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Old 08-05-2011, 09:22 AM   #1
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Aggression

Yesterday the nurse left a phone message saying my FIL has been aggressive lately and he even tried to strike out at the staff. Fortunately he has no cane so he could not use the cane to hit people.
Today I called the other nurse and she told me it is actually due to his urinary situation. He is incontinent now. He pees a lot at night, not the day. He hates to be wet in his pants. He cannot walk on his own to the toilet. This adds up to form his aggression.
They are checking to see if he has UTI since he does have some residual urine in his bladder after his prostate issue last year.

The doctor has increased the dosage for his anti-depressant and lowered the dosage for his heart med which slowed down his heart rate too much.

The new stuff here is he had never been aggressive like this in the new home.

It is not a surprise to us back home. He tried to be aggressive with me using his cane and he often blamed people a lot. It was honeymoon in the new home last year!! Now the honeymoon is over.

The fortunate thing was he moved to the home after his prostate issue was resolved and no more urinary catheter.

I also think maybe it is the decline. They keep saying it is the med or it is the disease or whatever. Don't we all do that? When we are sick or weak, we feel bad and moody and then we get depressed!

Hope the anti-depressant can help. Maybe he will need something stronger later.

Nina

Last edited by ninamarc; 08-05-2011 at 09:24 AM.

 
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Old 08-05-2011, 12:31 PM   #2
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Re: Aggression

Nina, good they are checking for a UTI. If it is positive then you will be with some of the rest of us that have celebrated that test being positive because it gives a reason for the change in behavior. Yes, a UTI can cause aggressive behavior.

I would ask the frequency of these aggressive episodes. Are they at a specific time of day? How often do they occur? When did they start? Was it a sudden change or something that has been building over time? You truly need a time line to determine why.

Aggression can come from frustration or it might come from not feeling well. It could come from his inabilities or it could just be a few bad days. Both of my parents went through periods of aggression as their abilities deteriorated and the dementia got worse. My first line of defense in those times was... ice cream for Dad and Chocolate for Mom. If they can be calmed by distraction it's probably frustration with their world becoming for foggy and scary. If you woke up in a world you didn't know, with people you didn't know, doing things to you that you didn't understand... you might take a swing at one of them! This is the world of dementia every moment of every day.

Antidepressants didn't have a huge effect on Mom's aggression. It was not caused by depression but by the fact that she was scared and frustrated by a world she didn't understand. It presented in bipolar, schizophrenic type behaviors and medications for those became a solution.

You know this is just another phase of the disease that your father has to get through. Hopefully the staff will find what helps him get through this. Right now we will just hope it is a UTI because that's fixable with the right antibiotic

Love, deb

 
Old 08-05-2011, 03:18 PM   #3
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Re: Aggression

Deb,

The aggression started this past week. We just saw the home Sat. last week and no nurse told me this. The anxiety part from the activity director was from July. It all started after he started to use the walker and has trouble getting up and etc. In May/June he was on a strong painkiller that made him sleepy so it worked. Now he is getting to know that something is wrong.

I checked the website and the scientist said in 2007 that the drug (citalopram) may perform as well as a commonly-prescribed antipsychotic (risperidone) in the alleviation of severe agitation and psychotic symptoms of dementia. It was associated with "significantly lower" side effects. So maybe it will work. It was studied in NIH.

Surely it may be the UTI since he now pees a little differently and more frequent. To me I think it is both factors - the emotion and the urine.

I will see. Sometimes when I thought of his violence (verbal or physical threat) back home, I don't feel I like him anymore. It is mixed feeling... I know I respect him as a professor and FIL and elder, but I know what his defects are and so on... My husband is kind of passive about what is going on. I think his parents had made him passive in his life.

Oh well!

Nina

Last edited by ninamarc; 08-05-2011 at 03:18 PM.

 
Old 08-05-2011, 04:36 PM   #4
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Re: Aggression

DH still has aggressive episodes, and sometimes it's hard to tell what has triggered them. They occur more when he is anxious or uncomfortable, such as when his pants are wet or when another patient is acting out. He can be set off when he's in his room and another patient wanders in, or when another patient tries to touch him.

I see that other patients perk up when religious ceremonies are conducted over the intercom system, and others respond when a pet is brought on the ward or a favorite kind of music is played. DH is on a ward with patients in Stage 7 or late Stage 6, but each patient still maintains something of their own individuality. Oddly, DH's really, really strong opinions about fidelity seem to have survived. He becomes very angry when any of the elderly women try to grab his arm or attempt to flirt. He has gone so far as to try to push them away, which is not acceptable in the NH.

There are one or two aides who are great at identifying the issue causing DH to be upset. If he's upset about noise or another patient's behaviors, they'll take him to a quiet area and separate him from the other patients for a few minutes. If they talk quietly to him and smile or laugh, his aggression switches off quickly.

There are a few other nurses and aides who are fast to complain about DH having aggressive episodes, but who don't take the time to try to fix the situation. Some of these nurses and aides are fast to use medication. (I can always tell when they're on duty when I walk onto the ward, since the majority of the patients are sedated by the end of the shift.) I'm sure people won't agree with us, but we don't get too upset if the nurses choose to rely on sedatives when DH is being very hard to handle. They've referred to it as a "chemical restraint," and have told us that medications can't be used that way. While it isn't as desirable as having the aides with patience helping him, we know DH gets peace from his anxiety and anger when he's sleeping...

Last edited by Beginning; 08-05-2011 at 04:36 PM.

 
Old 08-05-2011, 05:48 PM   #5
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Re: Aggression

I totally agree with Beginning concerning the difference in caregivers. There are some in Mom's facility that are wonderful in identifying the problem and alleviating it. Others have very little patience or tolerance. Some want to resort to PRN medications.

Mom did go through a geriatric psych facility. At that time she was hysterical, aggressive, and combative. We truly didn't have a choice in that nothing worked. The right combination of medication has kept her functional and calm for the last 28 months. I can tell when the meds are given late because the anxiety returns. Dad on the other hand used PRN meds and light dosages of other meds. He was fairly easy to distract. What is needed depends on the patient... and what is given sometimes depends on the caregiver on duty.

Love, Deb

 
Old 08-05-2011, 07:47 PM   #6
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Re: Aggression

Beginning, you are right. there are 2 kinds of things they do in the nursing home when it comes to the patient's mood and aggression. I think both are important and can be used together - the caregiver's patient distraction and the med. I find that given end stage, the med is needed because it is simply too much stress given the decline and loss of some vital abilities.

The residential home where my FIL is has done lots of distraction but I have to admit some young caregivers don't really get the clues. Some even asked my FIL if she is his girlfriend??? Some even play with the resident ridiculously treating them like kids. Some caregiver still tell the resident something that is not what the person wants to hear. The person said she is in the middle of something and the caregiver told her she is not in the middle. Frankly I don't see any specific way of coping with this. It is like anything goes. As long as it works, why not...

Back home before my FIL moved to this home, the home care crew and his GP didn't want to use lots of med. to make him less aggressive. He at best had benadryl. In the beginning he only had regular depression drug before he was diagnosed with AD.

Thinking back, some medication would have helped his aggression back home. Now I am glad the doctor gave him this new med that can help dementia.

Some people may say try not to give them such med to make him sleep or calm him down, but what can you do? If you allow him to go crazy like that, it is bad for his congestive heart failure. He is too old to have this kind of violent behaviors... It is bad for other people and the home would not tolerate any real violence if he does hit someone...

We are lucky this home is understanding and even the staff needs to use the med. to help the residents.
I don't see why not. Of course if some homes deliberately put them down in order not to care about them, then it is wrong. So far, I don't think anyone means harm.

How could anyone spend 24 hours to make sure the elder does not go crazy? That was what we did before he moved. It was nightmare at home. People wonder why send him to a residential home? But what can you do? The home care nurse used to say, oh, don't let the hospital nurse bother him if you can help it: don't let them sponge bathe him in the hospital because he got upset and hit them... Well, how can you go anywhere trying to pamper him like he is a king??? It is not working.

I am glad we have this home that is helpful to my FIL.

Hugs,
Nina

Last edited by ninamarc; 08-05-2011 at 07:52 PM.

 
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Old 08-05-2011, 08:08 PM   #7
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Re: Aggression

Some good points Nina... and I have seen all kinds.

I am a firm believer in not over medicating. They should not be in a stupor. But on the flip side, why should they be allowed to remain in emotional pain. There is a happy medium. Mom was a difficult case... per the geriatric psychiatrist. She was a fighter with stubborn determination and her world was upside down. She intended to right it no matter what it took. Now she is content... and as functional as she can be. They found her happy medium after several attempts. The only difference is the smile that greets me now. Those that say just let them be in their emotional pain have obviously not experienced this type of debilitating emotions. You are right Nina, it is stressful for the loved ones to be agitated and that is not healthy.

I found it a very interesting statistic that most loved ones are placed in a care facility because of behavioral issues rather than physical inabilities. We can deal with them not being able to shower or brush their teeth. We can feed them if necessary. What we have trouble dealing with are the behavioral and emotional issues. Yet that is the last thing we tend to treat.

Love, deb

 
Old 08-06-2011, 09:44 AM   #8
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Re: Aggression

Deb, the reason we moved my FIL was that he was both physically and mentalling failing... The doctor recommended it because of the urinary catheter issue. Anyway, we also had money issue. Certainly this mental thing is also important.

If he lives with us, my husband would not be able to rest all day - my FIL would ask my husband to "work for him". Back home in his house, he actually forced my husband to come down to talk about something "important"...
There is a funny request back in 2007. My FIL had done research in pharmacology about drug and brain. He no longer knows what kind of stuff he should look at. One day on TV there was a defected pig with 2 noses. Well, guess what, my FIL right away told us hey it is a hot topic, study it and write up a paper ASAP!!! He didn't even dare look at me and said such thing!!

How can we live with him like this? His force on my husband to work was ridiculous. Thank God now he forgot about it unless we stupidly cue him about work!!

Hugs,
Nina

Last edited by ninamarc; 08-06-2011 at 09:45 AM.

 
Old 08-06-2011, 12:16 PM   #9
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Re: Aggression

Hi Deb,
I agree about meds being helpful,my mother is only given 1mg, of larazapam when really needed - about once a month or longer even though she can be really aggressive sometimes and she seems to be getting worse.
Last week she accused me of stealing her purse and she was going to tell all the nurses about me, this week she wanted to buy me something.
I am an only child and visit her every day, she was sleeping yesterday but when I went in today she told me to open the door,all the doors in her room were open and when I asked her what she meant she shouted at me "get out you stupid c*w ".
She kept calling me that and when I touched her hand she went to hit me, I said "Mam it is me" but I don't think that she actually knew it was me.
The nurses said that she had been in a bad mood all day ------that is what they like to call her aggression. They are wonderful and tell me not to take things personally and although she can be in a bad mood she can also be lovely.
She has been in hospital for 20 months and I have not had a holiday with my husband or on my own since then, the nurses are telling me to take a break as she is safe so if this goes on next year I will have to have a few days away I think as it is unfair on my husband who is awaiting hospital tests himself to see if he needs a heart bypass.
It would be nice to visit her and be assured of a smile when I see her but I don't know what she will be like from one day to the next and there now seem to be more bad days than good.
It is good to have a site like this to unburden.

God Bless

Pat

 
Old 08-06-2011, 05:28 PM   #10
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Re: Aggression

Pat, it is my understanding that the UK is one place they don't like to "medicate" for behavioral problem. My thought on that is, who are you being unfair to? Why the loved one that is trapped in the scary, frustrating world of dementia. Don't turn them into sleeping zombies but hit a middle ground that makes these last years as bearable as possible for the loved one and the families.

I do understand how you feel not knowing which Mom will be there when you arrive. I swear my Mom had a bit of Dr Jakyll and a bit of Mr Hyde in her. One day she was sweet as sugar and the next day she was hot pepper. I love you came out one day and I disown you came out the next.

You do know not to take any of these statements personally. They are not about you at all. They are about her frustrations and fears. She is trying her best to express herself and you are the safe person in her life. The safe person is the one she knows she can release her frustration to and they will not go away. I have seen it happen so many times. The faithful one is the one that gets all the grief!

As for a vacation... take a few days. Mom is safe and she will be ok. She doesn't have a time line. Today she will fuss because you have not been there in days and tomorrow she will fuss because you are always there So take a few days. I did. Two years ago, after moving Mom and Dad here, getting Mom's recurrent UTI cleared up, and getting her settled in... I actually went to Hawaii for two week!! Sister 2 did check on Mom and Dad from time to time and I did have to deal with one crisis over the phone... but it was all good and I came home ready for the long haul. If Mom is in a good place then let them do their jobs and you take some time for yourself. You have to balance your life with caring for Mom. If you don't you will burn out! Start by taking off one day a week. A day just for you or you and hubby. Mom will be ok. You can stretch that to two days a week... a weekend. It will be ok and you will be a better caregiver for your Mom if you do this!

Love, deb

 
Old 08-06-2011, 09:39 PM   #11
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Re: Aggression

Pat,

I am sorry your Mom is in this state. My FIL has not got to the point to think of his son as his enemy but he does take me as the safe one to get angry at. You know it is the in-law that takes the blame sometimes...

I am not sure why your Mom is in the hospital for 20 months, but it is a long time. If the nurse is able to take care of your Mom, you really should take a break. You don't need to see her everyday and you should see to your own family like your husband more often. You can visit your Mom a few times each week... Sometimes I think if you leave her for a while, she would get used to her caregivers and nurses in the hospital. This way you give both your Mom and yourself a chance to balance things out. You would not feel resentful if you don't spend too much time with your Mom and get burned out.
We have all been there. First you worry if the staff is good enough and then your Mom would hold on to you like you never came before... The guilt and etc...
But it is nothing wrong to balance out the family life. Your hubby needs you as he may need bypass.
I suggest that you give some space to the caregivers near her or hire some part-time caregiver for you to watch her. This way you can have more time for your family.

God bless you too,
Nina

Last edited by ninamarc; 08-06-2011 at 09:42 PM.

 
Old 08-07-2011, 05:45 AM   #12
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Re: Aggression

Hi Nina,

Thanks for your reply, mam has gone through the stage of taking it out on me as she knows that I am the one who will always come back for more.

She is in hospital because she fell and broke her femur and can no longer walk, she broke her hip 7 years ago and came to live with myself and my husband then ( same year my only daughter and her family emigrated to Australia).

She has always used a walking frame since breaking her hip but managed to get around the house and we were able to take her out in the car,we went away for a week's holiday and had a carer coming in daily and it was fine so we did the same thing again but she fell and ,although she did not do any damage to herself, when we went away after that she stayed in respite care in a local care home and enjoyed it ( no dementia then only mobility problems).
In Nov. 2009 we went on a 2 weeks holiday with friends and mam went in to respite care as normal but fell on her 4th. day and was taken to hospital with suspected minor crack to hip so we came back early from holiday.She was starting to be aggressive to the nurses there and we put it down to shock but it must have been the dementia starting.
While recovering in hospital and still using her walking aid she fell while in the toilet and broke her femur, they tried her with Physio but she would scream the place down so she no longer has any mobility at all.
While in hospital the nurses spoke of dementia but I was still in denial even though her behaviour was erratic and not at all like her, so a brain scan was done that showed she had vascular dementia.
Over here in the UK we have what is called Continuing Health Care so that anyone who needs regular nursing care will have financial support in a nursing home or have continual care in a hospital ward dedicated to their condition. I chose to have mam stay in the hospital because I feel that the 24/7 care she needs is best provided there with nurses on duty day and night on the small 11 bedded ward and the ratio of nurses to patient is much better.
I also worked for the National Health Service for 33 years and know how good this particular hospital is.
You are right about taking a break and I will do so as soon as hubby is sorted. We had booked to go to Australia before my mother fell but my husband insisted on me going while he stayed behind with her so I haven't seen my family for nearly 2 years but he hasn't seen them for 3 years;we cannot leave her for a month which is how long we go to Australia for but I am tring to persuade hubby to go on his own next year He is an absolute saint and the only positive thing that has come out of his heart condition is that I know I did the right thing about listening to the doctors when they said we could never manage mam at home, he was the one who had to lift her every time she fell and that was getting more often.
Well thanks again for your reply, we are off to visit mam again in about 5 minutes so wish us luck that she is in a better mood today

God bless you all

Pat

Last edited by patw27; 08-07-2011 at 05:49 AM. Reason: wrong word

 
Old 08-07-2011, 08:07 AM   #13
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Re: Aggression

Pat, even if you can't get away for a month you can get away for a day or a weekend. Spend time with your wonderful hubby. Take a day for yourself, just to pamper yourself. I do hope you get to see your family soon. It is hard to miss your loved ones. It is good that you have your Mom in a good place which can care for her properly. Take advantage of the good situation and take a break. Even a short one

Love, deb

 
Old 08-07-2011, 09:19 AM   #14
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Re: Aggression

Thank you Debs,
I will do that soon.
Visited mam today, she let my husband give her a kiss and then went to sleep.

It was as I thought yesterday, she didn't know it was me, the nurse said she told her I had been but mam said I hadn't.I think she was in her own world of demons poor thing.

Nurses say she was fine today and ate all her lunch so that was good.

Thanks

Pat

 
Old 08-07-2011, 10:29 AM   #15
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Re: Aggression

Pat, I am glad the UK has this good system to hold your Mom at bay in the hospital.
In this case, you should have enough money to hire part-time caregiver. Hire someone who works there for 2 or 3 hours in some days each week and report to you. The hospital should also offer the caregiver programs or co. brochures. You need to take advantage of this great program in the hospital. We don't have this in Canada or USA.

Definitely you have to take a break - now your husband may need serious surgery and you will need to get away from your Mom for a while.

Deb is right too, take time away to be with your husband or go to your home country. Your Mom will be fine. She forgets that you came last time, right? Well, it is nothing new for us. My FIL never, never remembers that we came last time.
We see him sometimes once or twice a month as we are 2 hours away (not in the same country.) Fortuntely my FIL likes his residential home and the staff is like family to him.

Take care,
Nina

Last edited by ninamarc; 08-07-2011 at 10:30 AM.

 
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