Tuesday, October 9, 2012

Dementia Patients in the Emergency Room - Think UTI First


This hair raising emergency room story had a happy ending. It does not always end that way. In fact, more often than not it doesn't.

By +Carole Larkin
+Alzheimer's Reading Room 


Carole Larkin
Carole Larkin
Yesterday in the late afternoon I received a phone call from a professional caregiver I had placed in one of my client’s houses a long time ago. I consider this lady to be one of the most extraordinary caregivers I have ever seen, anytime anywhere.

She is taking care of a client that I consider to be one of the most extraordinary clients I have ever had (and NOT in a good way).

Anyways, the caregiver called and said that the client had woken from a nap and was talking and acting different than she ever had before.

She said that the client was hallucinating and that her sentences contained words in the wrong place in the sentence and even had some non-words in the sentences. I had her put my client on the phone and I talked with my client for a few minutes. It was true.


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My client for the first time was talking what is called “word salad”.

Dictionary.com defines word salad as:

Incoherent speech consisting of both real and imaginary words lacking comprehensive meaning, and occurring in advanced schizophrenic states.

The caregiver and I talked about it.

Was this just part of the natural progression of her disease? The client had been diagnosed with Alzheimer’s. Was it a stroke or something else biological? We decided to watch her for a little bit. The client napped a little more and when she arose, it was the same, so the decision became clear.

Off to the emergency room we go.

In the emergency room my client was disoriented, no surprise there! The caregiver and I talked with the emergency room physician and to our surprise and delight -- he listened.

We asked about a TIA (mini-stroke) and he had a CAT scan done.

Nope- no mini stroke. We brought her meds. No problem there. We went through a bunch of other possibilities. My client has heart and gastro problems. EKG was done. Again no problems. Finally I said, “Let’s just check for a Urinary Tract Infection (UTI) just for grins.”

Voila! There was the culprit. It had actually caused her to go into a type of delirium that mimicked schizophrenia! Yikes!

You know that it’s a matter of course that in the emergency room they put in a Foley catheter, to just about any older person who comes in there. They wanted to do that in this case too. However, I stood my ground in front of the bed, with my arms crossed and said, “No way will you put a Foley in her!”

I said, "She doesn’t need it. She can urinate on her own."

Thank God I did that. Had they put the Foley in her, it would have further irritated her urethra causing severe pain and would have resulted in agitation, causing them to sedate her, and then bringing up a whole lot of other problems.

Phew! That was a close one!

Think UTI first. Things go faster in the emergency room if you do.

Don’t let them put in a Foley catheter if the person can urinate on their own. It usually causes more harm than good.

We had monitored her temp for the last year as a possible indicator of a UTI or infection. Her temperature remained normal. So we had counted on an indicator that didn’t pan out.

Live and learn.



Carole Larkin
Carole Larkin MAG,CMC,CAEd,QDCS,EICS,
is a Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia patients. ThirdAge Services LLC, is located in Dallas, TX.
Original content +Bob DeMarco the Alzheimer's Reading Room