Taking Care of Mother- My experience with a Broken Hip and Vascular Dementia Diagnosis
How it began
After recovering from a fall where Mom had fractured her hip, she stayed with me and my family for a couple of weeks. During that time, we noticed things like she was forgetting that we had just given her the pain medicine but she kept continuously asking for it. After eating and her dishes being cleared, she would ask if we could fix her something to eat. We decided it was the narcotic pain meds and aging that was causing her confusion and we let it go. After two weeks, she continued complaining about being miserable and she wanted to go back to her home where she lived with my youngest brother. Mom also has Bipolar , so her unhappiness and complaining was nothing out of the ordinary. So, we agreed to allow her to go back home and we readied things at her apartment to allow her new life with a walker more manageable. Things like replacing furniture so that it was easier to get around and adding safety bars in her shower and a lifted toilet seat for easier sitting and standing.
One day, after being back home for a few days, my brother called to let me know that Mom had fallen in the shower. When I asked Mom about it, she could not remember how or why she fell.
Fast forward to a week later, Mom was back in the hospital, this time with a broken hip from falling and not remembering how or why again. Surgery was scheduled and done and while recovering she would forget that she couldn't walk or get out of the hospital bed without assistance. Then, while still recovering in the hospital , she had an "episode" where she could not be calmed down and her heart started going crazy and she was rushed down to ICU and a breathing tube was put in her throat. It was found she had Pneumonia and they were keeping her asleep and pumping her full of antibiotics while she recovered until she could breath steady again on her own.
While in the ICU, her hip "popped" out of place and required another surgery to attach a rod to her new hip and leg bone to keep it in place, but we had to get her stabilized with the breathing first. The Doctor had to "pop" her hip back into place and we waited until she was stable enough for another surgery.
The second surgery finally happened and Mom seemed to be doing better, but now she was having trouble swallowing her food and drink as it was going into her lungs and she was having Pulmonary Aspiration. She got Pneumonia again in her other lung and a feeding tube was then required through her nose as they worked to clear up this lung and prevent further aspirating. During this time , she became very confused and very agitated, again, we thought this normal with everything she had been through and even the Doctors were telling us sometimes this happens after anesthesia and bad illness in the elderly," it should clear up", they would tell us.
The typical signs and symptoms of a UTI include:
- Urine that appears cloudy
- Bloody urine
- Strong or foul-smelling urine odor
- Frequent or urgent need to urinate
- Pain or burning with urination
- Pressure in the lower pelvis
- Low-grade fever
- Night sweats, shaking, or chills
UTI Symptoms in the Elderly
Elderly people with serious urinary tract infection don't exhibit the hallmark sign of fever because their immune system is unable to mount a response to infection due to the effects of aging. In fact, elders often don't exhibit any of the common symptoms – or don't express them to their caregivers.
UTIs in the elderly are often mistaken as the early stages of dementia or Alzheimer's, according to NIH, because symptoms include:
- Confusion, or delirium-like state
- Other behavioral changes
- Poor motor skills or dizziness
Muscle atrophy is when muscles waste away. The main reason for muscle wasting is a lack of physical activity. This can happen when a disease or injury makes it difficult or impossible for you to move an arm or leg.
What happened next- The "Probable Dementia" Diagnosis
After , the insertion of the feeding tube, it still didn't get any better, her confusion was at an all time high. She pulled her nose tube out twice and then she got some fancy little boxing gloves to put on her hands in an attempt to keep her from pulling things out. She was Houdini, she eventually figured out how to work and work those gloves until she got one off and out came the nose tube again. We had a choice to make, let them insert a stomach feeding tube or let her slowly die from pneumonia and starvation. We chose the stomach tube with the understanding that it would only be temporary until the pnuemonia cleared and her swallowing improved. They could find no physical reason as to why she should not be able to eat normally again.
Fast forward, to physical rehab, in a rehab center and we are now on our 3rd stomach tube, from leaking or her pulling on them. We also have severe atrophy in her left leg where she has her new hip and we are trying to learn to walk again. We have also been introduced to UTIs(Urinary Tract Infections) and Delirium. UTIs are very common in the elderly and more so in people with Dementias. Mom was not a stranger to having before all this and she always new when one was coming on. The difference is, apparently now she wasn't or she couldn't communicate it to us anyway. With delirium, the person is not their normal self, they are agitated, they are in constant movement and they are anxious. Most facilities recognize this, but if a person is new to the facility, they depend on you to point out what is normal and what is not normal. It was hard to tell what was "normal" with Mom anymore, she was not the same since the hip surgeries. So, now, we had to be checked out by a Psychiatrist and sent to the local Mental Hospital where, thankfully, it was found that she had a UTI and was then transferred back to the regular hospital. I was also told at this visit that Mom had "probable" Dementia. But nothing further was done except different Pyschotic meds.
Mom finally come home
Mom never did recover fully from the hip surgery and learn to walk again on her own, she could only walk with assistance and with the use of a walker. We did, however, finally get her swallowing under control and were able to remove her stomach tube. We had a healing issue with her wound that required another surgery , but again, a great Doctor appeared and handled it perfectly.
Mom was still having short term memory issues and now, hallucinations. In fact, anytime a new medicine was introduced hallucinations were common, She still became anxious at times.
It wasn't until Mom had a mini-stroke (TIA) that we witnessed, that we finally were able to get a full Vascualr Dementia diagnosis after a brain scan was conducted and showed the deterioation of the brain and the mini-stroke scaring. This was not her first TIA apparently and more than likely, this was the cause of all her falls.
Some things you need to have in place
I was lucky in that Mom had made me her Medical Power of Attorney years earlier, therefore, I was able to advocate for her in her medicals wants and needs.
I was able to tell a Doctor "no" or "yes" and I was able to keep searching for a better Doctor or a better choice.
She had a "Living Will" that stated she did not want certain things to be done if she were unable to make that decision.
My next article will discuss more about caring for a parent with Dementia and more detail about Vascular Dementia. It is a horrible disease and caring for a parent with Dementia is stressful, tiring and sad. What the person stricken with this disease goes through is horrible.
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