Ways to deal with a combative person with dementia?

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Ways to deal with a combative person with dementia?

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My mother has severe dementia. We have the same routine every night. I will take her to the bathroom, get her ready for bed and she takes her meds. Every night when I go in her room to tell her that I need to help her up so I can help her to the bathroom, she gives me a mean look and just stares at me. She doesn't like to stand and walk because it hurts her back and knees. Once I get her up she's pretty good at walking, just slow. However, getting her to cooperate is horrible. She fights and struggles against the chair, refusing to help me. She pushes back with her feet and hits and kicks. She's very strong. I have to get her into the bathroom so she doesn't have an accident. What can I do? I get extremely anxiety filled every evening when I know that the battle is soon to begin. I try to be as nice and comforting as possible. She's fairly cooperative in the mornings and pleasant during the day. It's the evenings that are so horrible. Is there a way to overcome this? Is there something I could do different? She only uses the bathroom twice a day now because I can't get her to go. She says she doesn't have to when I ask. I know that she has to go in the evening. We barely get her on the toilet and she's going. I will take and suggestions. I am at my wits end and a stressed out wreck over this.

Alzheimer's & Dementia Anger Dementia Behaviors Violent Behavior

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Is she on a calming medication like Ativan which can help? You can consider putting her in disposable briefs for the night and do away with the toileting entirely. The vast majority of elders with advanced dementia do wear disposable briefs due to incontinence.

Best of luck to you.

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I agree with Lea that it's time to discuss medications with the MD. Sometimes you don't even need sedative type things. For some, a low dose anti-depressant improves overall mood, and may be worth a try.

I know that you already likely know that you may be looking at a time when this isn't doable by one person in-home, so I will surely spare you that whole talk until you come to us wanting to discuss it.

I surely do wish you the best of luck but the only recommend I have for you, being you are pretty much a pro at this, is to discuss with the Doc. I hope you'll update us.

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Sounds like Mom is sundowning and I think for some that suffer from Dementia it can last for a few hours.

Yes, ask the Dr for something to calm her.

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Consider putting a commode next to her bed so she only has a minimum distance to travel to relieve herself, or get rid of all her cloth undies and replace them with disposable briefs (maybe the kind with velcro tabs for easier on and off).

Agree regarding meds.

She is no longer able to bring her broken mind to a place of cooperation and acceptance because she isn't able to figure out how to communicate her feelings and needs, so it is merciful to help her with this. It may not be a perfect solution and it may require trying several different drugs at different dosages before you find a good fit.

You will need to readjust your expectations and pick your battles so you don't burn out.

I also agree to maybe tour some facilities and figure out the financing of such so that you never have to do it in a crisis.

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I did that for my mom. I put a bedside commode next to her bed. It did help.

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I second the idea of putting a bedside commode right next to her bed if you feel she must get out of bed to pee. Otherwise I would just let her be and let her pee in her Depends or the like, as it just may be easier to change her while she's lying in her bed with waterproof pads under her.
If you're only taking her to the bathroom twice a day, I'm sure you're already having to change her Depends in-between those visits, so what's a few more times if it saves you and her the aggravation?

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My mother’s behavior changed dramatically after going on Ativan and Seroquel. She was finally able to get some rest at night.

Mom wore Depends at night. I did put a bedside commode next to her.

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I agree that the judicious use of meds can make a world of difference in managing elders who are combative.

DO NOT worry about addiction or what 'the neighbors might think--we're drugging mom to keep her manageable'.

Do what you HAVE to to get her to be cooperative. My MIL takes Ativan in the day and Xanax at bedtime. (Why the combo, IDK). Without the Xanax at night, she is completely incapable of cooperating with her kids who are her CG's.

I joke with DH as he tries to make her 'understand' b/c he can't. I said "Give a Xanax to Mom and you take one too". I'm joking, of course, but the point is, they BOTH get agitated and upset when she's not cooperative. And once she gets to raging--well, forget it, she is impossible.

She does toilet herself, but wears Depends all day. They are pretty well soaked, but she can change herself.

There's no way in the world she would put up with a commode in her bedroom. I bet a lot of seniors feel that way. (I would.)

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I get that the idea seems unsanitary. My 94-yr old Mom has one in her room on and off (her choice). As a retired RN she knows that many senior falls happen at night on the way to the bathroom. The OP's Mom has "severe dementia" so I doubt she may have an opinion about it.

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This became a problem with my mother in the last 8 months of her life. She was prescribed Seroquel. It made all the difference. Good luck. This is a very difficult situation.

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My mom has had the same issue. The Seroquel seemed to have helped (something did) but it took a week or so to work. Also, a uti can cause some of these same issues. We put her on an antibiotic for that at about the same time as starting the Seroquel so that's why I say "something" worked. She is off the antibiotic and is still no longer combative...knock on wood.

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We have had a very similar problem, mostly surrounding the bathroom and Mom now takes 1/2 a 5mg Lorazepam in the morning and the other 1/2 in the afternoon which makes the bathroom trips (she is incontinent) and night time routine so much better for all of us.

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My mother also gets Lorazepam. She gets the liquid and I squirt it into her mouth with an oral syringe. It's been a life saver.

At night, I also use a bedside commode so she doesn't have to walk to the bathroom. Easier for both of us. I use commode liners with pads that I buy on Amazon or Walmart which make cleanup a breeze. Here's a link:

https://www.amazon.com/OUMEE-Commode-Absorbent-Portable-Disposable/dp/B0BQWLVGBW/ref=sr_1_1_sspa?crid=36LY34X7OEQKI&keywords=commode+liners+and+pads&qid=1705072160&sprefix=commode+liners+and+pa%2Caps%2C590&sr=8-1-spons&sp_csd=d2lkZ2V0TmFtZT1zcF9hdGY&psc=1

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This is so common with Alzheimers. My father was living in a memory care facility and he had a standing Rx for Ativan 30 minutes before showering. Sounds like she may need some meds to calm her and help you manage. Not sure if its fear, invasion of privacy or a bit of both, but very common. Also I suggest setting a reasonable goal for weekly showers, my father had 3 and this was a huge accomplishment!! You cant look at it with your standards so you just have to accept what is doable.

hope this helps!

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I love that: "You can't look at it with your standards so you just have to accept what is doable. "

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Please share this with her PCP and, request a " level of care needs" assessment; go from there with PCP recommendations to home health, hospice or facility care ; with the assist of a Geriatric Care Specialist or perhaps a Licensed Social Worker you can navigate the options for which type of care will best fit your mother's needs and provide you with support. Get help..... It will only get worse .... Also home health or hospice will provide supplies such as depend undergarments etc, bed pads etc etc if keeping her at home. And they will help educate you on some best practices to cope with the combative behaviors and many other challenges.

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I would recommend that you start to put your needs first, not hers.
If you get injured 'helping her' through these evening ordeals, who will be there for her? - and you? If you keep going, you will burn out and not be able to care for her - or yourself. You are at your wits end so it is time to stop and find an/other way. Even if it means placing her in a facility. And see below.

Medication?
Get a strong/er caregiver in at night to do this.
Don't argue.

There is nothing you could do different wherein she will be 'nice' and agreeable to what you are doing. She hurts physically. Mentally/psychologically she may believe that you are (wanting to) hurting her so she is rebelling. And, she may 'just' be so confused that she is angry and/or in a self-protection mood.

The one behavior you do not do is 'push against' / argue.
This makes everything worse.

Get a caregiver in there asap for the evening needs, including showers.
Do not ask. She cannot make these decisions. Introduce her to your NEW FRIEND.

Gena / Touch Matters

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Feel for you. I’m having the same issue with my husband. He doesn’t want to use toilet. He doesn’t want to use bedside commode, he doesn’t want to sit on incontinence chair pads. Everything is a battle. He will wear disposable pull ups though. That doesn’t meet the needs of the “output” of an adult male, but it’s the best we can do.

I will be speaking with his Dr on adjusting meds. at next appt. He takes Sertraline and Bupropion (antidepressants), Mematine (for Alz) Rispiradone (antipsychotic) and wears the Rivastigmine patch (also for Alz). He has Alzheimer’s and was diagnosed almost 4 yrs ago.

I’ve always heard the main caregivers are the ones who take the brunt. So far, it is the case with me. He is cooperative with anyone/everyone else. Of course that could change.

Speak to Dr first to see about some meds. Also look into Hospice help. It’s not just end of life…there are people who’ve been on hospice for years. Medicare usually covers Hospice. They have nurses who come and check vitals and aides that help with showers. Between hospice help and meds, that should give you both some relief.

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Seroquel made all the difference with my mother with dementia, when she was not cooperative, and was combative. I don't know if this is an option for your mother, and not sure if insurance would pay, but there are lifts which help move patients from bed/chair to bedside commode. We have an Invacare Get-U-Up hydraulic lift which we use to move my mother to and from the bedside commode and she doesn't seem to mind it. And I recommend hiring a caregiver to help with the process. We have a home health aid come in and the 2 of us can manage nicely. And the best thing is that there is no lifting for any caregiver. I'm sure there are a variety of other lifts which could help your mom specifically for people with back issues, etc., if the brand use would not work for her. Hope this is helpful.

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If getting up and walking is causing her trouble, perhaps she would be more comfortable wearing an incontinence product, like depends pull ups, or diapers.
Disposable bed pads are also a good option, you can roll her on her side to place and remove them.
Or can you place a bedside commode close to the bed, so it's just a matter of helping her stand and pivot?
Can you hire an aide to come in and help with getting her up and to the toilet?
From what you describe, I don't know that medication would be the answer.
If her mood is pleasant except when she needs to get up, it must really be hurting her. And if she is medicated, you run the risk of her being too drowsy to be able to stand and walk. You both could be injured!
I would try and get help - either from professional aides, or a hoyer lift, and ask if she would rather use an incontinence product so she doesn't have to get up and walk to the toilet.

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Sedation - find her a Geriatric Psychiatrist.

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This is a difficult situation. We’ve been using a commode with bars and handles next to her bed. That way she doesn’t have to walk and she can mostly handle her own toileting. Who knew caring for someone could be so difficult. I know what you’re going thru.

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There are many good suggestions on here. My mom suffers from sundowning and so do many in her memory care facility. Her symptoms are combativeness and delusions. We (me with hospice advise) started her on Seroquel and that seems to have worked but it did take a week or so. We also gave her a round of antibiotics for a uti so that could have helped as well since the symptoms are similar. I advise to try only one thing or med at a time so you know what works and what doesn't.

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Seroquel has worked wonders for my Mother, we started with a low 25mg day, every 6 months or so we have had to increase a bit. It is tolerated well and helps to keep her calmer

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rquellet: Opt for a bedside commode.

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First, you’re not alone. My husband is exactly the same. His incontinence is hard to deal with at night and the poor man hardly gets the recuperative sleep he needs; which means he’s not alert a lot during the day.

one caregiver uses a urinal at the bedside and if he’s already wet himself, she tears the sides of his depends to remove the wet diaper( it tears off easily) then she slips another one on him. Serves several purposes: doesn’t have to get out of bed, his diaper isn’t full at night so he can sleep longer and avoids any UTI from breeding). Not sure if you’ve tried any of the female urinals found on Amazon.

Finally, take care of yourself. Find a way to get away for a couple days. Have another family member give you that short respite. It’ll work wonders.

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There’s some great suggestions given. I’d try the bedside commode. It worked for my mom in the early stages of her illness rather than walking her to the bathroom. She’ll just need to stand up and pivot. But use disposable chucks underneath the commode in case she has accidents.

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Ways to deal with a combative person with dementia?

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