Hospital Delirium

If you have an older parent or other family member, read this article in the New York Times.

The article is about hospital delirium, which sadly happens all too often to older adults in the hospital. About one third of all hospital patients over 70 develop delirium, which is frequently misdiagnosed. No one is exactly sure why so many patients develop delirium, but it can be caused by improper medication use. Sadly, many doctors do not understand that older people do not tolerate medication dosages that younger people tolerate, so they are given the typical dose, then, when delirium develops, they are restrained, and medicated, to deal with the agitated behaviors. Some other causes of delirium include lack of sleep (hospitals are noisy 24 hours a day, 7 days a week), not making the older person's glasses or hearing aides available, and changing rooms. I worked in one hospital where patients were moved from room to another constantly, which resulted in different nurses, different case managers, new roommates, and we wonder then why they become delirious.

Crazy?

I had an interesting experience last weekend, although not a unique experience. I have a friend and colleague who is a private professional guardian. She is the guardian for several people, and she gets appointed guardian in situations where the Ward does not have anyone to act as guardian.

One of her Wards is a woman I'll Mae. Mae has dementia, and according to my friend, Mae is not a pleasant person. Mae has children, but they don't want anything to do with her.

My friend called me last Saturday, asking a big favor. It seems that Mae was at a local hospital, having been sent there by her nursing home because she injured one of her caregivers. The hospital medicated her with her some pretty strong anti-psychotic medication, deemed her medically stable, and was putting her in the ambulance to return to the nursing home. The nursing home was refusing to allow Mae to come back without a private sitter in place, for the protection of their staff. And my friend was out of state at a wedding.

For those who are my facebook friends, that's why I spent Sunday afternoon at the psychiatric emergency room at John Peter Smith Hospital.

My friend was able to find a sitter who could stay with Mae Saturday, and she did return to the nursing home. My friend also engaged a private duty service to take over on Sunday, but by Sunday morning Mae had injured the Saturday sitter, and had continued to hurt nursing home staff. The nursing home was done, and insisted that she leave.

Again, long distance and over the phone, my friend arranged for law enforcement and emergency medical responders to take Mae to the psych. ER at JPS. She called me when she could not locate Mae anywhere in the hospital system.

We eventually found Mae in the regular ER, because she had complained of chest pain while on the way to the hospital. She was absolutely calm and non-threatening when I found her. She was mean, but not violent. I stayed with her until we got her admitted to the psychiatric unit.

My friend cut her trip short to come back to Fort Worth for a couple of days to get Mae situated in an Alzheimer's facility that I helped her locate, and she's leaving again today to finish the rest of her vacation. So I might yet be called out again to help with Mae.

Some of you reading this may identify with this situation. Our medical system has no good way to deal with those people with dementia who also have behavior issues, including violent and aggressive behaviors. There is something inherently wrong with having police take a frail, 76 year old woman to be involuntarily committed to a psychiatric unit. Regular hospitals are unable to provide the medication management required in a situation like this, and a guardian has no legal authority to admit a Ward to a psychiatric hospital. The nursing home clearly had no idea how to manage the behavior, and Alzheimer's units like the one Mae went to yesterday, where they do know how to manage the behavior are incredibly expensive (over $5000 a month). Mae is lucky she can afford to live there.

I don't know what the answer is, but we are going to have to find a better solution, because the numbers of people with dementia will only grow as the population continues to grow older. I'd love to hear any ideas.

What Happened?

OK, I know you're wondering what happened.

I got bored.

I am one of those people who changes wallpaper and screensavers on a regular basis. So when I saw that there were new template designs, and picture backgrounds, I just couldn't resist.

I would have preferred it if there had been a longhorn--you know, for Cowtown, but the powers that be at Google apparently don't see the charm in cattle; I guess they've never been to Texas.

So, I settled for rocks. Lest you think they aren't relevant, think again. The journey we are all on can be rocky and treacherous and beautiful. And I hope that some of what you learn here helps you along on that journey, so that you miss the more dangerous passages, but still experience the excitement and beauty.

Here's to the next leg of the journey--wherever it is!

Walking the Floors

Mobility. However you are mobile, it's important to do it safely.

Of course most people are familiar with canes and walkers, but not a lot of people ever get the proper training in how to use these devices. I worked with physical therapists long enough to know that those walkers with 4 wheels and hand-brakes that everyone seems to have in assisted living are not all that safe. If a person has trouble with memory, they might forget to lock the brakes, and if they have trouble with sequencing, they might not be able to use the brakes properly. Because they have 4 wheels, they move faster, so the person might not be able to keep up.

My best advice: see a physical therapist to find out what will work best for you, and to make sure you know how to use your equipment properly.

Other safety tips:

• Get rid of all the throw rugs. Even large rugs can be a problem, because we had one that would not stay in place, and this resulted in Mom's fall last Fall.
• Make sure cords of any ilk (extension, phone, cable, computer) are out of the way. If you can shorten them and attach them to the wall, even better.
• Promptly clean up spills, and pay special attention to greasy or slick spills. I had my own fall a couple of years ago when some greasy food was not properly cleaned up. The floor looked clean, but it was still very slick, and falling in front of 50 people was as bruising to the ego as it was to my knees.
• Make sure furniture is placed so that there are wide pathways to accommodate a walker if one is used. Remember that furniture walking is never a safe option.
  
• Nightlights are your friends. There are lots of varieties, so you should be able to find the right type for every location.
• Carry a phone with you, or even better, install an emergency response system ("I've fallen and I can't get up"), so you can get help if you do fall.

These are just a few ideas to make mobility safer.