Fluctuation.

I know i've already done a post on dementia, but because every patient presents differently, i thought i'd write about this particular patient and the encounter i had with him. I am currently on a geriatrics ward in Freo.

He is a 74yo gentleman who came into hosptial with dehydration/fall. We is quite a tall gentleman, and at first his dementia seems quite mild. He was alert, cooperative and oriented. He also seemed quite a good historian, making sense of all the questions i'd asked him about his mobility and exercise pre-admin. i then assessed his mobility. He was generally 1x min (A) with t/f and amb with WZF. So i went ahead and completed his mobility chart. And that was day one.

Day two, i went to see him for some ambulatory exercise. He managed to get up with min (A) and amb to the toilet (about 20m). He needed a loo stop. Now this is where things went abit funny. He refused to get up from the commode. After 15mins of talking and rationalising the reason why he needed to get up and return to his room, all he yelled out was "Just leave me alone!" I tried to get him up with some facilitation, getting him to move his bottom, lean forward, etc. He got up halfway, screamed out! and then trioed to sit down. I had blocked his knee and pushed on his ischial tub. so he couldn't. We were kinda stuck, beacuse i knew if he sat, it'll be really hard to get him back up again. However, i lost the battle. He forced himself to sit, and just yelled "why can't you leave me alone!". I replied "well, you're sitting in a commode, you're in the toilet, and you don't have a pad on." At this time i managed to flag down the ward PT and get him to help. We tried a 2x (A) STS with no luck. He just refused. We eventually just wheeled him back and basically t/f him into the bed with 2x max (A).

now, the thing is. the day before, he was fine! i would even say standby (A). And he was fine walking to the toilet. But for some reason, he just wouldn't go back. i reasoned and reasoned with no luck. I had a chat to my supervisor and he said people dementia can often change their mood quite quickly. He said there was not much you can do at that point, apart from just wheeling him back, otherwise you could be stuck with him for 1hour (and you've got the whole ward to look after).

What i've learnt is, you need to be re-assessing someone's mobility everytime. Err on the side of caution and put down more (A). I mean, i didn't know the first day, because he did not present like that at all. I will continue to monitor his mobility and have noted that his mobility fluctuates.