Comments on: What's wrong with Granny?

Question: What's wrong with Granny?

socrateaser — Mon, 19 Feb 2007 15:19:15 -0800

My mom went to visit my 96 year old grandmother in the nursing home today and found her slumped over in the wheelchair, drooling, clammy and unresponsive. The nursing staff said this had happened before (we were not informed then). They didn't think she had stroke, only possibly that her blood pressure had dropped. However, it was within normal limits when they got her back into bed. She was able to say "no", when asked if she was in pain. The only medication she is on is aricept. Aside from her age, what would cause her to lose conciousness like this?

By: roofus

roofus — Mon, 19 Feb 2007 15:34:31 -0800

The list of possible causes of loss of consciousness is long, and includes potentially serious underlying conditions. It is not normal to be having hypotensive episodes that cause unconsciousness, even at 96. Check with your grandmother's primary care physician or geriatrician that they aren't already aware of the problem, and if not, arrange for them to review her.

By: foxy_hedgehog

foxy_hedgehog — Mon, 19 Feb 2007 16:10:49 -0800

I know this doesn't address your question directly, but I'm concerned about what this incident and the one preceding it say about the care your grandmother is receiving in this facility. There seem to be some signs of major gaps in care and communication here that may be aggravating her health problems and potential vulnerabilities. A meeting with her physician may be able to give you a sense of how this might have been/should have been handled.

By: finding.perdita

finding.perdita — Mon, 19 Feb 2007 16:29:58 -0800

I think only a doctor would be able to tell you why she lost consciousness, and would be able to make sure her medication is correct and appropriate.

Which is why I'd be worried about the fact that the staff didn't call a doctor the first time this happened. However old you are, loss of consciousness makes me think that something isn't right.

Contact her GP. And make sure that the staff inform you if anything like this happens again.

By: de

de — Mon, 19 Feb 2007 16:45:10 -0800

your gran could be having transient ischemic attacks (TIAs). aricept would indicate she does have cognitive decline so is easily a contender.

medical review is appropriate and when you say nursing staff: you still have qualified nurses in your aged care facilities? ask... because you may be dealing with certified aged care attendants, and not qualified nurses.

By: kika

kika — Mon, 19 Feb 2007 16:59:15 -0800

Also: cardiac arrhythmia.

By: matteo

matteo — Mon, 19 Feb 2007 17:56:31 -0800

I say TIA, too

By: bkeene12

bkeene12 — Mon, 19 Feb 2007 18:01:03 -0800

Maybe she was tired. What makes you think she was not asleep?

By: luckyshirl

luckyshirl — Mon, 19 Feb 2007 18:22:13 -0800

I think you have two urgent concerns:
First, that this occurred and the staff seemed unconcerned. This sounds like neglect to me.
Second, it might be low blood sugar. My elderly mother has diabetes, and I've occasionally found her unresponsive, sweating/cool (clammy), as you describe. Has her primary care physician screened her for diabetes?

By: gramcracker

gramcracker — Mon, 19 Feb 2007 18:54:28 -0800

At her age, practically anything. She should see her doctor.

By: docpops

docpops — Mon, 19 Feb 2007 19:31:14 -0800

At her age, practically anything.

Seconded.

But frankly, when you say "clammy, drooling, and unresponsive" the differential isn't very forgiving as far as rapidly reversing issues. Normally if that were reported in an elderly person, any number of things, from stroke, heart attack, sepsis, seizure, drug toxicity, all come to mind.

I think the larger issue is whether the staff is acting appropriately. If your grandmother has given explicit wishes to be left to the whims of nature, then her comfort ought to be the primary concern of the staff. If she's a "Full Code" as they say, then it's a bit concerning.

It's worth a call to the NH Nurse Supervisor to see if there are real communication issues somewhere in the chain.

By: drstein

drstein — Mon, 19 Feb 2007 22:08:30 -0800

Ugh. I feel for you. I work a lot of EMT shifts where we do nothing but run back n' forth between nursing homes and hospitals all day. A lot of the people that work in these facilities are complete morons.

One would think that upon finding a drooling, unresponsive patient that they'd call 911, but sadly that is not the case.

Third the "see a doctor." It could be diabetes. It could be a whole list of other things.

By: drstein

drstein — Mon, 19 Feb 2007 22:08:55 -0800

Oh yes, and make damn sure that she has an advance directive filled out properly and on file somewhere.

By: Slarty Bartfast

Slarty Bartfast — Mon, 19 Feb 2007 22:30:04 -0800

Low sodium. Dehydration. Urinary tract infection. High blood sugar. Low blood sugar. Pneumonia. A nap. Being given the wrong medication. Realizing that she lives in a nursing home where the staff don't care whether she's responsive or not, in other words, depression. These are the things I run through in my head if I get this call in the middle of the night. These are the most common things, in my experience. Ditto what everyone else says about the home.

By: jdl

jdl — Tue, 20 Feb 2007 07:47:41 -0800

I'm concerned, as well, that they didn't tell your family about the earlier episode. My grandfather is in a nursing home and they call for everything, including when they have to put a band aid on his hand for a hangnail.
In addition to speaking to her doctor, perhaps there is a case worker-type who you could speak with at the nursing home about communication with the family. Best of luck, I know it's hard.