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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest remedies for fever in a person with dementia

Answered by
Dr.
Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 3134 Questions

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Posted on Thu, 25 Aug 2016 in Elderly Problems
Question: My wife's stepfather, has dementia and for the past two months has been in the hospital three times, one occasion for almost a month, due in part to the a great deal of negligence on the part of the hospital. Since then, we've found a lovely Board and Care for him where he was for one week before having to be taken to ER and hospitalized again for yet another week for both feet/legs infected from cellulitis. He received antibiotic and a transfusion as his red blood cell count was dropping.After discharge, he was returned to the Board and Care, a place "familiar" and intimate and was there for not quite an hour before he had an aggressive episode and had to be taken to ER, where he was once again admitted to the hospital. He had a violent episode there and attempted to leave, at which point, it took four nurses to restrain him, place him in a Posey jacket and wrist cuffs and sedate him. Throughout, he has continued to run a low-grade fever, continues with Dementia, his food/fluid intake minimal. We were told by the hospital to find a Board and Care, then Skilled Nursing facility, now Memory Care. Each time, we have searched/researched facilities, found one, only to have him return to the hospital. He has been in the hospital most of the past almost two months. I've a feeling based on what has occurred, that once he's discharged and placed in Memory Care, that within a few days, he'll either have another violent/aggressive episode, or that he'll once again be admitted with fever, infection, or...When is it time to think about Hospice? This month is the ten year anniversary month of my mother's passing and for some reason, I think that he may want to leave. I and my wife are exhausted on every level you can imagine. We live 500 miles from her stepfather and have been away from our home, family, and friends for almost two months now, staying at stepfather's house until we can get him situated and have been handling his affairs, but nothing seems to be helping. I know this is a long message but I wanted to give you some background so that you might be able to assist somehow. Per the psych NP, his prognosis is not good, as she told me last night. He's 82, skin and bones, being pumped full of antibiotics, sedation, and just not wanting to eat or drink. We have set up his room in a nearby Memory care facility I must ask the question: Is it time for Hospice? This is very hard to know what to do for him. Thank you, sincerely, for any help/advice you may have.
doctor
Answered by Dr. Ashok Kumar 6 hours later
Brief Answer:
I think no but still better to discuss as he have terminal illness

Detailed Answer:
Dear XXXXXXX
Thanks for using Healthcaremagic.

I read your query with keen interest and understand your concerns.

I understand it is very difficult to care for dementia as care giver burden is too high particularly when somebody had behavioral and psychological symptoms of dementia (BPSD).

I understand that he had repeated admissions in last two months and needing almost continuous treatment but I feel he does not qualify for Hospice. The criteria employed by most doctors and hospitals across US is less than six months to live but I feel this is not applicable for your wife's stepfather. I understand that he is denying food and fluids and had repeated infections but they are treatable condition to some extent.


I must acknowledge that since he is battling terminal illness discussing hospice care with treating them will not be wrong.

I hope this helps you.
If you have more questions feel free to write back to me.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar 8 hours later
Thank you for your thoughtful response. Indeed, hospice is not a decision she would want to make and yes, six months is what we've read as well. Knowing who he is, he would not want any of what is happening to him and would absolutely not want to burden anyone at all, ever.

Perhaps palliative care, but then again, he is going into a lovely memory care facility, so this may help him, if he can manage to avoid going back into the hospital every week or so.

Thank you.

Best regards.
doctor
Answered by Dr. Ashok Kumar 1 hour later
Brief Answer:
You are always welcome

Detailed Answer:
Dear XXXXXXX
Thanks for follow up.

I am glad to know that information was useful for you.

If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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