[trent123]

My 88 year old father was recently hospitalized for severe pneumonia. He has now been moved a an LTACH or whats known as a long term acute care hospital. While in the first hospital, he had several complications, including extremely low blood pressure coupled with an attack of atrial fibrillation, most likely due to the sedatives he was given for his delirium, which he developed suddenly while in the hospital. Now 2 weeks later, he still has the delirium, even though supposedly he does not show clinical signs of the pneumonia. He is extremely nasty to the nurses, cursing at them and even threatening to kill them, or he'll bark orders at them. Other times he is almost his gentle self. And still others he is enveloped in a sea of hallucinations and delusions and almost unable to speak or be roused (almost as if unconscious). At one point he thought he was in a war training camp in 1949. Another time he thought he was in China. Other times he knows he is in the hospital and in the US. He has no history of dementia. None of the doctors at this hospital nor at the other one want to take it seriously. I have read extensively on delirium since this all started, and all of the articles say is should be treated very seriously, regardless of age. But I am not getting that feeling from his doctors here at this LTACH, nor from the other hospital. When he was brought here, I was told the average length of stay is around 3-4 weeks, but he hasn't even been here a week, and the doctor is talking releasing him to a skilled nursing facility for rehab, but I don't think he is ready. I can just see him not even be able to follow a physical therapists commands to do exercises, and then Medicare will cut paying for the rehab and he'll be left to rot in a nursing home. Is there anyway to get these doctors to look into this further? They haven't ordered any brain scans, nor any follow-up arterial blood gasses (ABGs). His ABGs were all off at the other hospital, for example his C02 level was 70 - normal is below 45. A follow-up ABG at the other hospital showed a C02 level of 63 just a few days later, still way above normal. But they won't order any follow-up ABG's or any other tests here, saying it's not necessary.

Please, keep any insensitive comments about his age to yourself. I have been getting this "oh but he's 88 years old, what do you expect" crap from the doctors, I don't need it here as well, please. I realize he is 88. I am not blind, nor stupid to that fact. When one of the doctors in the ER said that, I said so why don't you smother him with a pillow if you people want him dead so badly, and then he promptly called security on me. They don't want to treat old people, they want them to die. It's unbelievable. I just want to give him the best chance possible.

[mrsD]

Welcome to NeuroTalk. This has to be a very difficult time for you. Watching a parent in distress is very painful (I had that experience with my mother years ago too)

One thing that does happen with the elderly is that common drugs that are given to them (some are even OTC now) can cause delirium. And example is Zantac (and other H2 antagonists like Pepcid). When people age, the blood brain barrier starts to let things into the brain which it didn't before when the patient was younger. This situation then leads to unfamiliar side effects.

Many other drugs are capable of causing delirium and behavior changes in the elderly. Here is a link to a discussion we had here in the past:
http://neurotalk.psychcentral.com/sh...light=delirium

Also since then, statins (for lowering cholesterol), have been listed by the FDA as affecting memory and this means that they too are getting into the brain and they could perhaps affect other functions as well.

The elderly also can have a sudden decrease in thyroid functions, when very ill or during trauma/surgery. So the thyroid should be tested ASAP IMO. If the thyroid cannot keep up with the tissue demands during these times, then supplemental hormone can be given.

An ER doctor may or may not know of all the drugs that are difficult for the elderly to handle. So you have to bring this up and ask them to research it.

If your father was given high dose Levaquin or Cipro or Avelox for his pneumonia...this antibiotic goes into the brain of older patients and does mischief there too. So even antibiotics can cause problems, confusion etc in an elderly patient.

Typically, also the elderly can get very low in vitamin B12. A test should be run on your father and the results should be 400pg/ml or higher. Labs still report low values as "normal" so get the numbers. Low B12 is a common cause of dementia-like symptoms in an elderly patient.

I'll look in on this thread daily to see if you have any further questions.

[ginnie]

I am so sorry that your family is going through this. Mostly I am sad that you don't think he is getting the best of care. All older folks deserve that as someday we will be in the same situation, including those that care for him.
My mother experienced the same type of confusion. I do think it was do to the cocktail of medications she received. Once she was in her own home, with some home help nurses, she regained some of her ability back. I hope that there is a recovery. No one here would ever say anything to hurt. Believe me, we all go through some family member being sick in their senior years. Love conquers all. Go give him a huge hug, talk to him. Bring in photos and music to jar the memory. Anything he likes, try to show him. Music is used in therapy in nursing homes, that are in tune to the older person. My son is involved with this and said it really helps. Let me know if you try this. I believe it will help. ginnie

[Kitty]

trent123 It's so hard when our parents age.

I went through similar with my Dad before he passed away in 2005. Luckily, I was able to be at the hospital/nursing home/hospice with him most of the time and I questioned everything that was done to and for him. Not questioning out of doubt.....but I wanted to know what and why because he couldn't be his own advocate. So I applaud you for wanting the best for your Dad.

mrsD has offered some excellent advice and you'll find her to be a great source of wonderful information.

I hope everything goes well for your Dad. Thank you for being there for him.