Urinary infection / old people / confusion / testing
Urinary infection / old people / confusion / testing
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Discussion

Kiltie

Original Poster:

7,505 posts

275 months

Sunday 12th January 2014
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I thought that if an elderly person started to display some confusion, the starting point was always to check for a urinary infection.

Is that still the case?

If so, on a hospital ward, are the nursing staff able to check using those cardboard strips which look like litmus paper?

CragGriff500

46 posts

236 months

Sunday 12th January 2014
quotequote all
New acute onset confusion in an elderly person can occur for many reasons. If a person is admitted to hospital it could relate to the reason for admission depending on what that is. It is always important to rule out infections such as urinary tract infections, chest infections, cellulitis etc. I would suspect a clinical examination and thorough history by the ward doctor would be the first step to identify likely causes. A doctor should have a listen to the chest for signs of infection (plus or minus chest x ray depending on symptoms/signs). A urinary dip should be performed as urinary infections in the elderly man be asymptomatic. You just need a urine sample and it is tested instantly for blood and nitrites and other things that could be present with infection. It is then generally sent off for culture in the lab. Basic observations such as pulse/BP/oxygen saturation would help to ensure the blood is carrying enough oxygen etc. Blood tests can sometimes help too.
Elderly people can get become confused from dehydration, as a consequence of medications such as certain painkillers, sedatives etc. The very process of admission to hospital can worsen a previously evident chronic confusion.

What I am ttying to say is that it could be many things. Urine dip has a role but a thorough examination and history is most important.

Kiltie

Original Poster:

7,505 posts

275 months

Sunday 12th January 2014
quotequote all
CragGriff500 said:
New acute onset confusion in an elderly person can occur for many reasons. If a person is admitted to hospital it could relate to the reason for admission depending on what that is. It is always important to rule out infections such as urinary tract infections, chest infections, cellulitis etc. I would suspect a clinical examination and thorough history by the ward doctor would be the first step to identify likely causes. A doctor should have a listen to the chest for signs of infection (plus or minus chest x ray depending on symptoms/signs). A urinary dip should be performed as urinary infections in the elderly man be asymptomatic. You just need a urine sample and it is tested instantly for blood and nitrites and other things that could be present with infection. It is then generally sent off for culture in the lab. Basic observations such as pulse/BP/oxygen saturation would help to ensure the blood is carrying enough oxygen etc. Blood tests can sometimes help too.
Elderly people can get become confused from dehydration, as a consequence of medications such as certain painkillers, sedatives etc. The very process of admission to hospital can worsen a previously evident chronic confusion.

What I am ttying to say is that it could be many things. Urine dip has a role but a thorough examination and history is most important.
Thanks for taking the time to provide such a comprehensive and informative reply.

You've joined up some dots for me there and I'm very grateful.

It's my father I'm concerned about but I'm hoping to speak to his consultant tomorrow.

Thanks again and I hope you enjoy the rest of your evening. smile

HughS47

613 posts

163 months

Wednesday 15th January 2014
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As above, (and a +1) for poly-pharmacy. Most crumblies are on a cocktail of medications. Get an opinion from an MFE (medicine for the elderly) consultant during his admission.

Kiltie

Original Poster:

7,505 posts

275 months

Saturday 18th January 2014
quotequote all
Thanks.

My old fella is still completrly out of it.

They're moving him to a room beside the nurse's station so they can keep a better look out for him.

He's convinced he's seeing a cat in the ward (this is just one example). I try to reason with him and ask if cats in hospitals is consistent with his expetience but he's not interested.

Smiling and agreeing with everything doesn't seem right though.

I spent a lot of time in ortho trauma and rehab wards in 2011 and I see his behaviour as being vety very similar to old blokes I shared wards with. I was forever buzzing for nurses when they were doing their best to haul out their catheters.

He's had a feedinv tube in his nose but was pulling it out so I think they've given up.

One thing that puzzles me is an apparent fasconation with small things. I saw this with the other old blokes I came across and my dad is demonstrating exactly the same. He's obsessed with his finger tips and wants to always twiddle the edge of his sheet or blanket. It's really weird, does anyone know what that's all about?

This is destroying my mother. I try to tell her he'll come out the other side but as time goes on, I think I'm becoming less and less convincing.

He was admitted due to really bad pain which they'vecstill not figured out bug are leaning towards an ortho issue (he's being / been looked at by a person from the department of medicine for the elderly).

When he first went in, he was crying out in pain whenever he moved. I'm not seeing this now.

I try to tell my mum that he's not in hospital for the confusion and it's not evena symtom as such. Having had some experience of 5/5 pain myself, I try to trll her that I'd rather be confused any day if the week. She doesn't seem to get it though.

A week aho, he was away with the fairies when speaking to family but as soon as a nurse or doc spoke to him, he was back in the room. Now he's pretty much out of it regardless oh who's there.

All very distressing for everyone involved. Anyone else been through similar?

Kiltie

Original Poster:

7,505 posts

275 months

Sunday 19th January 2014
quotequote all
My old man seemed a bit better at visiting last night.

Towards the end, he was rambling a bit and aggitated and obsessed with his mobile phone and if it was working.

By the time I'd got home, he'd phoned my wife to ask her to buy a card for my mum's birthday on Tuesday.

Astonishing.