Aging Parents: Frightening Hospital Psychosis

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hospital psychosis

It’s not uncommon for aging parents to suffer what is referred to as hospital psychosis in the acute care setting {think hospital, emergency room, intensive care unit}. If your mom or dad already suffers from dementia or memory impairment, the chances are even higher.

Signs and symptoms include disorientation, paranoia, hallucinating, delusional thoughts and nightmares.  They may become agitated, combative, try to pull out IVs, or climb out of bed unassisted. Sadly they may not recognize you!

You may hear the staff refer to this as delirium, altered mental status or hospital psychosis. Your parent could seem fine the day before a hospitalization then quickly become someone you don’t recognize.  It can be disturbing and downright frightening to watch. 

If you’re in this situation, I’m glad you’re here. Knowledge will empower you to be a strong advocate for your elderly parent and help ease your mind!

What Causes Hospital Psychosis?

This is not an easy question to answer because if varies from person to person. This is why it’s important for you to educate yourself so you can advocate for our elderly parent. As you read through this list, consider your situation and ask yourself if any of these causes may apply. Better yet ask the health care providers caring for your mom or dad.

  • Stress and fear. Imagine being elderly and not understanding what’s going on around you? Maybe you can’t see or hear well. Perhaps your memory isn’t what it use to be and you don’t understand what the nurse is saying.  This can cause a lot of stress which can lead to confusion.
  • Lack of good sleep. If you’re setting in an intensive care unit or emergency room, you can see how loud and disruptive the environment is. Just as your elderly parent nods off another nurse is in to check vital signs. It’s almost impossible to get good sleep or the sleep they are getting is drug induced.
  • The hospital environment. Look around you. Bright lights, loud noises, no windows, confusing conversations. Hospital environments are not user friendly to the elderly patient. AND I’m always amazed at the lack of knowledge some doctors and nurses have about communicating and caring for elderly patients.
  • Medication side affects and interactions. Medications that are protocol in the ER or ICU can be brutal on older adults. There may also be interactions between these medications and the ones that are already in their system, from home. Also, medications that were taken at home may not be given in the hospital. This is particularly true of psychiatric meds.
  • Out of control pain. It’s difficult to assess pain in older adults that are unable to communicate accurately. Imagine experiencing severe pain and not being able to communicate to anyone. I’d probably try to crawl out of bed too!
  • Critical illness and trauma. Don’t underestimate the affects of an intense disease process, accident or trauma. The stress that an illness can cause on a 93 year old body can be traumatic and the mind can respond in mysterious ways.  
  • Metabolic disturbances and dehydration. It doesn’t take much for an older adult to become dehydrated and suffer from an electrolyte imbalance. As a matter of fact, it’s possible this what landed them in the hospital in the first place.
  • Dementia and cognitive impairment. If your elderly parent already suffers from dementia or memory impairment, anything on this list is going to increase their dementia symptoms and behaviors in one way or another.

Tips for Surviving Hospital Psychosis!

Setting bedside with an elderly parent suffering from hospital psychosis is not fun. We look to the doctors and nurses for answers and sometimes they don’t have them. It’s easy to become overwhelmed and frightened. Here’s some tips to help you advocate for your elderly parent suffering from hospital psychosis.

  • Communicate with staff so they know this is “not normal” behavior for your mom or dad. Say it over and over again to every doctor, nurse, therapist that comes in the the room.
  • DO NOT leave their bedside. I know it’s hard but you’re going to need to stay close by. Call in other family members and friends to relieve you.
  • Hire professional caregivers. It’s not always possible to be bedside 24 hours a day. Non-medical caregivers can at least provide a calming constant voice and support.
  • Provide an updated medication list. In a perfect world, ER and ICU doctors would have an updated list in the chart or computer system but that seldom happens. YOU need to make sure they have an updated list.
  • Provide medical and social history. Don’t assume the medical staff has access to medical records and history.  A history of depression, mental illness, Post Traumatic Stress Disorder can be important factors in the BIG picture of what’s happening.
  • Touch and soothing words sometimes help. Stay close and hold their hand, talk to them as normal as possible. Sometimes it helps just to hear a familiar voice.
  • Ask for a warm blanket. Most hospitals have them. You’d be amazed at the comfort a warm blanket can bring.
  • Ask questions over and over again. Go over this list with doctors and nurses…
    • Is she dehydrated? Are you pushing fluids?
    • Did my dad’s lab work give any indication to what’s wrong with his mental status?
    • Do you think he’s in pain? What pain meds is he on?
    • Could there be a drug interaction that’s causing this?
    • Can we turn out the lights?
    • What kind of test can we do to find out what’s wrong?
  • Be open to medications. If you’ve exhausted all of these tips and your elderly parent is suffering, your doctor may recommend a sedative. Ask a lot of questions about side affects but be open to the fact that this may be your only option for now!
  • Prepare yourself for discharge. If the recommendation is to transfer your elderly parent to a rehabilitation unit in a skilled nursing home, take charge and start looking early. Once they are stable medically the altered mental status is rarely seen as acute and discharge is going to happen soon.  For more about hospital discharges…

Bottom Line…

Hospital psychosis is more common than you’d think and it disproportionately affects older adults. I know this doesn’t make you feel better as you watch them suffer but I want you to know you’re not alone.

The good news is hospital psychosis is often temporary and often vanishes after a good night sleep, hydration or pain management. However some people aren’t so lucky.

If your mom or dad are “not bouncing back” be sure to follow up with their primary care physician or neurologist. Hospital psychosis is scary but it’s important you educate yourself so you can advocate for your elderly parent.

Feel free to leave a comment or provide feedback, your insight may help others struggling with this issue!

If you’re interested in a one-on-one consultation to gain clarity, visit LuAnn Smith @ My Elder Care Consultant.

For geriatric care management services in Northern Colorado visit LuAnn Smith @ My Elder Care Consultant or call (970) 980-1362!

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LuAnn Smith is a geriatric care manager, blogger, public speaker and consultant. She provides an array of services designed to assist aging families and the organizations that care for them. She provides services and information to empower both individuals and businesses to be the best they can be for the older adults in their care.

Please note: I love to hear from my readers; your comments, advice and tips could help someone else struggling to care for an elderly parent. I reserve the right to delete comments that are offensive or off-topic. Thank you for understanding!

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24 thoughts on “Aging Parents: Frightening Hospital Psychosis

  1. My mother has just been diagnosed with hospital psychosis. It came on overnight as confusion disorientation and restlessness. She had a cat scan that showed no sign of stroke (which I was sure was the case). She has high calcium so her electrolytes were way off and low heartbeat. She was delusional and hallucinating hearing voices (her hearing is very bad) and nightmares. She is improving on the third day of her stay to where she is describng her experiences and saying that she was probably dreaming or having a hallucination. It sure looked like a stroke with aphasia and slurred speech langage. It was very stressful to see her in this state but am seeing improvement.

    • I just brought my dad home from the hospital last night. He experienced hospital psychosis while there and had to be restrained.`He kept climbing out of bed, removing his IV and became so combative security had to be called. Anti psychosis medication had no effect on him.
      The only way we got through the night without all that drama was when I spent the night in his room. I insisted we keep all the lights but the tv turned off, his room door shut so he couldn’t hear the beeping/ringing of machines in other rooms and no staff was to approach him at night until I woke him up first and told him what they wanted to do to him (ie take his blood pressure, give him meds). This worked really well for us.
      He was supposed to go to rehab from the hospital but I ran into difficulty getting him into rehab because of the psychosis. He was so upset in the hospital that I decided to bring him home and arranged for in home physical therapy.

      • Sorry to hear that about your father and glad to know that you staying with him helped. It doesn’t surprise me that you had a hard time getting him in to rehab with that psychosis.
        Here’s a tip: you have a 30 day window after leaving the acute hospital in which you can still utilize his Medicare A benefit in a skilled nursing facility. If you get him home, he settles down and you sill think he could benefit more from skilled rehab, I’d make another run at it. Good for you for staying with your father and working through that psychosis. Good job Nichole!

        • The hospital stay seemed to advance his dementia but the downhill slide eventually tapered off. He’s living with me now and it’s been an adjustment for both of us, but overall he’s doing pretty well. Thanks for asking!

  2. I am so glad I read this article and the comments. Both my parents had been admitted to the hospital for serious illness when they were elderly, and their mental status changed markedly once they came home from the hospital. I never could understand what hospitalization had to do with their changes in behavior and thoughts, but this helps clear things up a great deal.

  3. My Dad, 90, is in the hospital now (since yesterday). This is the second visit inside of two weeks. With the problem he entered ER with apparently taken care of, he has been diagnosed with “Hospital Psychosis”. I just got home from being there all afternoon. He is only semi-lucid, he only occasionally recognizes us (my sibs and me), and they cannot keep his IV in.

    At first, when I heard the term, I had doubt… because he looked and acted as if he were in pain. We have, over the past 3 months, (at least me), been deeply involved with his care and questioned many things. It has been like pulling teeth; we’ve gotten into arguments (on extreme), been involved with any debates, assured over-busy, or “un-caring” staff paid attention when needed.

    I’ve learned alot…

    • It’s a real eye opener isn’t it? I hope your dad feels better soon and that you and your family can find some peace in the process. Do you have any recommendations for families that may be dealing with their own hospital psychosis? thanks for stopping and leaving a comment… LuAnn

  4. So here is my question – my mother most likely has “hospital psychosis”, but how can we know that it is safe to take her home with my elderly father? She is in the hospital right now, and she is hallucinating and combative with the nurses, and has thrown things at my dad. She was not found to have an physical problems but does have progressing dementia. No relatives live nearby, but we can stay a few days at a time.

    • You have basically two options upon discharge Barbara…

      One would be to transition to a skilled nursing facility (nursing home), for possible short term rehab. If she has her 3 days of qualifying stay in the acute setting, Medicare A will possibly cover 20 days 100%. The thought of going in to a nursing home is scary; I’ve been there with my own dad but we had no one to care for him so we felt it was the best option for us and it was. Be aware however that if her psychosis interferes with her ability to participate in medical rehab services and there are no other professional services being provided, that Medicare A coverage will be very short term not necessarily 20 days. Second, you could discharge to home but I would highly recommend that someone stay with your mom and dad for a couple of weeks to see how long term her psychosis will be and be available to provide her daily care needs. You may also be able to access Medical Home Health under her Medicare Part A benefit for some short term nurse monitoring and rehab. I was also find a non-medical home health agency that can provide you with support. The huge advantage to your mom going home is that she will be in a familiar environment with people she knows; this may be an intervention that works for her but be prepared in case it doesn’t. My heart goes out to you and your family. I hope this information helps in some small way…

  5. Thank you for the information. This is all very new to me. The “funny” thing is that my mother was only admitted for “observation” because there is nothing whatsoever physically wrong with her, so the three days thing doesn’t count (so they say). They have moved her to a geriatric psych floor in a nearby hospital. I guess they figure she is too unruly and psychotic to go anywhere else. I believe her doctor’s plan is to try to get some medication into her and hopefully get her back to reality. I surely hope it works…

    • The observation period versus admission is becoming common place across the country as hospitals figure out their loopholes related to new Medicare regulations. It really puts people in a bad spot and I could go on about this forever; so I wont. Moving forward the geriatric psych unit isn’t a bad idea but as a family I want you to keep these two things in mind. One, medication can be a wonderful thing but there are often side affects and you don’t want her to be zonked out. Ask a lot of questions about dosage, side affects and diagnosis. Secondly, ask the hospital physician and staff what type of non-pharmaceutical interventions they are attempting or have care planned. As a family, you can help the staff by providing ideas of your own since you know your mother best. Third, I recommend you get a list of medications and hospital records upon discharge to take to her primary care physician. Often times the PCP is not in the loop and they obviously need to be; families need to make this happen. I know it must feel like there is no end in sight. It sounds like her situation is very fluid and may change day to day; tie a know in your rope and hold on tight. Best wishes to you and your family…

      • Mama went into a “memory care” assisted living after that hospital, but declined rapidly and passed away in February. She still knew who we were but was confused about many things. I did not realize they could decline so rapidly.

  6. My mother is having these issues, except its been over a year almost since she had the procedure and its still going on. She was put on meds, and the dementia patch and is still hearing people up stairs although she lives in a trailer, the night she came home from the hospital she began seeing dead people and its just been going on from there.. she no longer sees things but can hear people talking and making noises. And she is forgetful on short term and can not copy images onto paper and has now had her license pulled also.. I am beside myself right now. She was admitted to the hospital last night for observation and an MRI this morning.

    • Sometimes the psychosis becomes a new baseline and is very hard to manage. It’s hard to watch an aging parent suffer. I hope your mom was able to get the help she needs…

      • After the Physiologist realized that the Delirium fits her to a tee he also said that it has seemed to trigger dementia in a mild case. She was losing her pills all over the house, things were coming up missing, she now only hears the people up stairs only knows there not there but feel that if she could just see for herself there is no up stairs from the inside she would be ok.. they did increase her Dementia patch to the next setting. Hoping that works.. she also was fine at the hospital so we are leaning on maybe its a medicine she started taking after she got home for her last stay at the local hospital where they did a med management. Some meds they didn’t give her there.. also we think she isolates herself at home without realizing it.. thank you for your feedback and well wishes :-)

        • If the voices upstairs aren’t upsetting to her I wouldn’t worry a great deal about it but if they’re causing distress it needs to be addressed. Isolating is never good and the biggest challenge of living home alone… It sounds like she’s in good hands both professionally and personally. Great job…

  7. My husband went in at first for a severe case of pnuemonia. But the things that happened following going in were a nightmare. 9 days later he was discharged home, surprising both the nurses and us upon doing. Before morning we had to call 911 for help. He had gotten impossible to handle, and was a danger to hisself and us. They even sent in a police officer first to be sure would be safe enough for the medics. They took him back to the same hospital. Then was release again 3 days later to a nursing home. But they were not equipped for his condition, allowing a nurse to be hurt and 911 needed once again by them. But took hours to locate him, as they sent to a different location this time. Hopefully things will be a little easier when he is released again in a few days after a detox time for some wrong medicines the first hospital had given him. But whether we will get back the man I knew, or the constantly changing one they were dealing with is another story.

  8. My Mother suffers from dementia and is currently also experiencing hospital psychosis . It has been going on for over a week, and has caused her to injur herself further and intere with treatment. It’s comforting to read that she may come out of this state of mind, but it is emotionally excrutiating watching her go through this. The hospital staff never said to us that this can be common in the elderly. I wish hospitals had staff members who specialize in elder care and dementia. Their advice to hospital staff and patient’s families could be so valuable. If your loved one is experiencing this, I send you my love and hope they get through it quickly.