Old folks, hospitals, & "sun-downing"

Miscellaneous and Personal Stuff I Must Share
1

Anyone have a parent or grandparent go all wack-o while in the hospital?

We took my grandmother, 88, into the hospital last week because she was kinda wheezy (otherwise she’s been in excellent health except for occassionally losing her balance). She was diagnosed with chronic obstructive pumonary disease (COPD), which they took care of for now, but we do understand it will get progressively worse. Unfortunately, while there she fell and broke her hip (or, rather, it is more likely that her hip gave way), and she required surgery (which went well and she’s already started physical therapy).

Her stay in the hospital, however, has been marked with marked bouts of paranoia, disorientation and delusions. She thinks the hospital is watching her (videotaping, recording phone conversations), that they know she’s going to sue them for her fall (which she isn’t, as it wasn’t negligence), and her roommate is a spy. It was so bad that on one occassion they had to restrain her.

In speaking with her doctor and others in the profession, this is a common situation, sometimes called “sundowning.” It seems that elderly patients, when put into the hospital, have medical problems and are on various medications, go all bonky when the sun goes down. 1 mg of Haldol, an anti-psychotic, and they’re fine; give them the normal adult dose of 5-10 mg, and they get worse.

So she’s getting the Haldol, and now she’s fine - about 95% of the time. The other 5% she continues to believe there’s some kind of hospital/Medicare fraud/scam going on, but she’s kinda vague on the details. Talking sense to her, of course, is futile. (In fact, in trying to do so, she accused me of being on “their side,” so I wisely shut up and let her babble.) And now that she’s mostly sane again, she is actively involved in her recovery, which is the most important thing she needs to do before complications set in from the surgery.

So anybody else been through this with an elderly relative or friend? It’s really kinda freaky.

Side note: When my father was in for several months last year he started to get depressed, so they gave him Ativan, an anti-depressant, which made him go wonky - he was hallucinating that he was a British secret service agent, on a fishing boat, and in a submarine. Very odd. Needless to say, they took him off that quick. Kind of amusing in a bizzare sort of way, though. We joke about it now.

Esprix

2

BTW… Ativan isn’t an anti-depressant, it’s a tranquilizer.

Seriously, tho, sundowning is a real thing. I work at a VA hospital which tends to treat older (60-ish and up) patients. Some get violent, some get logy and some just get really really weird.

And, as you get older, your body reacts to medications differently. A dose of drug x that works fine for you may be too much for a patient in his/her 70s. Combine that with the multiple meds that these people take, and it’s no wonder that it happens.

Robin

3

Be careful of assuming that her accusations are delusions. They probably are, but elder abuse is a depressingly frequent problem in senior care institutions.

4

That’s interesting. I wonder if it has to do with food intake? The medication could be strong enough to cause a reaction if the person hasn’t eaten since the morning. Just a WAG, based on the fact that my grandmother never ate much after noon. She would always get paranoid about her health at night, as well, afraid she’d die during the night and no one would know.

5

My grandparents never turned paranoid, just a lot more passive and forgetful, and apologetic about both.

6

wow, this is a real condition?!?
my mum got very paranoid during a long hospital\rehab. stay after a car accident. this one time she actually cackled and did a lady macbeth thing with her hands. it took us by complete suprise, i swear we must have zipped back our chairs by a good foot or so. we tried to change the subject, unfortunatly the only two subjects that she would want to talk on were: the nursing conspiracy, and the contents of her bed pan. what IS it about older people and
bed pan contents? she would go into extreme detail.

i understand what you are going through,esprix.

suo na, she was having eating problems in the hospital. things did ease up a bit once she got into a rehab facility and was eating better. although there was still a nurses aid conspiracy that was aimed at keeping her from going to the bathroom.

7

I’m an RN and I worked midnight shift on a busy med surg floor for 5 years. I have seen this happen many, many, many times. Some sweet little grandma will fall and break a hip and then the next night go completely bonkers after the sun goes down, hence the term “sundowners”. This is often a very early stage of dementia or alzheimer’s.

Haldol is often very helpful, but the easiest remedy is often the most overlooked. The confusion is directly related to the darkness and lack of stimulation. So if someone was confused, instead of fussing with them all night to try to get them to go sleep, which was almost aways futile, I did the opposite. I would turn on all the lights in the room, find a familiar program on the tv and give them a “job” to do, such a refolding washcloths or
counting paper cups or some other harmles task. Or I would bring them out in the hall or to the nurses station and keep them occupied. By morning they would be more lucid and catnap all day. Much easier than trying to guess how much meds to give them, because as stated before geriatric doses can be difficult to determine.

8

Well, I don’t think there was a large black man holding a gun to her head, I don’t think they locked her in an elevator all night long, and the hospital is not out to get her or defraud her just because she thinks we’re suing them because she fell and broke her hip (we’re not, as it wasn’t their fault).

Esprix

9

WAG:

Many people, as they get older, experience some sort of dementia-forgetfulness, confusion, etc. We often refer to older people being “set in their ways”, and I think it is often true because routines and familiar settings help keep them centered. When my grandmother became unable to drive due to a number of small strokes, the changes in her behavior were very subtle. She continued to drive long after she should have been stopped because she only went to familiar places by familiar routes. By confining herself to the routine, she was able to hide (even from herself) her increasing confusion. We’re probably lucky she never ran anyone down.

Being in an unfamiliar setting like a hospital is likely to exacerbate those symptoms. Being hospitalized is scary enough. I imagine that it is much worse for older people who depend on familiar surroundings to keep them grounded. Fear, increased confusion, lack of privacy, lack of control-I can see how that could lead to paranoia.

As to why it occurs late in the day, perhaps they are simply stronger and clearer when they wake up and as the day progresses and they become more tired they become less able to hold on to reality?

10

According to all of the medical professionals I’ve talked to, senility is not an “expected” part of becoming older; and no one can explain why people “sundown” - it is a mystery even to the professionals. All they know is 1 mg of Haldol settles them down (but too much makes it worse).

Just goes to show how little we really know about medicine and our bodies.

Esprix