Sorry, a bit of a long story but background is necessary. We recently have had to move my mother to an ALF, previously lived with me for 9 years. She had a weeklong hospitalization that left her extremely weakened, to the point of becoming non weight-bearing. (Previously could transfer herself to toilet, recliner, bed, made her own coffee and could operate a microwave). Next step was rehab. I was hopeful as we had used this rehab before after a fracture with good results. She was there for 6 weeks, unfortunately much of it in lockdown status so I was unable to be involved outside of phone calls to nursing and therapy. She had issues with uti’s, bladder incontinence and then severe retention. In the middle of her stay they put her on an antidepressant (Celexa) Didn’t find this out until a interdiscipline meeting, and mom says she was unaware they had done this. I don’t doubt that she had some situational depression going on, especially when her body seemed to be failing her and she had limited contact with her family. Fast forward to now and she has been in her new apt. About 2 weeks. She came out of rehab a different person, profound loss of memory. Alert and oriented, but kind of flat affect, needing prompts for how to do things she had done on her own before. I have been trying to get a trial weaning of the antidepressant, just to see if this has rendered her somewhat foggy. (The new facility has been reluctant, but they are ordering a psych consult to see if she needs her dose increased??) Just wondering if anyone out there has had a similar experience, and am I just in denial of what might be a normal decline? No one dealing with her care now knows her pre-rehab condition and I feel like they are considering her behavior normal for 93. TIA for any answers, trying hard to continue to advocate for her.
Illness/hospitalization/rehab normally WILL create profound changes in an elder your mother's age. I've seen it with both of my parents; dad was 90 and my mother was 92 when they went thru hospitalization & subsequent rehab stays for various issues. Both came out quite changed for the worse. It took each of them a couple of months to bounce back but neither of them 'bounced back' to the level they were at before the health incidents occurred. Dementia and cognitive impairment seems to hit when anesthesia is involved and/or when they're taken out of their normal environment and sent off to hospitals and rehabs, having to deal with new situations/faces/people, etc. Both of my parents have been put on anti-depressants; dad it was Zoloft after he broke his hip. He was weeping a lot and the Zoloft helped him significantly. Mom it was Wellbutrin after she had a hospital stay for ulcerative colitis and was very depressed and full of self pity, thinking everyone was talking about her in the apartment complex so she refused to leave her unit. The Wellbutrin helped her a lot too. Nowadays she's 94.5 and on a combo of Zoloft & Wellbutrin and I'd hate to think what she'd be like with NO anti-depressants. Scary thought, since she's pretty mean WITH them. But she has advanced dementia, so there's that.
You need to talk to your mom's doctor about her medication regimen. It's not always a good idea to immediately blame meds for a new behavior but to understand that decline is normal after a harrowing experience at 93. You don't know what she'd be like without the anti depressants, either. You didn't get a chance to see her progress, or lack of it, in rehab thanks to the stupid covid restrictions, so it's impossible to really know. It's hard to know WHAT'S going on, so I'd speak to her doctor before making any decisions. Celexa can take a couple of months to start changing your mom's moods.............and it basically raises the serotonin levels in the brain, which is normally a good thing. The side effects aren't very dramatic, either, so I wouldn't think a 'flat' effect is coming from the meds. Google it and see what you think.
It also is a change for mom to acclimate to the new ALF, so keep that in mind as she adjusts.
Wishing you the best of luck with everything.
At 93 people just don't rebound very quickly and less so with each consecutive health knock-down. The more meds she's on for varying treatments, the more complicated managing them as a whole becomes. There could be interaction, there could be lack of tolerance for the antidepressant she was being given, etc. But they usually try different meds in different dosages and combos. Plus if she's lost or losing weight then the dosage may now be inappropriate. I agree with your strategy to wean her off to clear the "fog" but I don't know all the details plus I'm not a doctor. Did she have any anesthesia during her hospital stay? This can also cause a fog afterwards, sometimes permanent. There's really no way to know what's "normal" unless she's off the meds that may be causing the fog. Just keep advocating for her and working closely with her doctor. Wishing you success in improving her quality of life.
Since you said she has had past issues with UTIs - I would always check that first (you may have already done so).
In 2019 the year of moms stroke we added in an antidepressant 6/7 months in and she didn’t do well with the few we tried. We recently trued in a new one at half the dose and once we attempted to increase it to the full dose she seemed more flat as you state. So we went back down but also confirmed a uti. It is so hard to figure out is it a combination - is it the infection - so her dr is waiting to clear the UTI before trying the full dose again.
I would speak with her new dr - er current urine and bloodwork and ask if you should continue to even just taper down to see if maybe it is just the incorrect med or dosage for her. Some people need higher doses and some actually need less.
My mom is only 73 and even prior to her stroke was very sensitive to medications - now since her injury even more so than before. It is difficult to find a balance and takes time but is always worth being aware and advocating for her when you see such a change. Many things do change and they can have significant declines from infections etc. But I had also seen my mom do 180 back to her self after some medications are completed or changed. Wishing you well in finding some answers 🤞🏼