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Old 07-04-2007, 02:32 PM   #1
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mamaduck4 HB User
Combative Behavior

I could use a little help understanding what is going on with my hubby. He has all of a sudden turned into a very combative person, trying to bite people that are trying to help him, lashing out verbal insults, swearing, tries to hit the nurses, etc.

We had noticed his bad behavior on a smaller scale recently. He was in assisted living and seemed to have a problem with one lady there. It was understandable as she was very frustrating to be around all the time. However, we moved him to the Veterans Home and when we arrived he was not happy to be there at all!!!! To make a long story short, they suggested we leave so he could adjust to his surroundings. (I might add that we were four hours from our home) so we went to the hotel. My husband became so combative that they had to call for help and put him in the psychiatric ward at the nearby hospital fifty miles away. Now the VA doesn't know what to do with him and we are going to be left with him going to a hospital near our home. The Veterans Home said they would take him back if he could be calmed down but otherwise we are out of luck. I call every day and he is always in restraints. They have taken him out of restraints a few times but they always have to put him back in.

Has anyone had problems like this????? Is this part of Alzheimer's or is there something else going on here??????? Anyone that has any suggestions at all, please share with me.

Thanks so much,
Jan

 
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Old 07-04-2007, 04:15 PM   #2
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angel_bear HB Userangel_bear HB Userangel_bear HB Userangel_bear HB Userangel_bear HB Userangel_bear HB Userangel_bear HB Userangel_bear HB Userangel_bear HB User
Re: Combative Behavior

Hi Jan,

It's frightening and upsetting when our Loved One goes 'off the rails" like that, and 'bad' behaviour that has never been exhibited before often leaves the family 'jaw dropped' and saying things like "but he's never been like this before !!!"

And he probably hasn't! He hasn't had Dementia before!!

So now it's time to put yourself in his shoes and perhaps try and understand WHY. I'm going to put what could be his reponses in italics .. hope this helps.

He's been taken from familiar surrounds and a familiar routine (no matter how wacky it might have been) and the world has gone a little bit (a lot bit) upside down and everybody else is acting a bit odd ( remember, in his mind he's fine thank you very much!)

NOW:
He's been put in unfamiliar surroundings
He's got strange people telling him what to do.

He's getting a little defensive at being told what to do (because you need to remember, many MANY dementia people don't believe there is anything wrong with them, they believe the rest of the world has gone nuts)

He doesn't want help !! (I can do it myself) his dementia has created his own world and he doesn't understand that people are just trying to help him be 'normal' (because I'm fine darn it !!! I don't need help, Why am I in here? What are you doing to me?)

Put yourself in his place. If you TRULY believed YOU WERE FINE, how would you feel having strange people come in, undress you, shower you, shove food at you, tell you when to go to bed, take these pills, and generally boss you about a bit (cause nurses do have to boss a bit unfortunately). How woud YOU behave?

Complacent? Combative? Resigned? Defensive?

Anyway, there are medications that can assist, however they can (and will) make him groggy and a fall's risk (respidol is an early start favourite and does work with a 0.05mg dose but as the body get's used to it, it needs to be increased). Temazapan is a 'sleeper' and can make them calmer, however they will be very very groggy.

A restraint chair (usually) can assist so he can't wander off ......

But with a 'violent' patient ..the best thing you can do is hope for the right team of nurses, because MOST TIMES it is in the approach to combat the violence ...

He might need medication for a little while so the nursing staff CAN approach him, and get a routine established so the medication can be reduced eventually ......it can be that simple ....and no it might not always work, but yes, it can be that simple.

Hope this has helped a little.

Cheers

 
Old 07-04-2007, 04:17 PM   #3
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ceedee HB User
Re: Combative Behavior

Oh, my gosh, sounds like my husband. I am having a similar problem with my husband who is also in a VA home, 4 hours from me also.

He was put in a geri-psych hospital twice from an assisted living center before he went to the VA home. They drugged him up so bad then he could barely walk or talk. I was not happy. He had hit a resident then when he was trying to take his toothbrush.

He went into the VA home 3 months ago and they had a lot of problems with him the first few weeks. They were calling me all the time about something he did. One time they called me because he kissed another resident, and another time he got in bed with someone. I laughed about those. They also said he had swung at the aides.

He does wander all the time and goes into other rooms. He gets very agitated and becomes very angry if someone is forceful with him or he is spoken to rudely. He has always had a quick temper but never hit or bit before.

He finally calmed down and just last week the nurses commented how sweet and friendly he is. It wasn't a day later they called me and said they were sending him to a psych unit for 2 weeks in another city. He hit a resident and bit a nurse!

He has hit others before, including me, but never did bite! I was so upset but what can I do? I think this is fairly common in people with dementia to get combative. I have heard of people who have never been violent who become so with this disease.

They never restrained him at the VA though. I didn't think it was legal to do so. They would give him shots of sedatives to calm him down.

They may need to adjust his medications which is mainly why they send him to a geri- psych hospital. They also should try to figure out what triggers the behavior and try to distract him before anything happens. I do think the aides could be gentler sometimes.

Of course, I realize they can't watch him all the time and there isn't enough staff to do that anyway.

He has been at the geri-psych hospital for a week now and they said he is just fine. Ha! They do have one on one care there though.

I don't know what I would do if they kicked him out. I couldn't handle him at home anymore, the stress was just too much for me!

Hopefully he will get adjusted to it.

I know I couldn't really give you any answers but at least you know you aren't the only one with this problem.

I feel your frustration.

Carol

 
Old 07-04-2007, 07:52 PM   #4
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petal*pusher HB User
Re: Combative Behavior

Angel bear...you certainly have the correct name....your answers are always compassionate and straight to the point. I wish I had your insight at the beginning of this journey to lead me thru this tunnel along with mom and family!

Mamaduck...I shook my head when reading your post because of the likeness to many "clients" where my mom is. Mom was VERY combative in the beginning...I seemed to be the target of her outbursts. Swearing, spitting, kicking, hitting...it was challenging! I had to keep reminding myself that MOST of the challenges were for mom...she was still aware of the changes and I knew she was scared.

I'm so sorry for all of you who have to endure this...but it does happen in most cases. One time, my mom had a black eye when I visited...another client had done it before a caretaker could stop him. Mom started plenty of fights on her own too. We are fortunate at the facility where she is that each caretaker is carefully selected...it DOES take a special person to work with Alzheimer's daily.

There are so many here who share information, challenges, and stories........you are greatly appreciated!......Pam

 
Old 07-05-2007, 09:56 AM   #5
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mamaduck4 HB User
Re: Combative Behavior

Thank you all so much. Angel Bear you really are a wealth of information and I can always count on you for helpful comments.

I guess misery loves company and it was a big help to hear how others have had to deal with this problem. Part of the problem with my husband is he cannot tolerate medications that seem to be so wonderful for others. They seem to like to use Heldahl (sp?) and that alone turns him into a real monster. They filled him so full at the hospital that it took three days for him to come down. What was so upsetting is I told them he couldn't take this drug!! I explained what would happen and sure enough it did. Can you imagine when he was in a state of combativeness anyway then add a drug he was unable to tolerate it was awful!!!

I just pray that the VA doesn't wash their hands of him, he needs help and I feel he deserves it.

We are waiting as I write this to hear what the outcome will be for him. VA or regular hospital.

Thanks to you all, this board has been a lifesaver for my sanity.

Jan

 
Old 07-05-2007, 03:10 PM   #6
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lollylegs HB User
Re: Combative Behavior

I used to manage a dementia specific nurisng home, we had a no restraints policy. so one was ever restrained no matter what. It can be done with good staff. It really is possible.
When dementia sufferers get aggressive there is always a trigger. exactly what the trigger is may not be clear. First is to check out his physical health, (teeth, urine, infection, pressure sores, feet problems, other illnesses).

then if they are OK staff would methodically document every incident and all the things in the environment at the time, yes it took an effort but it really paid off in helping identify triggers to aggression, and besides that is what the job is about.

then we would work on eliminating triggers until we 'fixed it'. again this took time and effort on everyones part.

One thing that comes to mind is that if they are veterans they often are being trigered by sounds or experiences that remind them on wartime events. This can be as simple as the sound of heavy footsteps approaching. One of the saddest things I saw was a client who used to hide under the bed, terrified, and he was very very aggressive when we would try to get him out.

After talking with his family we discovered that as a German citizen in the second world war he hid his wifes jewish family in his home. Eventually he had to go into hiding also until he could escape. the sound of heavy shoes 'marching' down the hall would send hime under the bed.

His aggression, he was just trying to save the people he loved.
so the combative behaviour makes sense at some level, just not an obvious one. for veterans there are the added issues. I work with some veteran now in a different role and truly the experiences of wartime are just horriffic.

anyway I just wanted to share to explain about the triggers
I hope that you can find a place for him where restraints are out and compassion and hard work to solve the problem are in.


lolly

 
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