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chickencam

elderly relatives in hospital and sedation

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My Grandad who is nearly 93 has been in hospital for the past 3 weeks. He had a fall at home during the night and bashed himeself up quite badly, ended up with a massive cut and bruise in his eyebrow and forehead as well as other cuts and bruises, and a cracked rib and wrist. He had loads of tests in the first few days and was declared medically fit infact they were amazed by his general health. He is however very frail and wobbly on his feet and since he has been in hospital he hasn't ben sleeping at night just during the day. He is getting very distressed and confused at night and keeps trying to get out of bed, after about a week they prescibed some haloperidol for him to calm him down. I am a bit worried about this now because he is getting more and more drowsy during the day and seems to be becoming more confused. When he was in the first ward they were getting him up and into his chair for a couple of hours a day, but he was moved to a lower dependancy ward about 10 days ago and they tried this but he fell asleep in his chair and then slipped out of it.

 

Anyone any experience of elderly people deteriorating in hospital?

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Thanks, he is waiting for carers to be allocated to him at home to help him get up and wash in the mornings and again at night. He lives with my uncle who is quite a simple soul who loves him to pieces but hasn't necessarily got the skills to care for him on his own. It is generally thought within the family that had my uncle been born a couple of decades later he would be classed as mildly autistic. He isn't very good at asking the right questions about Grandad's care but if you give him a list of instructions is more than capable of carrying them out. My other uncle and aunt are away on a treck until Monday and have nothing more than emergency phone contact, he seems to have deterioratered over the last week since they went. We are going to see him tomorrow and giving my uncle a break for the day, we will take it in turns to sit with him and see for ourselves how he is, I have spoken to my uncle every evening but can only get over to see Grandad once a week because we are further away and the children have had exams etc. I am hoping that he won't have changed as much as I am imagining from what i have been told.

 

I just have a nasty feeling that he is being given the haloperidol to calm him and keep him out of their hair, I appreciate that his safety is also important, but it seems to be me that he is even more groggy on the medication but he still wants to get out of bed as soon as he wakes up. One problem is that he has suffered from urge incontinence for a while now so it is almost a sub-concious reaction to get to a toilet when he wakes. I have no idea if he is going to be able to get home and almost feel that he would be better somehwere safe with professional care. he must be a classic example of bed blocking ie. filling an expensive hospital bed because there is no suitable alternative available, I had heard before this that it is a big problem for the NHS.

 

Sorry I am rambling but it is a difficult situation made worse by the fact that my father his eldest son hasn't spoken to him for 27 years. :(

 

edited both posts for rambling typos :roll:

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I assume hes had blood tests etc. Other things spring to mind - it could be an infection or if its a head injury ( you mention eyebrow) due to that. has he had a skull Xray to check for fractures. urine and chest infections can lead to confusion and so can hypoxia (low oxygen). Or dehydration - esp if sleeping all day - is he drinking enough. i hope they have checked bloods esp the blood sugar, sodium levels etc. Any sedative can have a bad effect on the elderly. I would think if may be dehydration. also check hes having some food. Good luck and hope he improves

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Have you spoken to his Consultant? It may be worth setting up a meeting with him to discuss the careplan for your Grandad and, specifically, his drugs - perhaps they could try reducing the dose? Equallly I would ask that your concerns are documented. Have you looked the drug up to see what the side effects are - this might give you a clearer idea as to whether that is the root of the problem.

 

Does Grandad really NEED to be in hospital or could he go into a nursing home for a few weeks until he is able to return home? When I have had elderly relatives in hospital they seem to get 'institutionalized' very quickly and lose their independance so maybe the nursing home could be some sort of halfway house?

 

Grandad is very fortunate in having such concerned family!

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Probalably wasn't there because I was trying to edit out the typos :roll:

 

He had test for most of the things that you mention in the first few days, he went in with a mild urinary infection which he had been suffering from on and off for a while, this may well have led to the fall in the first place. he had a course of antibiotics for the first week. He isn't drinking much but we have made sure that he has had a drink whenever we have been in and my uncle is encouraging him to drink when he is there, but of course the staff don't really have the time to check on this overnight and during the morning. They only allow visits between 3-8.30pm.

 

His care is not helped by the fact that he is stone deaf and blind in one eye. I don't envy the nurses caring for him and the other elderly patients on the ward, but is is so hard when it is your relative, not to be critical at times.

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I'm sorry to hear about your grandad :( . I have no medical knowledge so can't offer any advice but a similar thing happened to my dad 4 years ago after a nasty fall. He ended up in a nursing home after a few months (much better off there than in hospital, where he caught C.diff and seemed to be left alone a lot). I hope your grandad gets the care he needs soon. xxx

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In my experience, and I'm probably biased because I think my Dad's care led to his death, moving him out of hospital as soon as possible would be a good thing. Sedation can lead to daytime drowsiness, so you're right to be concerned about that, although given staffing levels they may feel it's their only option.

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Being hospitalised for more than a few days often has a really detrimental affect on people, whatever their age. Every day is the same, the routine is the same, and the memory starts to get affected. For older people it can be even more pronounced.

 

I would raise your concerns and kee raising them until someone puts your mind at rest.

 

My elderly neighbour went into hospital (a few years ago now) and she started to lose her marbles. I kept raising this with the staff, but they (a) told me they couldn't talk to me because I wasn't her next of kin, and (b) asked me what I expected at that age. My neighbour was as sharo as a tack when she went in, and they wouldn't listen when I tried to tell them that something wasn't right. Her family lived a long way away, so didn't visit very often. In the end, I had to get her son's number form her mobile phone, and i phoned him to tell him of my concerns.

 

Nothing was resolved in time, very sadly.

 

It doesn't mean this will happen to your Dad.

 

Jut don't let them fob you off.

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Sorry Chickencam I wasnt being critical - sorry if I sounded huffy - i have been spikey all day. Glad you are encouraging fluids. It will flush out bugs. Has he got a hearing aid? i feel for you - My FIL always deteriorated in hosp - occasionally it was neglect often short staffing. We had it drilled into us about fluids. The most lucid old dear goes loopy when dehydrated. Good luck.

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It's so hard seeing a loved one in this state, I am sorry.

 

You could ask about why he had the urine infection, it could be prostate, constipation, diabetes etc., it doesn't just happen in a man. Yes he's elderly but there are conditions that can be helped or it will repeat.

 

There is technology that can help with your peace of mind. Yes he'll be more orientated at home but there are systems that can detect whether he has been out of bed for over a set time at night, or a bodyworn falls detector etc., that in our area link through to a central control or in others to the ambulance service. There's a small charge but worth investigating. The ward therapists will know all about what is available or social services when they speak to you about his care package.

 

If he is getting confused and having problems after infections etc are being dealt with you have the right to ask the GP for a referral for a memory assessment then you can get expert advice on managing a confused elderly person.

 

It's not easy but have you talked to him about the future and alternative places to live.

 

Good luck

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Don't worry Ali I didn't take it as critical at all :D

 

We will do what we can tomorrow and my uncle was going to raise our concerns this afternoon. I will be happier when my other uncle and aunt get back on Monday, because they will be more proactive, my aunt has loads of experience of elderly care.

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Sedating any patient just to keep them out of the nurses' hair is a no-no (I can say this as I am one!).

However you need to ask a few questions, I think, to find out exactly what's going on and why.

Haloperidol is quite a strong sedative and sadly if your uncle is not sleeping at night, he will continue to be sleepy and confused during the day. Haloperidol will just make this worse.

Alis girls is right - checking all that can be checked to rule out the most likely causes of confusion / falling etc. In elderly people, infection and dehydration can cause no end of problems. Plus it's known that hospital admissions can add to that, but sadly sometimes it's necessary.

Ask to speak to the Charge Nurse of the ward he's in and ask them to tell you what's going on with your uncle and explain your concerns. Ask about his medications and why he's receiving them and how long for. Ask about the tests he's had done and what the results were. If you're unhappy, you can also ask for an appointment with his consultant.

He should have a care plan in place with regard to all aspects of his care and risk assessments with regard to his falls / confusion etc. Ask to discuss it.

If you're still unhappy, you can take your concerns further.

 

I hope you get some answers and that your uncle starts to improve.

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Liz, I'm so sorry to hear about your Granddad. I would be very worried about how drowsy he is, surely there is something less potent that they can give to him to help him sleep at night without being dozy during the day. Urinary infections can make people very disorientated and not with it though.

 

My Nan was taken into hospital for an infection (17 years ago so I can't remember quite what for), she'd not been ill for ages and hadn't been in hospital for anything that I can remember. She was always on the ball and to see my Nan drugged up was awful. We all felt that this was due to being given sedation and not being able to move around a little. She literally was laying in bed all the time. She did die sadly, now whether this would have happened anyway due to her age (82) or it was due to dare I say it, being old and not worth bothering too much about I don't know.

 

If it was me now I would be questioning everything that is happening. I hope you get some answers and that your Granddad gets better. As you say it will be easier when your aunt and uncle get back.

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My OH works on a ward where he (as the only male on the staff) is often tasked just to watch one male patient all shift as sometimes they get scared and confused in hospital, he has been threatened, punched and stabbed with cutlery all the while the relatives don't see what is going on because visiting times are restricted or proclaim their relative incapable of such behaviour

 

So in short I am saying get your support from the forum but speak to the people in the know about the sedation, they may be able to give you much more reassurance or explanations at least - don't be fobbed off and insist on speaking to someone who understands the medication

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Thanks everyone. Aparently he did hit someone the other day, he does get frustrated when he can't do things for himself, but is not a violent or even bad tempered man as a rule.

 

He barely opened his eyes yesterday afternoon when my uncle was with him, a doctor came around and my uncle askedhim a few questions and they said that they would assess him again because they too were concerned about how sleepy he is and also his blood pressure is a bit erratic. i spoke to the nurse in charge this morning and she said that she was waiting for a team to come round, so hopefully we will know more when we go,over there later.

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When we went to see him on Saturday afternoon, he wasn't really asleep, but not really concious either. He was sort of aware of himself, he was obviously uncomfortable and wanted to be pulled up the bed and wanted to know when his tea was coming and a few other things, but he really didn't know we were there. We managed to get him to eat a small amount of mashed potato and some juice from his baked beans, he then wolfed down his ice cream and when we said that it had all gone he said 'that's a bother'. Apaprently this was a vast improvement on the previous day and he improved again yesterday.

 

We spoke to the registrar on Saturday and she told us that he had another fall on Thursday and because he was shakey and sleepy they decided to do another CT scan on him which showed some bleeding behind a large bruise in the middle of his forehead, she said there was no added pressure there and he was probably just concussed again and would improve over the coming days, which is what seems to be happening. He had some lovely staff looking after him when we were there, but I think that they were feeling a bit guilty about him having another fall on their watch.

 

We asked the registrar about the Haloperidol and she said that he was on a low dosage and they had tried taking him off it but he became very anxious and restless again without it. I will be glad when my aunt and uncle come back later today, because they will be there daily again to fight his corner.

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I had a long chat with my aunt last night, they will be going in this afternoon and she has had a call from the social worker who wants to set up a meeting to discuss his future care. He had another bad day yesterday, so I am glad that she is back to fight his corner, they only live 15 minutes from the hospital.

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We were told last week that he unlikely to recover a great deal, he now doesn't really recognise us apart from my uncle sometimes and he talks about him and asks him to do things for him who ever is there with him. he has lost loads of weight and it looks like he is slipping away. Aparently he recognised my aunt as she said goodbye to him yesterday. He is only really eating ice cream and soft milk puddings along with Ensure drinks, it is sad to see him like this, but he doesn't really seem aware of what is happening now. The hospital have said that he will stay with them and they do seem to be caring for him quite well, but it does depend who is on shift.

 

We are going to see him at weekends and he has someone from the family with him for about 5 hours a day, it does make you realise how alone a lot of old people are though. :( My husband has really surprised me, he has been lovely with him holding his hand and feeding him etc, he has known him for nearly 30 years and he has always been good to us. The children all want to see him each week too, I just hope he knows that his great grandchildren care about him that much, because he has always been such a family man.

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