hasn’t recovered from the infection.

Preventing a infection is the only sure defense against this type of sudden increase in dementia. Taking advantage of the things we know that prevent infection. Taking a oral probiotic daily, especially something fermented such as sauerkraut. Taking a vitamin D supplement as well as an Oregano capsule. We have all now seen the chicken commercials from Perdue where they tell how they have moved away from antibiotics in their chickens water by the addition of Oregano.  So the elderly can also benefit not only from a little chicken soup but the Oregano that is keeping the chickens healthy.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

Please support the mission of this site by accessing Amazon through my book icon- it is not necessary to purchase the book, just by going on to Amazon via the icon supports this site – many thanks!

REASONS FOR SUDDEN DEMENTIA – DELIRIUM AND DEMENTIA Part II

The Center for Medicare requires healthcare professionals to investigate causes and reasons for sudden dementia including these changes:

SIGNS OF POSSIBLE DEHYDRATION

  • recent decrease in volume of urine, more concentrated urine or a darker color
  • recent decrease in eating habits, skipping meals, leaving food uneaten, weight loss
  • nausea, vomiting, diarrhea, or blood loss
  • receiving IV drugs
  • receiving diuretics or drugs that might cause electrolyte imbalance

FUNCTIONAL DECLINE

  • falls or increased risk for falls
  • recent decline in the ability for self-care in hygiene, dressing, walking, eating, etc.

MEDICATION REVIEW

This area requires the services of the pharmacist. A medication review would first focus on new or recent medications and possible interactions with other medications the patient is taking. All narcotics need to be investigated, the elderly may become unreasonable, angry, or argumentative on narcotic medications. All behaviors that are different for the patient since beginning a new medication must be explored. Especially so for any drugs used to change or modify  behaviors such as anti-anxiety, antidepressants, sleep medications and of course anti-psychotic medications.

SOCIAL CHANGES

  • social withdrawal – recent loss of a family member or friend
  • recent changes in mood – crying or anxious\
  • a recent move – out of state or from home to facility

UNUSUAL BEHAVIORS

  • recent change in sleep habits, sleeplessness at night and sleeping during the day – nightmares
  • unusual, inappropriate or unsafe movements
  • hyper-active or hypo-active, a recent change to the extreme in a person’s level of activity

 

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

REASONS FOR SUDDEN DEMENTIA – DELIRIUM AND DEMENTIA – Part I

The increase number of people experiencing sudden dementia has caused delirium to be a focus of Medicare. As with everything else the way to capture attention is to create a monetary connection. In this case, Medicare reimbursement for sudden dementia is tied to identifying the cause of the patient’s delirium. The list of possible reasons, is to be a guide for consideration for every patient on Medicare with sudden dementia or delirium. Or any person admitted to a nursing facility who has sudden dementia as a diagnosis.

The basic physical changes that can cause a person to become delirious:

CHANGES IN VITAL SIGNS – COMPARED TO BASELINE (baseline, you always want to compare with what is usual)

  •  elevated temperature – 2.4 degrees higher than baseline
  • pulse rate less than 60 or higher than 100 beats per minute
  • breathing slower than 16 breaths a minute or higher than 25
  • a significant drop in blood pressure compared to baseline
  • a significant increase in blood pressure compared to baseline

ABNORMAL LABORATORY VALUES

  • electrolytes
  • kidney function
  • liver function
  • blood sugar
  • thyroid function
  • arterial blood gases (this is blood tested from an artery instead of a vein to check the ph of the blood as well as to see how well the lungs are moving oxygen into the blood and removing carbon dioxide out of the blood)

PAIN

  • how often is the pain, how intense, how long does it last, what is the quality of the pain?
  • how is the pain affecting the patient’s ability to function?

A complete pain assessment must be conducted at this time.

SIGNS OF INFECTION

  • fever
  • cloudy or foul smelling urine
  • congested lungs or cough
  • shortness of breath – or painful breathing
  • diarrhea
  • abdominal pain
  • wound draining pus
  • any redness around an incision or wound

Some of these symptoms may be present but if there isn’t a good reason for something such as a slow pulse –  that is related to a medication the patient is on, then this symptom must be considered as a cause for the sudden dementia, and investigated further.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

 

SUDDEN CONFUSION – Part III

May is 89 years old and suffers from sudden confusion and dementia. While her story is sad and even tragic, it really demonstrates how the combination of extreme life stressors and the smaller brain can lead to equally extreme confusion. Until recently May was functioning on a very high level for someone her age. In fact she was providing some of the care for her aged husband.

Then due to the care she was providing she required back surgery. May suffered from excruciating pain prior to her surgery as well as following the procedure. This required her to be on narcotics, something that was certainly an assault to her brain. And one of those things known to cause elderly brains to shrink.

While recovering from her surgery, her husband of so many years died. Before May could adjust to the loss of her husband she received the news that her granddaughter had suddenly and tragically died as well. May then began to mentally spiral down, with the combination of grief, pain and narcotic medications, she could no longer cope.

May became delirious causing her to now be medicated with high powered psychotropic medications. She was physically restrained in a hospital bed, confused, agitated, delirious  and manic to the point of chewing on her fingers. Resulting in chewing off 1/3 rd of one of her fingers, in her extreme mental distress.

While the story of May demonstrates how extremes can result in sudden confusion, dementia and delirium. Her life tragedies could not have been for-seen nor avoided. The loss of her husband was expected but not the loss of a much loved granddaughter. Her back problems were possibly predictable depending on how much physical support she was providing for her ailing husband. However, that she would need back surgery and be on narcotics for the pain was not predictable.

But what we don’t know about May is how good of a job she had done taking  care of her brain during those 89 years. Our assumption is that she was doing a good job taking care of her health and her brain, due to the fact that at her advanced age she could participate in her husbands care.

So for May as well as many other elderly, sudden confusion and delirium are not all that unexpected or sudden when the tragedies of life arrive.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

SUDDEN CONFUSION DUE TO ENVIRONMENTAL TOXINS – Part II

Sudden confusion is related to the reduced capacity of the aging brain (size of the brain)and the many environmental abuses experienced. Reduced brain capacity happens over many years due to a variety of factors.

The size of the brain at birth is currently determined to be 23 billion cells. The brain grows not due to creating more cells but rather to creating connections between the cells.  Through learning the baby’s brain creates connections between cells that triple the size of the brain by the individual’s early 20’s. While those connections are important the connections noted to be the most important in increasing the size of the brain are those connections which in fact nourish the brain.

Babies and growing children who live an enriching environment will have significantly larger brain mass than those deprived of this environment. Then the goal becomes maintaining that brain capacity and constantly adding to the brain by creating new connections.

Researchers agree on these basic areas that will reduce brain size as you age:

  • medications
  • disease, especially chronic disease like heart disease
  • extended grief over personal loss
  • alcohol
  • not having a stimulating partner in life
  • bad living situations
  • inflexible personality style
  • sedentary lifestyle
  • high blood pressure – especially in middle age
  • lack of stimulation
  • low education level – lack of desire to learn – lack of curiosity
  • malnutrition
  • depression

When it comes to the brain it is certainly true that the more you have the more you can afford to lose. Knowing these areas that only do not support or maintain the brain but actually harm the brain, you can address these areas and reverse the brain shrinkage.Sudden confusion connected to reduced brain capacity then, though sudden is not really unexpected.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

SUDDEN CONFUSION DUE TO TOXINS – Part I

Sudden confusion due to toxins may be expected and at times unexpected. Ralph was 86 when he decided that he was finished with dialysis. Ralph had end stage renal disease related to diabetes, and was on dialysis for over 10 years. Now Ralph decided that enough was enough and he wasn’t going any more. Ralph understood that this would be the end of his life. Without dialysis toxins would build up, and he would become very confused before those toxins would end his life.

Mike arrived at the nursing home due to extreme sudden confusion, related to alcohol abuse. A very long history of alcohol use and abuse. When Mike arrived he had been begging for money from strangers on the street in order to go to a hotel, because he was sure someone had put cameras all over his house. He thought he could no longer live in his home because there was a bomb, and he was being watched.

Many elderly suffer from sudden confusion due to medication mistakes. When the elder is managing their own medications and do not have a good reliable system in place, mistakes often happen. The elder then is admitted to a hospital where lab tests are run, and the medication is identified. However it might then take some time for that sudden confusion to resolve.

People as they age begin having more and more difficulty with toxins. This is due to the lifetime of environmental toxins their brain has been subjected to. Just one example is the history of using leaded gas, and the toxic effects due to use of that gas. Research studies have shown that older Americans have much higher levels of lead than younger people who were not exposed.

As the elder ages, they have a reduced brain capacity due the shrinkage of the brain. The combination of reduced brain capacity and that lifetime of exposure to many environmental toxins, put them at higher risk for sudden confusion. The elderly brain just has less to work with and at the same time more to deal with. (see also delirium)

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

SUDDEN CONFUSION – GO TO EMERGENCY ROOM

While it is easily seen when a person has a dramatic change in consciousness and they are in a stupor or coma, delirium is not that easy to identify. The emergency department is usually the point of entry into the hospital for the confused elder. The ER runs at a high speed and it is necessary for an accurate diagnosis for the patient’s family or friends to give a good history.

Patients in a deep sleep or stupor, who can only be aroused with extreme physical stimulation are in a medical emergency. The emergency room personnel assume that the person is not always so difficult to arouse, and they recognize the emergency. However identifying changes in a patient with delirium is much more difficult because the hospital staff do not know how the patient usually is. This puts the burden of communicating the emergency situation on the accompanying family member.

It is estimated that ER physicians miss the diagnosis of delirium in 57 to 83% of cases. This wastes valuable time for the patient, time that they need for early intervention. This missed diagnosis can be due to the fact that the elder themselves do not know why they have come to the hospital. Or if the elderly person is agitated they may even be admitted to the psychiatric ward, without a good assessment.

Giving a good mental history:

  • when did you first notice a change in mental function?
  • do these changes seem to come and go – get worse or better over time
  • does the person have problems paying attention – give an example of what is normal for this person and how they are now not acting normally – having difficulty carrying on a conversation – getting distracted and changing the subject
  • patients who are inattentive may actually fall asleep when they are not engaged in conversation, this change in sleep/awake patterns needs to be stated
  • the patient now has rambling thoughts and disorganized thinking
  • if the patient has had any recent falls, this is a very important piece of information and will help the physician in their physical examination – looking for possible head trauma
  • maintain an accurate list of all of the elder’s medications as well as any over the counter medications they are taking – maintaining this list will make it much easier in an emergency situation
  • share with the emergency staff if the elder has a history of alcohol abuse or use of sedatives
  • has the elder ever experienced an episode like this in the past?

Being prepared and ready with this pertinent information is impressive and will more likely get the attention of the emergency personnel than saying “He is just not acting right.”

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

SUDDEN CONFUSION – CAN THE PERSON WITH DEMENTIA GET DELIRIUM?

Many people, including those in healthcare use the terms dementia and delirium interchangeably. Even tho they are not the same, patients can have both conditions at the same time. A person with dementia can certainly develop delirium, they are even more inclined under certain circumstances, to develop delirium.

The person with several disease processes as well as dementia, will be the person at most risk for developing delirium. Research has shown that the person with dementia has a lower mental reserve and less ability to adjust to a physical assault. That assault can come in the form of an infection such as a urinary infection or upper respiratory infection. Because the person is more vulnerable due to their dementia, they can under these circumstances develop delirium.

Other factors creating an increased likely hood of developing delirium are advanced age, history of alcohol abuse, poor nutrition, poor physical function, poor vision, hearing loss, dehydration, congestive heart failure, extreme pain (such as that related to a fracture), and many medications especially narcotics. Many times the cause of the delirium will not be found.

When the person is admitted to the hospital they are at increased risk to develop delirium if they have dementia. Due to the nature of the running of a hospital, the confused person may have physical restraints to keep them safe if they are trying to get out of bed unassisted. The elderly who are incontinent may now have a catheter for the purpose of obtaining urine specimens as well as easier care considerations. These possibilities as well as the likelihood of the elder now having an increased number of medications can result in an increased risk of developing delirium.

In the United States, hospital emergency rooms are currently seeing approximately 18 million patients 65 years and older. As the population ages, the number of visits to the emergency room by the elderly will increase dramatically as well. The potential for large numbers of the elderly population going to the emergency room for sudden confusion and developing confusion when admitted to the hospital is increasing. All of this adds up to an expectation of  not only the increase in elderly persons with dementia but also the increase in cases of delirium.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

SUDDEN INCREASE IN CONFUSION IN ALZHEIMER’S PATIENT – IS THAT EVEN POSSIBLE?

Harold came into the skilled nursing facility, admitted from the local hospital. Harold lives at Pleasant Meadows, an assisted living community where he has been independent. The problem arises when the nurse from the skilled facility  calls the nurse from Pleasant Meadows. The Harold that the nurse now describes in not the man the Pleasant Meadows nurse has know for the last 6 month, before he went to the hospital. Harold?  Uncooperative, disoriented, unsteady on his feet, falling, with generalized weakness? No, no the nurse from Pleasant Meadows insists that they (the skilled facility) don’t know what they are doing and don’t know how to take care of Harold.

Sadly this scenario is not unusual, for one healthcare facility to accuse another of not knowing what they are doing. Doesn’t the fact that because Harold already has the diagnosis of Alzheimer’s disease mean that it is understood that he is confused? Yes, Harold is always confused, but this new Harold is in an altered mental state. He was admitted to the hospital with pneumonia. Infections in the elderly many times can cause confusion. This infection caused Harold to experience a rapid decline in his mental functioning and an increase in his confusion.

Sudden increase in confusion can result in very vague symptoms. The family member might say he is “not acting right”, has different behavior, is either more sleepy or more agitated, is extremely distracted,  has recent inappropriate behavior. These sudden changes can come within days or even hours of onset. The great difficulty comes in diagnosing why the individual is suddenly more confused. As well as realizing that it is going to take much more time for the problem to resolve compared to the fast onset.

Harold will continue to have increased confusion even after he has recovered from his pneumonia. And Harold is likely not to return to his previous level of mental functioning.  This infection has tragically caused him to lose some mental clarity  and has resulted in progression of his dementia. Right now Harold needs one on one care, with people who explain the environment and what is going on, as well as protecting him from unsafe activities. All the while giving his mind the time to heal as well as his body.

Yes, it is not only possible for someone with Alzheimer’s disease to suddenly become more confused, it is more than likely when there is an infection involved. A sudden increase in confusion, or delirium continues to be misunderstood.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

WHEN DEMENTIA AND CONFUSION AREN’T PERMANENT – SUDDEN DELIRIUM

I receive emails from families who can’t understand what has happened to Mom, Dad, Uncle Charlie and so on. You see this person was just fine a couple of weeks age, driving, shopping, living alone, balancing their check book, and now the doctor says Mom has Alzheimer’s disease and needs to live in a nursing home. What usually happened is that Mom had an infection, an accident, change in medication or surgery and this put Mom into a state of delirium

Synonyms for delirium are; irrational, raving, deranged, and yes even demented. Once the stress is over, the elder returns to their previous state of cognition. But what if Mom is in the hospital when she becomes delirious? The hospital personnel don’t know Mom and  don’t recognize her delirium. Mom will be labelled a confused, demented elder and medicated to keep her under control and “safe.” This will only lead to increased confusion making Mom appear even more confused.

The presence of delirium can indicate that the elder’s brain has a decrease in capacity and may indicate an increased risk of developing dementia. The healthcare community sees delirium frequently with the elderly and infrequently with the young. The same person can have had no history of delirium, even though they have experienced several hospitalizations, yet when they are old, they become confused and disoriented every time they are admitted.

Whenever there is a sudden change in an elder’s ability to think, focus, reason, and remember, look back to whatever stress could have caused the change. The longer the person suffers from delirium, the more chance it will not be resolved.

Remember Alzheimer’s Disease is slow, delirium is fast and doesn’t have to be permanent.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing