Is confusion normal at night for stroke survivors, and will my father get better in a skilled nursing facility?

A fellow caregiver asked...

my 79 y.o dad fell and broke his hip a week ago... had surgery the day after, a stroke (TIA) 2 days later, some extra bleeding cuz he was already on plavix due to prior stroke. He was independant and doing well before the fall. NOw, a week into it, medically he is doing ok. but confusion sets-in in the afternoon, nights are terrible, he doesnt sleep much... we decided to stop morphine to see if it would help with confusion, changed to norcol (sp?) but he seems more unconfortable... I am so tired, he needs me... only sister just got married 2 days before the fall, my husband gets the worse part of the day (night)...nobody else to help... his english is limited... i feel he does better when I am here in the hospital, but I miss my family too. He will probably be release to skill nursing fac today. Would all this get better? I am reaching exaustion point and its only been a week.... is confusion really normal at night? everybody seems so used to seen this kind of stuff... and I am soooo upset... he is diapers because he pulls the catheter... he pulled his i.v 2 times during the night... he was just dancing a week ago at my sister's weeding.... is week 2 better? thank you so much. I need some support. Lisa

Expert Answer

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

Sorry to hear of your predicament.

It is hard to know how much of his confusion is due to a new stroke versus how much is "delerium". "Delerium" is common in elderly hospitalized patients, and is often made worse if he had any pre-existing memory trouble. As a standard work-up for this, I recommend MRI of the brain, urinalysis, and blood for vitamin B12 level, thyroid levels, complete blood count, and electrolyte panel. This should help make sure that there is no reversible cause that requires urgent treatment.

"Delerium" usually resolves with time - several weeks being my experience. Particularly helpful is if he is in familiar surroundings with people he knows. If the confusion persits longer than a few weeks, consider getting a memory evaluation from a Neurologist to see if he needs to go on "cognitive enhancing" medications such as donepezil.

As for help at home, I would ask the hospital social worker or case manager if you can have assistance either in the form of a home nurse or temporary placement in a nursing home until he is improved.

I hope that helps, and good luck!!