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help! Rehab for the elderly


Tina
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My very elderly dad broke his leg, had surgery and was transferred to a nursing home for rehab.  Now he's been transferred to another one.  It's time to start getting on his leg again.  But-- all the changes and/or some meds that doctors have decided he will have despite my mom arguing against them, have left dad very confused and sometimes a bit belligerent.  Has anyone dealt with this?  We're trying to figure out what options are if he can't focus enough to do the needed therapies, or if the confusion doesn't clear and becomes a permanent thing.  Scary times.  Looking for advise from those who have btdt.  thanks.

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does he have a history of sensitivity to meds?  or has anyone checked the meds to make sure there aren't any reactions?

checking for a uti is good - as not uncommon after surgery, and can have a huge mental effect on the elderly.

 

mil refused to do her rehab after hip surgery. she wasn't  confused - just very recalcitrant.  she's been in a wheelchair ever since.  

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I would definitely ask to talk to someone at the nursing home/ rehab center. This is not the first time they will have seen patients like this, but the key is that they have never seen your dad in his normal state, so they need to be informed that this is unusual for him. You can talk to the head nurse, but ask if they have a social worker or someone else you can connect with, as well.

Some people with dementia can have a change of personality and become belligerent, unfortunately.

But some elderly people can become not themselves when their body is under great physical stress. A year ago, MIL had a spinal infection and was hospitalized for two weeks. She was belligerant and uncooperative, and it scared the family, because she is normally the sweetest person you would ever meet. It was 100% not like her. She also was experiencing a cognitive affect that seemed like dementia, even though it was caused by her physical condition. There were a few bad days, but then she began to improve, as the doctors figured out how to treat the infection and medication was given.

She has since completely recovered from the infection. She has regained cognitive function and is herself again mostlyl. Sadly, in her case, she is declining and heading toward dementia (as her mother did, before her), and I think her illness last year probably hastened that. But the personality change was temporary, while she was sick.

Explore the idea that he may need his meds adjusted. Make sure the staff knows that this is not typical for him, and that you are concerned. Yes, make sure they test for UTI. Hidden infections can cause cognitive setbacks.

I'm sorry. I hope it's temporary for him.

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I don't have any tips, but I agree with Storygirl that extreme stress can make some elderly people (maybe just some people) exhibit a lot of signs of dementia that, once they're able to return to normal surroundings, mostly go away. That definitely happened with my grandmother, who had... I forget the name of it, but how the ICU can make you go a little crazy and get really confused. And then it took a good while in rehab before it abated a bit and then once she was out and back in assisted living with her friends, she was much, much better. I would definitely advocate with them constantly so they understand that this is not how he usually behaves.

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Just a few thoughts...  Both my parents (90) have been in rehab centers off and on this past year.  We were really shocked at how little the various doctors and staff work together. No one seemed to be "in charge" -- looking carefully at the whole picture, even though they claimed to be and talked like they were.  (But clearly once they began talking about meds and my mother's history, they hadn't read my mother's chart well at all.)

We were lucky because my brother is a doctor so was able to step in and sort things out.  I'm not exactly sure about rehab center policies, but are you able to get a family doctor involved in your father's care, someone who has known him and knows his history?

Does the rehab center have family meetings once/week?  My mother's had that, so we'd have a list of concerns to bring up when everyone (all the staff who worked with her) was there.  They only gave us about 45 minutes, and we generally had a lot more to talk about than time allowed, but at least it started the conversations and then we'd continue them with individual staff members after that.

Is your mother your father's POA?

Another question:  did you father have even mild dementia before this happened?  One thing we noticed with my mother, is that when she was suddenly thrust into strange circumstances with a whole different routine plus not feeling as well physically, it seemed to exacerbate her mild dementia.  

Once she returned home, she improved some, but overall her dementia did worsen during that period.  

But, if your father had absolutely no dementia, then I think the sooner he gets home, the better.  There is such a thing as hospital delirium among the elderly, or something like that.  It's a real thing.  Once he's home, he'll probably become himself again.  

If he stops making progress, they'll send him home, but then usually a home therapist will come to the house for a period of time.  Sometimes, people make better progress at home, depending on the other help he needs, of course.

Also, make sure his fluid intake is high.  Lack of enough fluid can really wreak havoc with the elderly.  It can affect everything.  We were also really surprised that the facility my mother was at did not push fluids. 

My mother stopped making progress eventually (after about 6 weeks) and was quite confused.  They had to discharge her and strongly recommended assisted living, but of course it was up to my dad to make the final decision.  He wanted her home, and Medicare allows for therapists and a home health aide to come for a period of time after that.  (The home health aide helps with showers, personal care, etc.)  My mother did so much better at home.  It is still a challenge though.  She needs a lot of help, and we know that this period when my parents can be home together again is just a sweet reprieve, but we're grateful for it.

Take care and best wishes!

 

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Just now, Seasider too said:

 

Re fluids, sometimes elderly hearts and kidneys are less efficient; too much fluid can put other things out of balance. 

I’ve wondered the same thing - you’d think the more fluids the better - but I think as long as the elder is one step ahead of dehydration, it’s often called good enough. 

It’s complicated. Medical interventions help us live longer, but there are so many moving pieces to keep track of. 

That's interesting, I hadn't thought of that.  We've been told many times how an elderly person's brain doesn't always interpret how much fluid it needs anymore (my mother is case in point regarding that!), and how even mild dehydration can have cognitive effects, but what you said certainly makes sense too.  I think a very elderly person's body works very delicately... even little things can throw the balance off so much more easily.

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It's not unusual for an elderly person to experience confusion and cognitive dysfunction following surgery with general anesthesia.  

Would it be possible to consult with a gerontologist or the doctor in charge of the facility to formulate a comprehensive plan for your dad's treatment?  (Someone up thread may have already suggested this.)

I'm so sorry your family is going through this.  

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Praying. If things go as planned, my mom will have major back surgery and transfer to a rehab facility in about three weeks and I can totally see her dementia worsening. I am so sorry that you are going through this.

This may not apply but at one point my mom experienced a very significant drop in cognitive function (this was years ago) and it turned out to be one of the anti-nausea medications they had put her on. It took longer than I thought it should to determine it was a new medication, possibly because my mom is on so many medications.  I think part of that is they can't fully know how each person's body will respond to a medication and sometimes the less common side-effect is the one you end up with.  So keep an eye out for any new medications introduced since he has been in the facility.

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19 minutes ago, cintinative said:

Praying. If things go as planned, my mom will have major back surgery and transfer to a rehab facility in about three weeks and I can totally see her dementia worsening. I am so sorry that you are going through this.

This may not apply but at one point my mom experienced a very significant drop in cognitive function (this was years ago) and it turned out to be one of the anti-nausea medications they had put her on. It took longer than I thought it should to determine it was a new medication, possibly because my mom is on so many medications.  I think part of that is they can't fully know how each person's body will respond to a medication and sometimes the less common side-effect is the one you end up with.  So keep an eye out for any new medications introduced since he has been in the facility.

That's interesting that anti-nausea medication would cause such a drop in cognitive function.  It seems so...unrelated.  But really good to know.  It makes you realize how delicate the balance is when it comes to an elderly person.  I think my siblings and I need to re-evaluate my mother's meds!

Best wishes to your mother!  I hope it all goes smoothly and that she's home before you know it.  It's tough watching our parents getting old.

 

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Keep in mind that patients always have the right to refuse medication. Just because the doctor orders it, it doesn't mean that the patient has to take it. The facility has to offer it and document that he is non-compliant, but he doesn't have to take it.

I highly recommend that your dad be seen by a geriatric specialist to go over his medications and for his care otherwise.

Rehab facilities are hit and miss - unfortunately we had more bad experiences than good ones. The ombudsman is your new friend - this person can explain what you should expect in terms of care and communication and can hold the facility accountable if laws and standards are not met.

You need to get a copy of the AGS 2019 Beers Criteria - I think it comes out at the end of this month. Prior to that, you can use the older version. This shows the drugs that elderly people are sensitive to and their effects. Make sure he isn't on anything he shouldn't be on.

 

 

 

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35 minutes ago, TechWife said:

 

You need to get a copy of the AGS 2019 Beers Criteria - I think it comes out at the end of this month. Prior to that, you can use the older version. This shows the drugs that elderly people are sensitive to and their effects. Make sure he isn't on anything he shouldn't be on.

 

 I found it here: https://nursinghomehelp.org/wp-content/uploads/formidable/17/Panel-2019-Journal_of_the_American_Geriatrics_Society.pdf

 

Thank you. This is very good for our family to have as well.

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