Delirium

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I am supporting my 76yo grandmother through stage 4 bowel cancer which has spread, prognosis from her oncologist nurse is 6 months she has just started a new chemo treatment, she was hospitalised with confusion over the weekend and discharged back home on Sunday with antibiotics, the confusion hasn’t improved and seems worse at night where she has fallen asleep on the stairs and stops answering her phone to us and does not recognise me when I have gone there to check on her, she refuses anyone to live in with her she likes her independence and can be quite stubborn. I have spoken to her GP who said she is going to arrange a care package for her to ensure her safety. What I’m asking is - is this delirium a path to the end or can she improve? She is eating and drinking and communicating during the day with everyone as normal. What am I looking out for and what do I do if this doesn’t improve. The hospital or the GP haven’t given me any information and I’ve never been through this before so unsure what to do, or what to expect.

  • Hello JadeB

    Thanks for getting in touch. My name is Helen, I’m one of the Cancer Information Nurses on the Macmillan Support Line.

    Welcome to the online community.

    I was very sorry to read that your grandmother has a stage 4 bowel cancer and that she has become so confused after starting her chemotherapy.

    You have asked if she is likely to get worse, and that is a hard question for us to answer without knowing the cause.

    You mentioned that she has been prescribed antibiotics which means that her doctors are treating an infection. Infections in the older person, particularly urinary tract infections, can cause considerable confusion.

    However, an infection should respond to antibiotics and get better. If the confusion is due to an infection, your grandmother’s symptoms should also improve.

    You have explained your grandmother is eating and drinking well, which is really important. Dehydration or a low blood sugar level can cause confusion. However, you feel her cognitive health is worse.

    There are other reasons beside infection that may be causing her confusion, such as her blood levels being unbalanced, especially if the cancer is affecting the health of her bones.

    For this reason, we would strongly advise letting her bowel cancer nurse specialist know. You mentioned an oncology nurse, and this is likely to be the same professional. If you don’t have their contact details, simply call the hospital switchboard and ask to be put through to the bowel cancer nurse team.

    She is very confused at night which means she is really quite unsafe. You can share with them the information regarding your grandmother’s confusion, nighttime memory loss and the fact that she is not allowing anyone to stay with her to ensure her safety.

    They will share the information with your grandmother’s cancer doctors who may wish to do further investigations or reconsider the chemotherapy or other medications that she has been prescribed. Treatment decisions need to take into account the impact on her safety, well-being and independence.

    When you speak to the cancer nurse, ask if there was a diagnosed cause for the confusion. This will help you ask further questions about recovery, and also what to look out for should your grandmother deteriorate. It’s also important the hospital team explain who you need to speak to in the event of any change for the worse.

    I am relieved to know that the GP is organising a package of care – this should be organised as a matter of urgency. If you have not heard anything by tomorrow, do recontact the GP to ensure it is an urgent referral – or you can call the adult social services team to see how far the referral has gone.

    If you put your grandmother’s town or city into Google, along with the words ‘adult social services’, you should find the number.

    The care package starts with an assessment of care needs, usually a visit to the home by an occupational therapist. The assessment may result in aids and adaptation being offered to assist your grandmother. It will also include a discussion about carers visiting to assist during the day.

    I would also really like you to give us a call JadeB. It’s important that you get support, as well as your relative. We would be better able to understand your grandmother’s situation if we could have a conversation with you, and perhaps give more focused information and support. 

    You can call us in the number below, or chat to us on webchat.  

    The Macmillan Support Line offers practical, clinical, financial and emotional support. You can call us free from landlines and from most mobile phone networks on 0808 808 00 00, 7 days a week, 8am – 8pm.

     

    I hope this information is of some help and we look forward to your call.

    Best wishes, Helen

    Cancer Information Nurse Specialist 

     

    Ref HM/BL