Dementia or Dehydration? Elder Care Requires Nurses to Think Outside the Box
Was it dementia or a urinary tract infection?
I knew there was a big problem when my 87-year-old mother, who lives alone in a senior complex, told me that the girls who had moved in with her had started throwing food on the floor and wouldn’t leave until she threatened to call the police. Almost immediately I got a call from the building’s office staff telling me that my mother was very frightened by these girls, that they had looked through her apartment for them, and as far as they knew there were no girls living there. Now my mother wasn’t the only one who seemed confused. What was she talking about?
It was after hours, so all I could do was take her to an urgent care facility nearby. My first thought was that she’d become dehydrated and somehow the medication she usually takes had reached toxic levels. I was right and wrong: The immediate problem was that she had a urinary tract infection, which the physician on duty told me is the most frequent cause of cognitive changes in the elderly. In addition, she had virtually none of the common symptoms of a UTI aside from what she considered bothersome urinary frequency that woke her up several times during the night. To solve that she’d simply stopped drinking liquids. This, of course, compounded the problem and produced the confusion that she was showing. She was in quite a state.
I’d like to say that rehydrating her fixed everything, but it really wasn’t that simple. Placing her on an antibiotic gave her an upset stomach and set off a period where she refused to take any medication at all since she really wasn’t sure which one was causing the GI symptoms. The lack of her beta blocker set off heart palpitations and all in all we had many trips back and forth to the doctor before her confusion resolved somewhat and her UAs were clean.
The moral for all of us is that what might seem to be a very small problem can have much larger implications, and sometimes we have to really think outside the box. Something as small as a blister for a diabetic can result in an amputation when an extremity becomes infected and fails to heal properly. When dealing with the disabled you really need to think about what is causing their behavior because often they can’t necessarily tell you what is wrong. When uncomfortable they can become irritable and restless while still not really clueing you in to what they are feeling. Those with a cognitive impairment often don’t understand the messages that their own body sends and sustain mild injury without realizing it.
We, as healthcare professionals, must understand and encourage them to drink, to take bathroom breaks, to nap, to dress appropriately for the weather, etc. Any increase in confusion or sudden change in behavior should be investigated for the underlying cause, not just regarded as progression of illness.
If you are dealing with a senior citizen with any level of dementia, you might feel like you are all alone in navigating not only their health but also the financial resources to provide their care. Don’t let your own denial of their symptoms rob you of the ability to get them appropriate help. You may benefit from looking at the webpage for the Alzheimer’s Association.
Christine Contillo, RN, BSN, has worked as a nurse since 1979 and has written extensively for various nursing publications, as well as The New York Times.
This article is from workingnurse.com.