Doctors in the Emergency Department are often dismayed to see patients arrive from the nursing home who are delirious from blood infections and dehydration — often a result of nursing home neglect. The nursing home may call to say the patient is on the way, and is “demented.” Just as often, the physician in the Emergency Department will find that the patient has a urinary tract infection, which may have seeded his or her bloodstream with bacteria.
The doctors will often discover through initial laboratory results, specifically the BLOOD UREA NITROGEN and CREATININE ratio indicates that the patient is severely dehydrated. Frail and ill elderly people are not always able to adequately hydrate themselves.
Elderly residents of nursing homes are vulnerable. If they weren’t, they would probably be at home. Often, there are physicians who serve as “medical directors” of nursing homes who fail to see the residents. These physicians will get a call about one of the residents, and sometimes because the staff turnover is so great the staff will report that the patient has “dementia.” Dementia is not the default setting for elderly people.
It is easy for physicians to dismiss residents of nursing homes, especially those that they don’t know, as patients with dementia. This diagnosis will follow the patient to the hospital. Hopefully, someone in the Emergency Department will be adequately alert to realize that the “dementia” is instead “delirium.”
Delirium is a change in mental status due to a systemic illness, such as an infection.
Typically, when elderly people get urinary tract infections, they may hallucinate or otherwise appear to have no grounding in reality. If the staff of the nursing home, or the physician who is medical director, doesn’t take enough time with the patient to observe their normal demeanor, they might dismiss the elderly man or woman with delirium as having “dementia.”
This does a huge disservice to the elderly residents of nursing homes. Sometimes, they are not adequately treated because their symptoms are presented as their normal mien, when in fact they are extremely ill from an infection. Elderly people often do not mount a noticeable infectious response, such as a high white blood cell count, when they have a serious infectious process brewing. The bacteria in their urine may be confused as “contamination,” rather than the true systemic illness it has become. Blood cultures, if drawn, may be positive for bacteria. Unfortunately, if they are misdiagnosed as demented, blood cultures may not be drawn. It should be noted that elderly people don’t always exhibit a high temperature as a result of an infection.
The mortality rate for blood infections in the elderly is very high. Missed diagnoses because the patient is dismissed as “demented” are not uncommon. The patient may be treated inadequately or not at all.
If you have a loved one who appeared normal when you visited, then arrived at the hospital with “dementia,” you may have a reason to suspect neglect. You should call Chicago’s top personal injury firm, Passen Law Group, to have the medical records evaluated.
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