Mom's sundowning got worse, starting at about midmorning instead of early afternoon, a few weeks ago, and was started on a course of Cipro for a UTI without testing, saying that if she was going to get better it would be in about 3 days...which would have been Monday. She is still starting to be belligerent, angry and mean (not her usual mental status) since then, Would it be reasonable to ask her to be discharged from hospice and admitted to the hospital to see if she has some other sepsis going on that might be treated, or is this just the "new level" of dementia going on?
My SIL is taking care of her and does not appreciate any of my input (though I took care of Mom for over 2 years before I was too worn out to continue) but if anyone thought it might be worth considering, I could mention it to my brother, who might be able to convince her. But if you all say it's probably not going to do any good, I won't say anything.
I appreciate your support. I have hardly had time to visit the forum, (or breathe with my husband's 2 caths in the last month and possible need for an ablation for atrial fibrillation) but I still want what is best for mom.
Thanks to all of you
My mom had a severe reaction to cephalosporin antibiotics for a UTI - she got worse and had a toxic reaction which caused toxic encephalopathy. So yes it could also be just the medications.
She should not have to suffer through that type of delirium - I would get the hospice nurse out ASAP make them get a urine catch and switch meds only after the urine catch was done. 🙏🏼🙏🏼
So sorry it is so awful to watch our loved ones go through this .
I can understand why they would prescribe Cipro without a sample because it generally does pretty well against UTIs, but it may not work in this case and that's why they need a urine sample.
Many elderly women have a variety of resident microorganisms in their urinary tract. If she is dehydrated then her decreased output of urine means germs dot get 'flushed out.'
Understanding the goals of hospice care (quality of life until a natural death) is important.
The actual process that leads to a natural death often involves infection/deydration/loss of organ functions, and death.
You have enough on your plate.
This sets a precedent for allowing treatment for a UTI while on hospice. So, no, you would not need to cancel hospice to get her treated for a UTI.
The treatment is not working and may be causing her harm. It is my understanding that Cipro is not a good medication for the elderly:
" Adverse reactions of the CNS are of particular concern for the elderly population. Elderly patients with impairments of the CNS (e.g. epilepsy, pronounced arteriosclerosis) should be treated with fluoroquinolones only under close supervision. Probably, many signs of possible adverse reactions such as confusion, weakness, loss of appetite, tremor or depression are often mistakenly attributed to old age and remain unreported. Fluoroquinolones can cause QT interval prolongation." Time is of the essence, persuading sister and brother may take too long.
You are correct, she should have been tested, and now changed to the correct antibiotic. Just because someone is on hospice is no excuse to allow the wrong treatment or care. Hospice provides comfort...can you imagine how uncomfortable Mom is having these behaviors and a UTI?
Next protocol would be medicating her for her behavior(s), making it worse.
Address the proper treatment for the UTI. Try to get the Cipro changed, STAT!
Right away.
You sound powerless to effect a change in treatment. Any good you try to do has to be done right away. Changing from Cipro did my elder loved one good, and he lived a better life until his end.
So, I am going to ask, how are you going to be able to push for cancelling hospice and having her sent to the hospital? I would do it for my loved one. My sister got a different hospice when we disagreed with their treatment/
mistreatment. But sister and I agreed. You might need to be present to get this done.
Proceeding with the current treatment is just wrong, imo. Ignoring that Mom has the wrong treatment is even worse. Do it today.
1) Call the doctor to report side effects of Cipro. Get it discontinued, imo.
2) Get a urinalysis, with a culture and sensitivity.
These are times when I wish I was wrong. I could be wrong, but how is finding out what is the right treatment is going to harm your mother?
Disclaimer: I could be wrong. Every patient is different. But going by what you said: They said she should be better by Monday, and she is not, plus added behaviors....
Best wishes for you, your Mom, and family.
It may be that the antibiotics that were given was not for the type of infection she has and needs a different type of Antibiotic. That happened with my Dad a couple times.
Hospice doesn't like doing it but if you tell them you want both a Urinalysis and Culture done or you will be checking her out of Hospice, they will probably do it.
It's hard and it's ugly and it doesn't get easier with dementia. It's terrible, too, to sit around and feel helpless to 'fix' things, isn't it? I hate dementia with every ounce of my being and watching my mother turn into just an angry, miserable person 24/7. I hope this ends for both of them sooner rather than later, b/c it's no way to live.
Both of these are 'educated guesses' and saves the hassle of getting an uncontaminated urine specimen in an elderly woman.