Pam's Delirium Journey & Why You Need To Know What Delirium Is

Do you know what delirium is? No? Neither did I until my Mum, Pam, was diagnosed with it just over a year ago.
I'm sharing her journey to bring awareness to this little known yet complex and terrifying illness. The more people who know this condition exists and can recognise the signs and symptoms, the greater the chance of ensuring their loved ones get the help they need to overcome it.  It can occur in any age group including children but is much more common in people over 65.  Pam followed a disciplined routine of Pilates, walking, nutritious food and brain exercises which I implemented to get her back to normal again and this is her journey.

Pam's Story

In February 2021, Pam was diagnosed with some heart issues, mainly atrial fibrillation and for the first-time in her life was put on prescription medication, the beta-blocker Metoprolol.  This was 10 days before her 80th birthday and from day 1 she had trouble tolerating this medication.  She was light-headed and dizzy for several hours each day.  However, at her doctors request she perservered, but over time she developed around 6 side effects of the medication.  In addition to being light-headed and dizzy she had cold hands and feet, nightmares and disturbed sleep, headaches and swelling in her hands and feet. Winter was a challenge as she was freezing cold and just couldn't get warm.  One weekend In early November she became depressed and just sat and stared which was not like her at all.  She is normally incredibly active in her garden, has several friends she talks to regularly and helps me with the admin side of my business . Pam even said  "I'm becoming like one of those old people who stares into space in a nursing home!"  Naturally, I was extremely concerned.  We had also been in lockdown since June 26 and were gradually coming out of it since mid October.  She improved during that coming week but the next weekend she had a complete personality change and was extremely confused and couldn't structure her thoughts . It was like her brain was scrambled and different topics were getting mixed together.  My usually mild-mannered, level-heaed Mum became agitated and agressive and she began saying things that just weren't true.  I couldn't get a doctors appointment until the following Thursday so I researched as much I could online and found that Metoprolol was linked to cognitive decline in the elderly and my sister and I made the decision to wean her off it over a 5 day period.  If that was the cause she should return to her normal state of mind a few days later, but this didn't happen.  When I spoke to her GP he understood our reasons for stopping the medication and suggested she may have psedo -dementia a type of fake dementia that presented as depression that he was seeing in many of his elderly patients as result of lockdown.  He advised me to take her out into nature which I did but she was no longer interested in her surroundings and by now I was terrified.  What was happening? That Sunday afternoon, I called Beyond Blue and explained Pam's sudden complete change of mental state and they asked if she been checked for delirium and without too much thought I said yes as I was keen to hear the other support and solutions they offered.  They then organised a phone assessment with the local area mental health unit and I would receive a follow up call the next day to arrange an assessment for her.  That night as I was falling asleep, the words "checked for delirium"  came back to me.  When I thought about it she hadn't been checked for delirium.  What exactly was delirium?  I had no idea and began more research.very early the next morning.  The description sounded exactly like Pam's condition and I was enormously relieved to see it was usually a temporary condition.  I made another appointment with her GP the next day who agreed it probably was delirium as it was getting worse not better and to get her to hospital immediately as it was a medical emergency.  The trigger for the delirium needed to be found or it could be life-threatening.

My sister took her to the emergency department of Prince of Wales Hospital at Randwick and Pam tried to escape by getting into a taxi and it took my sister and 10 staff 20 mins to get her out.  Then she lay on the road and was hysterical.  It was a horrific experience for everyone involved.  Fortunately my sister was just as determined to keep Pam there as Pam was to escape and she perservered until eventually Pam was sedated.  My once completely rational mother had become unrecognisable.  A stroke was ruled out and they concluded she had a UTI and would be treated with IV antibiotics and would be back to normal in a day or 2.  However, that didn't eventuate and she became like a paranoid, caged animal trying so desperately to escape at night that she was violent towards the nursing staff and knocked a Christmas tree over and cut her arm.  She was now a danger to herself and others.  One of the only ways the staff have of calming patients who are behaving like this is to administer anti-psychotic medication via injection.  This is a last resort and carries risks but something my Mum had to be given at least 3 times.  It was a devastating and harrowing time, especially when receiving  late night phone calls from doctors asking permission to administer the anti-psychotic medication and Pam could be heard screaming uncontrollably in the background.  Despite this, 4 out of 5 doctors who assessed her during her 8 night hospital stay said she would make a full recovery.  One wasn't sure but the others said delirium was all too common in older adults and something they saw all the time and it would take 3 months for her to recover.  3 months of living like this? My sister and I were apprehensive when she came home from hospital into my care.  She hadn't eaten for 8 days now as the hospital food was such porr quality.  She also rejected what we took for her as she was paranoid it was contaminated.  She was also refusing all medication so the only option was to try making her comfortable at home while she recovered. Delirium patients in general recover better in familar surroundings. The trigger was never clearly established at ths point but more about that in my next post.  Due to the Covid risk, I would be the only person responsible for her 24 hrs per day 7 days per week.  Would she be violent?  What if I couldn't cope?  My sister provided back up advice and emotional support by phone from early morning until late at night which was invaluable.  She also shopped for any supplies, medication and food that was often needed at a moments notice as Pam couldn't be left unsupervised for a minute.  Neither of us had ever imagined in our wildest dreams that our mother, the rock of the family, would lose her mental faculties, even if it was temporary.  Despite the diagnosis from the hospital we were both having a hard time believing she would ever recover from this as her behaviour was just so extreme.
In my next blog post I'll cover Pam's rehabilitation and recovery and eventual return to a normal life.  In the meantime, Here are some FAQs:

What Is Delirium?

Delirium is a sudden and severe change in brain function, leaving a person confused, disorientated and unable to focus.  The usual sleep/wake cycle is disrupted resulting in extreme tiredness. Psychosis and paranoia can also be present.  In most cases it is a temporary condition lasting anywhere from days to months.  Delirium patients are usually calmer in the morning and progressively deteriorate as the day goes on and by night time they are at their worst.  It can also occur commonly at the end of life and can be a sign the patient is close to death which is why it's important seek medical advice straight away.

What Are The 3 Types Of Delurium?

Hyperactive Delirium is characterised by being restless, agitated and delusional and can experience hallucinations which Pam did.

Hypoactive Delirium is the most common type and can be mistaken for depression as the patient is lethargic, withdrawn and stares into space which is exactly how Pam appeared right at the beginning which was a warning sign.

The third type is Mixed which is a combination of these 2 types and Pam definitely had a mix of the two.

To folow the next satge of Pam's delirium journey and successful rehabilitation with Pilates, CLICK HERE If you have any questions about this post you can contact me at info@jsmindbodypilates,com .. I would never wish this situation on anyone but I hope you are well-equipped after reading this post to be able to identify thie signs & symptoms in a loved one and get them the help they need immediately.