Delirium: a learning experience
This morning, I got a "Hi, we're missing you" email from Steemit – probably because it's 10 days since my last activity on the platform.
It's good to see that Steemit Inc are chasing up dormant accounts, and at the same time, it's a bit ironic, because last night I went on to Steemit, replied to a comment, and started to write a post.
Then things went a bit crazy at home again, and after that, I just couldn't focus.
My mum, who's in her late 80s, has been having bouts of delirium since July, when she was hospitalised for pneumonia. Delirium is common in elderly people with serious illnesses, though it can affect people of any age. I had delirium at the age of two, as a complication of measles.
The pneumonia caused Mum to have hypoxia, where the brain is deprived of oxygen, and this seems to have triggered the delirium.
The symptoms of delirium are confusion and distraction, and the main difference between delirium and dementia is that delirium comes on suddenly rather than gradually, and the symptoms come and go.
This has certainly been the case with Mum. She can be totally rational for days on end, and suddenly she'll start saying bizarre things.
When Mum got ill, we were told that the bouts of delirium could last for several months. It seemed to be steadily improving as Mum's physical condition improved.
But last week, there was a sudden deterioration in Mum's mental condition. It was a sharp reminder that this could be the first signs of dementia, something we've all been dreading.
I am the main carer for my mum. I'm currently living in her large flat. I've been hoping that I would eventually be able to return to my own flat, but that goal seems to get further and further away.
Last Wednesday evening I was doing exercises to a YouTube. I think the noise might have woken Mum, who was in bed, so once the exercises were finished, I put the headphones in, to keep the noise down, keeping just one end in my ear.
I heard Mum going to the kitchen, but I didn't think much of it. I thought she might be getting a glass of water.
About 20 minutes later I left my room to go to the bathroom – and I was horrified to see that Mum's bedroom door was wide open and there was no sign of her. Her walker, coat, bag and keys were also gone.
I had heard about elderly people wandering off in the night in a confused state, but Mum has never done anything like this before. When she was discharged from hospital, we were warned that the delirium could cause this kind of thing, and on days when she seemed a bit confused, I was careful to lock the door and hide the keys at night. But it never happened, and with Mum's condition improving and the delirium becoming less frequent, I had stopped worrying about this possibility.
I was almost in shock when I realised that Mum had disappeared. My heart was pounding as I looked for her. Although Mum's flat is on the ground floor, there are two flights of steps outside, and I usually carry her walker down them for her, while she holds onto the railing.
Alternatively, she can go down the lift into the garage, but there's quite a steep incline to walk up from there, and she can get a bit short of breath. I was horrified to think that she might have fallen down the outside steps, or have collapsed outside the garage – or that she might have walked out into the road in a dreamlike state and have been hit by a car.
I phoned 101 – the number for non-emergency calls to the police. They took so many details that my anxiety got worse. I was anxious to get out and look for Mum.
The police told me to stay at home and they would look for Mum – a much more sensible idea! Two officers came to sit with me and ask me more questions about Mum. Meanwhile, my brother-in-law joined the search party. My sister was away on a business trip at the time.
Just after midnight, we got a report from the police that Mum had been found safe and well, and in good spirits. I was so relieved I hardly dared believe it initially.
Another problem then emerged. We found out that Mum had taken two extra doses of her tablets – probably because I had left some of them out for her to take the next day.
It seems she had got up, thinking it was morning, and had taken her tablets and the granola I had put out for her. Those extra tablets may have made her slightly more disoriented due to dehydration.
She had apparently then taken MORE tablets, and had then decided to walk to the Friends Meeting House where she usually goes on Sunday.
I was told that we would need to go to A&E to get Mum checked out. It took until 4am for the doctors and nurses there to check Mum out and get her a bed for the night.
I got home at 5.30am, feeling totally drained. Thankfully, Mum was discharged the next day (Thursday), and she's been mostly fine ever since.
Balancing the body clock
Delirium, like dementia, can often get worse as night falls, and I had been a bit concerned about autumn coming on and the nights getting longer. I've been trying to get Mum out for walks during the day, so she get as much sunlight as possible, as it seems to be the disruption in melatonin levels that can worsen this condition.
Melatonin is a hormone made in the body that is of vital importance in promoting good sleep and regulating the "body clock". The body needs exposure to daylight in order to produce melatonin, but levels of melatonin tend to decline with age.
Yesterday Mum seemed relaxed and rational all day. I had signed up for an evening Meetup at the climbing centre. I told Mum that I was a bit concerned about leaving her on her own, and I'd asked her if it was OK for me to lock her in as a precaution. She said that would be fine. She usually goes to bed fairly early these days.
As we were having dinner, it started to get darker – and almost on cue, Mum started to behave oddly – so oddly that I realised that I would have to stay in for the evening.
Mum went to bed, but then got up twice before 9.30pm, thinking it was time to get up. Both times I had to gently persuade her that it was night time and coax her to go back to bed.
A therapeutic dose of daylight
Today, despite the miserable murky, rainy weather, I decided to take action, and get Mum out of the house from early on. We went out on a shopping trip, leaving at about 10.30am. It's my nephew's 18th birthday, and we bought a present for him and went for a coffee.
We were out for a few hours and despite spending most of it in the shops, Mum got a good dose of daylight. It seemed to work wonders. Mum remained calm and rational for the rest of the day, and in the evening, we had a lovely birthday dinner for Sam.
As soon as we'd finished dinner, I drove my sister and Sam to the cinema. When I got back, about 45 minutes later, ready to start clearing up the kitchen, I found to my astonishment that Mum had cleared it all up!
Every single bit – the kitchen was spotless!
This is really something, as since her illness in July, Mum has found it difficult even to remember which cupboard her breakfast bowls are in. I'm hoping it's a sign of her continuing recovery from the pneumonia combined with that good dose of daylight today.
The next steps...
I don't think it will be feasible to take Mum out every morning, but I've ordered a SAD (Seasonal Affective Disorder) light, which I'm really hoping will help Mum's condition.
We're going to have door sensors installed, to alert us if Mum goes wandering at night again, and I'm currently trying to find a personal tracker device that's not too heavy and that I can put in Mum's handbag. She's always refused to carry a mobile phone.
Before Mum got ill, she used to go out for a walk on her own every single day, and we're really hoping she'll be able to do that again in the not too distant future!
It probably won't happen overnight, and until we get the immediate crisis sorted out, my presence on Steemit could be a little intermittent... but I think things are looking quite positive.