What medical checks do we need for an elder showing confusion and agitation?

[chocolate-chip chooky]

I know this has been discussed plenty of times, but I can't find the threads.

My sister and I are noticing increasing behaviours in our 80yr old mother. 

Easily overwhelmed, easily distracted, confused - especially in group settings.

She and our Dad (also 80)  still live together independently

So, my first step is a general health check up. What should I be pushing for?

 

Nutritional deficiencies and UTI are my first thoughts.

Thanks for your help 🌻

[Jean in Newcastle]

Was definitely  going to mention UTI but it could be any hidden infection as well. 

[Terabith]

I would also want to know if difficulties hearing are playing a role in confusion/ being easily overwhelmed.  

[chocolate-chip chooky]

1 minute ago, Jean in Newcastle said:

Was definitely  going to mention UTI but it could be any hidden infection as well. 

Can a uti have none of the standard symptoms? 

Obviously, I'll ask all this of a doctor, but my sister and I are gathering our observations and our list of questions.

[chocolate-chip chooky]

4 minutes ago, Terabith said:

I would also want to know if difficulties hearing are playing a role in confusion/ being easily overwhelmed.  

This is interesting. 

I don't think she has any obvious hearing loss, but my dad's hearing is really really poor. My mum finds this frustrating, and it's isolating for both of them.

Covid isolation has been hard on her too.

[Jean in Newcastle]

2 minutes ago, chocolate-chip chooky said:

Can a uti have none of the standard symptoms? 

Obviously, I'll ask all this of a doctor, but my sister and I are gathering our observations and our list of questions.

Yes, uti’s can be sneaky. 

[chocolate-chip chooky]

1 minute ago, Jean in Newcastle said:

Yes, uti’s can be sneaky. 

I'm hopeful it could be something like this.

And if not, then at least it gets us in a doctor's office to get the conversations started.

[Terabith]

1 minute ago, chocolate-chip chooky said:

This is interesting. 

I don't think she has any obvious hearing loss, but my dad's hearing is really really poor. My mum finds this frustrating, and it's isolating for both of them.

Covid isolation has been hard on her too.

I have noticed that all of us have had our thresh holds for getting overwhelmed diminish a great deal with covid, honestly.  I mean, my family is chock full of sensory issues, but lockdown and reduced stimulation has made it much harder for us to cope with things we handled pretty easily before isolation.  

[chocolate-chip chooky]

We had a family function yesterday (my eldest got married!).

My mum's behaviour concerned everyone. Nothing huge, but a clear decline to those who hadn't seen her in about a year.

[Elona]

Definitely check b12 levels. They are known to diminish with age and low levels are associated with these types of symptoms. Also, if she has been on any medication for acid reflux (proton-pump inhibitors) those are known for depleting magnesium levels and supplements are recommended for individuals who are on them. 

[Porridge]

Urine dip for UTI

cbc complete blood count to look for other signs of infection or anemia

 basic metabolic panel to look for metabolic disturbances which are more common in the elderly and if she is also taking any meds

TSH to check thyroid

 screening for depression, which in the elderly can be mistaken for early dementia

[Laura Corin]

1 hour ago, chocolate-chip chooky said:

Can a uti have none of the standard symptoms? 

Obviously, I'll ask all this of a doctor, but my sister and I are gathering our observations and our list of questions.

Definitely.  My mum's symptoms of UTI in her late eighties were vomiting and confusion. She ended up passing out and spending time in hospital. 

[KidsHappen]

I would recommend a complete physical with all basic blood work as listed above and checks for B & D vitamin levels and med check to make sure there are no issues there. PPIs can also deplete B vitamins and leach calcium from bones. A check for a UTI is also a good idea. If all of that is good they may want to do an MRI of the brain and some tests for cognitive functioning.

[Drama Llama]

5 hours ago, chocolate-chip chooky said:

We had a family function yesterday (my eldest got married!).

Congratulations!

5 hours ago, chocolate-chip chooky said:

My mum's behaviour concerned everyone. Nothing huge, but a clear decline to those who hadn't seen her in about a year.

I am so sorry.  I hope that you find answers at the doctor.

[wintermom]

5 hours ago, chocolate-chip chooky said:

I know this has been discussed plenty of times, but I can't find the threads.

My sister and I are noticing increasing behaviours in our 80yr old mother. 

Easily overwhelmed, easily distracted, confused - especially in group settings.

She and our Dad (also 80)  still live together independently

So, my first step is a general health check up. What should I be pushing for?

 

Nutritional deficiencies and UTI are my first thoughts.

Thanks for your help 🌻

Have you talked with your mom about this? You can't normally do this without her consent. Maybe she has some reasons to explain her behaviour. 

I'm not trying to be iritating. My mom is in a fragile physical position now, but she is the one who is still in charge of her heatlh. Without her consent, I wouldn't be able to do anything. This is Canadian law. Not sure if it's the same as in Australia. 

[chocolate-chip chooky]

5 minutes ago, wintermom said:

Have you talked with your mom about this? You can't normally do this without her consent. Maybe she has some reasons to explain her behaviour. 

I'm not trying to be iritating. My mom is in a fragile physical position now, but she is the one who is still in charge of her heatlh. Without her consent, I wouldn't be able to do anything. This is Canadian law. Not sure if it's the same as in Australia. 

Oh yes, I've spoken to her, and she has agreed to visit the doctor.

She acknowledged to me that she can feel a bit confused and overwhelmed sometimes these days.

I told her that I'd like it if she had a full physical check up, and she readily agreed.

I'm now just trying to collate a list of things for her to ask to be checked.

I'm not sure yet if she'll want me to go with her. I'm hoping so. But I'm not doing anything behind her back or without her consent.

[wintermom]

1 minute ago, chocolate-chip chooky said:

Oh yes, I've spoken to her, and she has agreed to visit the doctor.

She acknowledged to me that she can feel a bit confused and overwhelmed sometimes these days.

I told her that I'd like it if she had a full physical check up, and she readily agreed.

I'm now just trying to collate a list of things for her to ask to be checked.

I'm not sure yet if she'll want me to go with her. I'm hoping so. But I'm not doing anything behind her back or without her consent.

Does she drink enough fluids? She may be dehydrated. My mom avoids fluids when she is going out of the house so that she doesn't have to race to find a bathroom in case of an emergency. Dehydration can cause these symptoms. 

Anxiety can also be an issue. She may also be overwhelmed in general, and for good reasons if she's the carer of her husband. 

I hope she can get the support and medical intervention to help improve her quality of life. Good for you for stepping in and helping her out. 

[chocolate-chip chooky]

3 minutes ago, wintermom said:

Does she drink enough fluids? She may be dehydrated. My mom avoids fluids when she is going out of the house so that she doesn't have to race to find a bathroom in case of an emergency. Dehydration can cause these symptoms. 

Anxiety can also be an issue. She may also be overwhelmed in general, and for good reasons if she's the carer of her husband. 

I hope she can get the support and medical intervention to help improve her quality of life. Good for you for stepping in and helping her out. 

These are both excellent points and super helpful, thank you. I think both could be contributing factors, for sure. I've added them to my list.

[chocolate-chip chooky]

Here's my collated list so far. Please let me know if you think of anything else.  I really appreciate everyone's input and advice.

 

- UTI

- dehydration

- B12

- Vit D

- Magnesium

- any infections

- anemia

- thyroid function

- general metabolic panel

 

- an assessment of all medications, the combinations, and any deficiencies or issues possibly related to them

 

-       Anxiety and/or overwhelm regarding:

·         Caring for my Dad and his diabetes diet and medications

·         Isolation related to Covid – lack of social interactions

 

 

[bookbard]

Sleep is a huge thing so that would be a point of discussion. Hopefully there's a dementia checklist - early diagnosis can be really important. 

[chocolate-chip chooky]

Can't believe I left sleep off the list - thank you!

[Melissa in Australia]

15 hours ago, chocolate-chip chooky said:

We had a family function yesterday (my eldest got married!).

.

congratulations 

[Melissa in Australia]

as well as all the above, medication and combinations of medication can have a large impact

you probably have already looked it up  but I thought i wound add some links

https://gplearning.racgp.org.au/Content/Tempo/202001_ACITE.html

https://www.healthdirect.gov.au/delirium-and-dementia Delirium can be caused by changes in a person's health, such as an infection or a medication change. It can also be caused by things such as constipation, dehydration and pain. Many people will have more than one problem leading to their delirium. Sometimes it is difficult to find the cause.

[Farrar]

What plans do they have for if one or both of them is in mental decline? And will they be open to talking with you about those plans? I would just be ready for step two once you've gotten screenings done and talked to the doctor.

[EKS]

A thorough review of medications.  You may need to do this yourself, as many doctors discount the effect medication can have on the brain.  Satins are notorious for producing memory problems, for example.

[NorthernBeth]

My mom's doctor also ran the MOCA, which tests memory and cognitive issues , both to see where she scored and to establish a baseline of comparison for the future.  You would need her consent for this, obviously, but I found it eye-opening.   There were items on there I would not have thought she would find hard that were almost impossible.....the test made clear that my sense of unease was based in reality and not an overreaction to a few memory slips.

 

[wintermom]

12 minutes ago, NorthernBeth said:

My mom's doctor also ran the MOCA, which tests memory and cognitive issues , both to see where she scored and to establish a baseline of comparison for the future.  You would need her consent for this, obviously, but I found it eye-opening.   There were items on there I would not have thought she would find hard that were almost impossible.....the test made clear that my sense of unease was based in reality and not an overreaction to a few memory slips.

Getting baseline data for future reference is a wonderful idea, both for mental faculties and physical. 

[Laura Corin]

While you are starting to think about this, please also make sure the you have Powers of Attorney in place as well as wills.  I know it's difficult to think in these terms, but it's much easier to help people be legally safe at a time when they are still able to make their own decisions.

[NorthernBeth]

3 minutes ago, Laura Corin said:

While you are starting to think about this, please also make sure the you have Powers of Attorney in place as well as wills.  I know it's difficult to think in these terms, but it's much easier to help people be legally safe at a time when they are still able to make their own decisions.

Oh my goodness... yes this too!!   We were under the impression I was my mom's POA, and then when we got down there, we discovered she had changed it about 10 years ago to my brother who lives closer and NONE of us remembered her doing it.. getting the documents for that straightened out is absolutely necessary in case you do have to look at things such as nursing homes, being included in medical decisions, and helping out with banking and finances.  These things were a huge relief to get figured out before things get worse.

For example,  we took mom to do some banking..... she could not find her bank card and could not initially find ANY ID.  She had brought a bank statement, but they would not initially take it.  It took us almost an hour in a bank where we were the only customers to get that straightened out enough for her to actually do any banking.    We got my brother added to her accounts ( with her permission) , so he can make sure all her housing, utility and such bills get paid on time.  My mom is always the one that handled the bills so to see the decline was pretty shocking to all of us.

[Tanaqui]

Just to piggyback on "medications", check to make sure she's not taking routine benadryl. Because it's OTC a lot of people think it's safe and won't bring it up with the doctor as a "medicine they take", but it's really not. It can cause or exacerbate the symptoms of dementia.

[ktgrok]

On 5/23/2022 at 3:59 PM, chocolate-chip chooky said:

I know this has been discussed plenty of times, but I can't find the threads.

My sister and I are noticing increasing behaviours in our 80yr old mother. 

Easily overwhelmed, easily distracted, confused - especially in group settings.

She and our Dad (also 80)  still live together independently

So, my first step is a general health check up. What should I be pushing for?

 

Nutritional deficiencies and UTI are my first thoughts.

Thanks for your help 🌻

Hearing check if group settings make it worse - background noise could be making it hard for her to hear. 

blood sugar/a1c

carotid artery ultrasound? reduced blood flow to the brain can be an issue (side note, this was found to be a problem in older men wearing neckties too tight!)

medications she's on - statins can cause confusion, memory issues, etc

sleep study - lack of sleep long term can cause major issues with memory and confusion

urinalysis

full lab work to check for vitamin deficiencies - can be common in older adults

[ktgrok]

https://www.medicalnewstoday.com/articles/275774#:~:text=Narrowing of the carotid arteries may lead to memory and thinking problems,-Written by David&text=Problems with learning%2C memory%2C thinking,Annual Meeting in Philadelphia%2C PA.

[chocolate-chip chooky]

10 hours ago, EKS said:

A thorough review of medications.  You may need to do this yourself, as many doctors discount the effect medication can have on the brain.  Satins are notorious for producing memory problems, for example.

I think one of her meds is a statin. Thank you.

[chocolate-chip chooky]

I just checked. Yes, she's on lipitor, which is a statin. I'll have to check with her how long she's used that.

When I called her yesterday, I asked her about all the medications both she and my dad are on, and she could list them all off and even spell them for me. She was completely lucid, sharp and funny even,  and it was a really helpful conversation overall. I think she's as keen as me to try to work this out. 

 

But at the wedding, one day prior, she was acting like she couldn't adhere to the social norms of the event eg wandering up to talk to people who were clearly lined up for group photos. 

[chocolate-chip chooky]

You are all so wonderful. 

I can't thank you all enough for helping me with this. I feel less overwhelmed knowing you're all helping me out.

Thank you🌻

[chocolate-chip chooky]

10 hours ago, Farrar said:

What plans do they have for if one or both of them is in mental decline? And will they be open to talking with you about those plans? I would just be ready for step two once you've gotten screenings done and talked to the doctor.

Thank you for bringing this up.

I'm pretty confident they'll be open to the conversations. 

[Tenaj]

1 hour ago, chocolate-chip chooky said:

I just checked. Yes, she's on lipitor, which is a statin. I'll have to check with her how long she's used that.

 

 

But at the wedding, one day prior, she was acting like she couldn't adhere to the social norms of the event eg wandering up to talk to people who were clearly lined up for group photos. 

Rest  and routine is a big factor for my dh's aunt.  Maybe your mom was tired from anticipating a big day. Plus, since it was a day where she was out of her normal routine she was not quite as sharp as at other times.  Our aunt gets very confused and rattled when my kids are all around at once with the grandkids mixed in.  

 

[chocolate-chip chooky]

7 minutes ago, Tenaj said:

Rest  and routine is a big factor for my dh's aunt.  Maybe your mom was tired from anticipating a big day. Plus, since it was a day where she was out of her normal routine she was not quite as sharp as at other times.  Our aunt gets very confused and rattled when my kids are all around at once with the grandkids mixed in.  

 

Yes, one of our observations is an increased need for predictability. 

Another observation is that characteristics that were always there as quirks are now ramping up further into the realm of inappropriate.

I wouldn't be surprised if we have a range of contributing factors.