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What Causes Vascular Dementia In Elderly?
Question: My step mother aged 92 has vascular dementia and was recently admitted to hospital with a urinary problem. This was resolved by use of antibiotics. She has been moved to a stroke unit and I am told that a scan has revealed moderate to severe involutional change. "There was evidence of blood" on the brain but surgery was not a good option. She is confused, eating little and can barely stand or walk.
I am told that when I visit tomorrow there will not be a doctor available to give an assessment. Relatives who visited today were told that the nurses were too busy to discuss matters.
What if anything can we expect by way of further in hospital treatment, and, is it likely to be sent home to be cared for by her 93 year old sister who has acted as a carer up until now? Thanks
I am told that when I visit tomorrow there will not be a doctor available to give an assessment. Relatives who visited today were told that the nurses were too busy to discuss matters.
What if anything can we expect by way of further in hospital treatment, and, is it likely to be sent home to be cared for by her 93 year old sister who has acted as a carer up until now? Thanks
Brief Answer:
A 93 year old is not an appropriate carer
Detailed Answer:
Hello,
a patient of this age and with absent cognitive and motor function cannot be cared for by a 93 year old individual. She needs to be moved (which sounds like impossible for a 93 year old woman) to avoid pressure ulcers. She needs to be cleaned at least three times a day (to avoid skin problems). She needs to be fed, which might prove much more difficult than it sounds. She needs enough fluids to avoid renal damage, which is perhaps the hardest part in patients who can't cooperate. And the list goes on...
An experienced nurse or properly informed but younger relatives may be able to take care of her but I doubt that a 93 year old woman would be able to do that.
I can't comment on her hospital treatment because I don't have information about her condition or her treatment. If you can provide more details, I'll be glad to do so.
I hope I've helped!
Kind Regards!
A 93 year old is not an appropriate carer
Detailed Answer:
Hello,
a patient of this age and with absent cognitive and motor function cannot be cared for by a 93 year old individual. She needs to be moved (which sounds like impossible for a 93 year old woman) to avoid pressure ulcers. She needs to be cleaned at least three times a day (to avoid skin problems). She needs to be fed, which might prove much more difficult than it sounds. She needs enough fluids to avoid renal damage, which is perhaps the hardest part in patients who can't cooperate. And the list goes on...
An experienced nurse or properly informed but younger relatives may be able to take care of her but I doubt that a 93 year old woman would be able to do that.
I can't comment on her hospital treatment because I don't have information about her condition or her treatment. If you can provide more details, I'll be glad to do so.
I hope I've helped!
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I agree that the carer is unlikely to cope but she has power of attorney and desperately wants to nurse her sister as long as possible.
I think the hospital is now only going to monitor her condition to be sure that the urinary problem does not return. There is a modicum of physio but the results are marginal at best. There is talk of setting up a care package and then discharge. Is it reasonable for me to try to obtain a forecast of life expectancy? If the forecast indicates weeks then perhaps we can put together a comprehensive at home plan. If it is u certain then perhaps j should push hard for a care home. I appreciate that without detailed case notes you can only give a broad brush answer, but, that will be better than nothing. In the case of my wife we were given such guidance and I took her home from hospital for her last 18 hours. A decision I do not regret. Thank you
I think the hospital is now only going to monitor her condition to be sure that the urinary problem does not return. There is a modicum of physio but the results are marginal at best. There is talk of setting up a care package and then discharge. Is it reasonable for me to try to obtain a forecast of life expectancy? If the forecast indicates weeks then perhaps we can put together a comprehensive at home plan. If it is u certain then perhaps j should push hard for a care home. I appreciate that without detailed case notes you can only give a broad brush answer, but, that will be better than nothing. In the case of my wife we were given such guidance and I took her home from hospital for her last 18 hours. A decision I do not regret. Thank you
Brief Answer:
I can't give a prognosis
Detailed Answer:
Hi,
I understand your situation. If she only has dementia and no other acute organic conditions then her life expectancy is - at best - unpredictable. A 92 year old lady may die without any significant incident going on - just because she's old. Dementia won't kill her unless complications ensue (like pneumonia, dehydration, kidney failure etc). A urinary tract infection can usually be managed.
So the answer is not that simple! There cases that the doctors may predict that death is imminent but I can't say that about your mother. Perhaps you should insist to discuss this with her doctors, because they know all the details. If - for example - her urinary tract infection has caused septic shock then she could die before even having the chance to go home or anywhere else. If she has an ordinary urinary tract infection then the antibiotics would likely do their job and she'll be fine.
Perhaps you can try something between the two choices you've mentioned - if you'd like to keep her at home. You can take her home and see how things go and if the need arises you can move her to more experienced care later. She is going to need close medical attention of course because it's almost certain that she's going to have problems at home.
Contact me again, if you'd like further clarifications.
Kind Regards!
I can't give a prognosis
Detailed Answer:
Hi,
I understand your situation. If she only has dementia and no other acute organic conditions then her life expectancy is - at best - unpredictable. A 92 year old lady may die without any significant incident going on - just because she's old. Dementia won't kill her unless complications ensue (like pneumonia, dehydration, kidney failure etc). A urinary tract infection can usually be managed.
So the answer is not that simple! There cases that the doctors may predict that death is imminent but I can't say that about your mother. Perhaps you should insist to discuss this with her doctors, because they know all the details. If - for example - her urinary tract infection has caused septic shock then she could die before even having the chance to go home or anywhere else. If she has an ordinary urinary tract infection then the antibiotics would likely do their job and she'll be fine.
Perhaps you can try something between the two choices you've mentioned - if you'd like to keep her at home. You can take her home and see how things go and if the need arises you can move her to more experienced care later. She is going to need close medical attention of course because it's almost certain that she's going to have problems at home.
Contact me again, if you'd like further clarifications.
Kind Regards!
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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