A Turn For the Worse

If I had a nickel for every time I heard the phrase "Since she has been at the hospital, Mother's dementia has taken a turn for the worse," I would be a very wealthy man. The idea that hospitals cause dementia is an amazing phenomenon to me that way too many people accept at face value as a universal truth of aging. Hospitals do not cause dementia. Granted, with the size and confusing layout of most hospitals even I forget how to get back to the parking garage from time to time. The fact that so many seniors never have the opportunity to return home from a hospital stay due to the mysterious "dementia monster" attacking them upon admission is troubling. The fact that this absurd logic is never even challenged is downright maddening.

What causes dementia is, in fact, a mystery. Scientists know that the greatest risk factor is advancing age but beyond that the entirety of medical knowledge on the subject resorts to what can be most aptly described as a "best guess scenario."The sudden, rapid progression of dementia is a far less complicated matter to investigate than actual dementia. So allow me.

In the normal aging process, senior's bodies begin to function differently than they did  in younger years. Kidneys do not function as efficiently as they once did. This particular facet of aging, I believe is responsible for a huge percentage of the post hospital rehab admissions today. Imagine this scenario:

A woman, age 94, has lived independently since her husband's death two decades ago. She continues to be fairly engaged in the community and has a caregiver who comes in twice a week to keep her company and assist her with errands and chores around the house. At times, she has troubling recalling certain things but the things she forgets will generally come back to her and do not interfere with her daily life. She is a model for aging with independence. One day she slips and falls while retrieving the mail. Due to the brittle nature of her bones, she fractures her left hip requiring surgery. The surgery goes extremely well, especially considering her age, and the doctors all say that after some quick rehab she should be fine to return home with limited assistance as before. Not so strangely, she begins to show confusion following surgery. It is gradual at first and then increases rapidly. The doctor's offer a simple explanation. Sometimes in a hospital situation, a senior's dementia takes a turn for the worse. AAAAAAAAAAAAAGH!! With respect to the kind hearted medical professionals, allow me to postulate another theory. This particular 94 year old has avoided medications for most of her life wherever possible. She takes a baby aspirin every morning and a multivitamin because an episode of Donahue told her that doing so might reduce her risk of certain cancers. Suddenly, due to her hip fracture, she is being given an anesthetic for the actual surgery, a sedative to help her sleep at night, a medication to prevent constipation, and Oxycodone to ease the pain. When you combine that cocktail with the knowledge that her kidneys are not filtering these drugs effectively, another possible diagnosis presents itself. She isn't suddenly demented. SHE IS HIGH!!

I wish I could tell you that this woman eventually stabilized and was able to return home. I wish I could tell you that she wasn't discharged to a skilled nursing facility where she was administered a daily dose of instant-dementia for the rest of her days. Most of all, I wish I could tell you that her's was a unique story. But alas, I am unable to make any of these statements and instead sit here at the keyboard typing, collecting a nickel for every time that I hear that someone's dementia has taken a turn for the worse.