My mother has dementia (late stages) and I’m at a loss as to how to manage it. She is currently in an assisted living facility in Florida and I am in Illinois so the distance clearly complicates the situation.
The problems started about 2 weeks ago for no known reason. She has become agitated and aggressive every single day striking out at staff and the residents, as well as throwing and breaking things and trying to escape. Out of the last 10 or so days her assisted living facility has sent her to the hospital 7 times.
No one seems to know what to do. Every health professional puts her on a different medication and sends her back to the assisted living facility just for the same pattern to repeat. I’m worried that the combination of drugs they’re prescribing could prove fatal as I read never to administer these antipsychotics to the elderly with dementia. Most recently they have taken away her Lorazepam and put her on Haldol and Risperidone.
I know of course she has dementia but what causes an otherwise docile person to suddenly become so violent? Any opinions, thoughts, theories?
Going out of control and being sent to the hospital every night cannot be her treatment plan. Please offer any advice you can or if you have been in a similar situation how you handled it. I very much appreciate it.
Your Mom is now more than an AL can handle. I am surprised they have not recommended Memory care. Even then, they too have limitations and LTC might end up being an option.
So we know I am my mother’s trigger. Days later, other visitors found her to be cheerful and welcoming. Good luck patterning out your mother’s triggers. Staff change? Delusion? Assuming the hospital tested for UTI, etc.
No rhyme or reason, just the decline. As long as she is kept mildly sedated during the day and then heavily sedated at night, she is manageable. It's when she refuses meds and gets over-wrought over something that the aggression comes to the fore.
Sadly, the meds don't always do the job real well. The 'kids' have had to play around with the dosages a lot to get the desired effect.
She's been in the hospital a couple of times to get things leveled out. It's a constant 'battle'. BUT do check for a UTI. Those can make you just crazy!
I am also a trigger for her, so I don't have anything to do with her, and my name cannot even be brought up in conversation (so I hear).
She'll last forever like this, I swear. The only 'hope' the kids have is to keep her sedated 24/7. Actually, for her, sedated is what 'normal' people act like.
My step-mother became somewhat aggressive in the afternoon (sundowners) nothing like your mother, we increased her dose of anxiety meds, calmed her down, she is in MC.
I am assuming a blood panel was done to measure electrolytes and be certain they are WNL (within normal limits) as a bit of a tilt in sodium and other electrolytes can cause this.
So I am assuming a FULL MEDICAL WORKUP has been done.
If that is the case, and there is some sudden worsening of her dementia (which is UNUSUAL--the suddenness that is), then you are down to she is going to have to have anti-psychotic and other medications tried. And by tried I mean it is anyone's guess what drugs or drug "cocktails" might work to help her be in some control, less agitated, and yet not sent into stupor.
This IS Rocket Science. (You remember that "it's not rocket science" adage; well THIS IS). First of all they try what has worked on others and worked in the past. When one drug doesn't work they play with dosages and add ons. And when this is done not in a SNF but in the nursing home itself it is ALMOST IMPOSSIBLE to evaluate. The docs can't see the effect. There aren't adequate nurse's notes to tell them how it's going.
You can see the impossibility of all this along with the fact you cannot BE there. This is as complicated as it gets. It will take patience and I hope that all involved have that.
If she ends up sent back to a SNF or a Neuro-psyc unit then to tell the truth, imho, that's a GOOD THING because at least there SOMEONE will treat this like the mystery it is, what diagnostic workup is missing, what will work, and what won't. It will be almost impossible to come up with good effect in MC.
I am sorry. I hope you will update us.
If her medication has been changing as often as she is being sent to the hospital it is no wonder that nothing has worked at this point.
Has she been checked for a UTI?
Are there any other factors that might be "setting her off" in the evening?
Is there a new caregiver? Is there a new resident? Have they started a new routine? Any of these factors could have an effect on her.
And because it is me answering this....Is mom on Hospice? It is another set of eyes on her as well as staff that can help manage symptoms.
To answer some of the questions posed here, yes she is in Memory Care and has been for quite some time. She mentions problems with the residents but I'm not sure if they're real or just what her brain is telling her.
As far as a UTI on her first few visits to the ER they said she didn't have one but on her latest visit they said she does. This is typical, one hospital/doctor says one thing and another something entirely different. This last hospital seems to have done a pretty good workup, with a CAT scan of the brain (nothing abnormal), a CBC (a lot of her blood levels (RBC, HGB, HCT,MCV, lymph are low and PT is very high).
One of the strangest aspects of this is that one minute she is in great spirts and the next raging mad. Its goes from one extreme to the other very quickly.
She is in Florida so they did a Baker Act on her which is a 72 hr involuntary hold for mental illness but because she has dementia they found it does not apply/they can't do it.
The memory care assisted living says they can't do anything for her either except send her to the hospital when shes shows aggression. The next step they say is to kick her out. What do I do then?
Again, thank you all for the kind words, ideas, advice and compassion, It is very helpful.
Memory care facilities are supposed to be equipped to handle aggressive residents. You may need to find one that can take her on and has a better plan than sending her to the hospital every time she has an outburst. Possibly this is your opportunity to move her into one closer to you so you can better monitor her care.
I lived 3000 miles away from my father so I totally understand how hard long distance caregiving is. He ended his own life so he never went into memory care, but he was about 8 months to a year away from needing to be placed. It was constant source of stress thinking about how I was going to manage that from so far away.
I agree with you that I thought places that have dementia patients would have some way to deal with them as they often get angry or aggressive but have since learned that is not the case. She instead was repeatedly sent to the hospital. Being so far away I didn't know what to say or do. Luckily she is doing better now but it took a long time to find the problem.
https://www.healthline.com/health/how-to-prevent-uti#prevention-tips
https://www.alz.org/