When we think about the health issues of old age, the issues that will really reduce independence or limit life span, we probably think of broken hips, frailty or dementia but when we really get into the trenches, we meet a thing we rarely hear about: delirium.
Delirium is a sudden, temporary state of severe confusion and impaired cognition, often arising from underlying illness, surgery or medication changes in hospitalised or older adults.
My mum has been hospitalised several times over the last few years and has had delirium each time. According to the definition, delirium is temporary but what the definition doesn't tell us is that, oftentimes, people don't fully recover. Mum has been left with a cognitive loss after every episode. One time she had a long running difficulty with numbers, it seemed to eventually resolve but for many months she would use numbers in ways that were just so far wrong, it was impossible to make sense of. She would announce a heart rate of 300 or a blood pressure of 20, she thought her wedding was in the 90s (1968)
Mum also developed confusion about her phone service. She had once had a working understanding of internet service, mobile phones and landline but after delirium they were all dumped into a cognitive basket for communications and she would say things like she couldn't find an email because the phone at the house had been disconnected. No amount of explaining could help her understand but she also refused to let go of trying make it make sense so we had an ongoing saga of "trying to pay for the phone/ fix the phone/ fix the email" which just couldn't be solved.
A man who came to work looking for care for his dad expressed his frustration about deliriuim and about the silence around it, saying that his dad developed delirium after a surgery and was still impaired months down the track. He thought he might have taken a different approach to his father's medical decisions if he had understood the implications of surgery in old age. He commented that unresolved delirium is the same as dementia and he was right, technically speaking delirium and dementia are different but if they make a person confused and steal independence, the end result is the same.
These past two weeks, mum has been hospitalised again and has developed the worst yet case of delirium. When I visited on Thursday she asked when Dad was coming, tried to rip her oxygen off, wanted to know if she had to pay for a towel (apropos of nothing), undressed herself multiple times, kicked her sheets constantly and told fantastical stories about the great buffet that had been laid out (in a public hospital) and which she wasn't allowed to eat. She wanted her bed up and down about 6 times in a half hour and was angry when I asked how I could help her. After I left she spent the whole night trying to climb out of bed.
It was bad enough that every nurse I spoke to on Friday mentioned it, including some who had been working down the corridor.
After seeing all that, I went home on Thursday night sure that Mum was dying and trying to figure out how to get her back to her nursing home so she could live her final days in peace. When I visited on Friday she was sitting up in bed writing text messages to her grand daughters, still a bit confused but much more herself. I guess I can leave her in hospital to finish treatment after all.
I'm sure there will be permanent cognitive changes again and I wonder how we will navigate them. The good thing this time is she has an aged care facility to return to and we won't be trying to manage a confused, combative person on our own.
