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Old 09-02-2011, 10:09 PM   #1
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Agitation

Well, my FIL has gone from aggressive to combative and now agitative. He got more angrier when they help him with toiletting at night or in the early morning. Either temporary catherized, wet diaper, or going to the toielt and all that. He was getting combative. The UTI is gone now.
So as I always know, the agitation is due to Alzheimer's. The home just never saw how mad he was before back home. This time he is like punching or fighting...
The doctor now added another pill antipsychotic risperidone. This is the one that could cause stroke but the doc. said it is effective with low dose .25mg. They started it with lower dose but Thursday they added it back to 0.25 mg. Thursday is the day the doctors visits the home.

His walking problem and loss of independence makes him more agitated. He is still OK in the day for activities or meals.

Not sure how long will this go. As the dose increases, I guess it is the path... Next year he may be under heavier dose when he uses a wheelchair completely.

Gradually he will have anger with the shower, the haircut and the sponge wash daily and walking and etc... Just one step at a time.

Nina

 
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Old 09-03-2011, 08:20 AM   #2
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Re: Agitation

Oh yes, I can relate so well! My m in law is the same- gets into such a state, kicking & screaming! It's like a sort of blind panic! It's a very difficult stage & one that will hopefully pass to some extent. Like you said, take one day at a time.
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Old 09-03-2011, 09:53 AM   #3
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Re: Agitation

Yes, it is a stage when they become angry and fearful and combative. The medication he is on may help some but if it is not effective don't hesitate to ask them to change the medication. There are many out there that help and it's a trial and error to find the right med or combination. Been there done that one with both Mom and Dad.

As for the medication... the percentage of people that have cardiovascular problems from this medication is much less than 2%. So 98 out f 100 will be just fine with it. I made the same choice you are. If there is a less than 2% change that Mom will have a stroke (the percentage of elderly that have strokes is almost as much anyway) but it will give her relief from her angst... then I will take the good with the bad

I do hope he will calm down and find peace!

Love, deb

 
Old 09-03-2011, 04:29 PM   #4
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Re: Agitation

I fought for months til I finally found the doctor willing to listen to me and willing to give my mom the drugs she needed to calm her. Strokes...ptooie!!!!

Yes, mom's neurologist said given certain drugs and she would have a STROKE!!!!!! AIIGGGHHH!!!!
Her hemotologist shook in his boots at the thought of giving mom anything stronger than ativan because it may cause a STROKE!!! AIIGGGHHH!!!

I finally took mom back to her regular old doctor and showed him the bruises up and down her arms from her thrashing and wild outbursts and strokes be damned, he gave her the combo necessary to give her relief and becasue of him, her last 9 months of life were peaceful ones. She never did have that STROKE!!!!!!

Love, Meg

 
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Old 09-03-2011, 04:33 PM   #5
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Re: Agitation

Let me add something.... I weighed the risks of a stroke and I was willing for my mom to go sooner than later from a stroke than to have what was left of her life filled with fear and terror and angst ridden. We all have to make that choice...it was an easy one for me.

Love, Meg

 
Old 09-03-2011, 09:23 PM   #6
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Re: Agitation

Meg, it is easy for me too. It is harder for my husband and his elder half-brother who is quite catholic... Guess they will see when they get there...

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Nina

 
Old 09-04-2011, 12:41 AM   #7
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Re: Agitation

I am not sure where religious preferences come in. Every medication you are given has potential side effects. All medications can do harm as well as good. The increased stroke risk was very minor. It was just a few percentage points greater risk that those that did not take the drugs... barely statistically significant.

The study found... Use of any antipsychotic drug was associated with a rate ratio for stroke of 1.73 : 1.69 for typical antipsychotics and 2.32 for atypical antipsychotics. In patients receiving any antipsychotic drug, the rate ratios were 3.50 for those with dementia and 1.41 for those without dementia.

So that is a 2.09 difference. Is that enough of a risk to warrant letting our loved ones remain in hysteria, angst, or extreme agitation when they already have a terminal disease? There are risk with pain medication as well but we don't second guess giving them medication for physical pain. Why do we hesitate so when treating them emotional pain? Perhaps that is an argument your husband and brother in law will understand.

As Meg I watched my Mom miserable with anxiety. She went from combative to hysterical and back to combative. She was miserable. If medication could alleviate this misery I felt it was my duty to use it.

Statins are the cholesterol medications that many take. Have you heard the warnings about muscle pains. That is Rhabdomyolysis. Rhabdomyolysis is a serious side effect in which there is damage to muscles. Rhabdomyolysis often begins as muscle pain and can progress to loss of muscle cells, kidney failure, and death. Yet there are millions of patients taking that medication every day safely. There are also serious cognitive side effects to statins that are not even on the label.

The difference is that the media has make a perfect storm of fear related to the stroke related dangers of antipsychotics in the elderly... but they totally ignore the statin side effects. Commons sense, weighing the risk vs the benefits is needed... and the knowledge that there are no other options for the elderly dementia patient except to remain in misery.

Just some facts to use with hubby and BIL

Love, deb

 
Old 09-04-2011, 02:47 PM   #8
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Re: Agitation

Excellent, Deb.

Love, Meg

 
Old 09-04-2011, 04:10 PM   #9
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Re: Agitation

I agree with you Meg! My parents dr said the same thing.
and always argued with me when I asked for stronger drugs!!
There is NO reason to let our beloved parents suffer anymore than they did
My dads dr thought I was nuts when I asked for RX for dads back pain.
He gave very low dose,,which did not work

Yes, those later stages are so very difficult for all
Brings tears to my eyes, when I think of the mental anquish dad went thru

Hang in there
Chris

 
Old 09-04-2011, 07:13 PM   #10
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Re: Agitation

I am referring to let him take the new drug and don't worry about stroke due to the quality of life that Meg was talking about.

Some people don't want to face the fact that the person is dying slowly. Really dying. It took a lot of times to explain this to them. If he has not seen this personally, he would not understand. Some people are conservative including my own family/my parents. They don't want to face the fact that death is coming and they don't want to face the issues that there is no more treatments or better med and etc...

We saw my FIL today. Well they say he is more active in the morning and very very tired in the afternoon now. They think it is not due to the new antipsychotic drug. The caregiver said the new drug helps. They just said he was combative and they had to come back the other days without the drug, that is all.
Well he is like no talking, sleeping in the bedroom and later on they used the wheelchair to transport him to the cafe for dinner. He stayed in the wheelchair for the rest of the day after he got up. Well, he was fine earlier until the caregiver had to help him with the toilet in his room around 3pm. Then he was very tired and fell asleep. All through this, just one sentence to my husband, "I am very tired". No talking after that. He smiled shortly when he saw us in the acitivity room at 5pm and that is it.
Maybe he will be better tomorrow in the day... However this is the image that he will be next year - wheelchair, no talking, sleeping....

Kind of unreal or surreal to see this. I know this thing today is temporary but he will get there pretty soon. It was like a little scary and my husband was a little bit shocked. My FIL is sluggish... He used to be more perky and alert to see us. I mean it seems to happen too fast although it is temp. Kind of shocked to be honest and I think my heart sank although I knew he is getting there...

The nurse was like praising him as he is still helping himself to eat. It is getting more depressing.

Religion has nothing to do with med but it has to do with how you want a patient to live or die. For some people this matters. But the true understanding like what you gals are talking about requires close attention to the very sick dementia persons. So I don't blame those people who don't understand this. It is better to die than live this way.

Nina

Last edited by ninamarc; 09-05-2011 at 10:01 AM.

 
Old 09-04-2011, 08:21 PM   #11
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Re: Agitation

It has nothing to do with religion or conservatism. It has to do with accepting the reality of the situation. Yes, it is easier to just bury your head in denial but that doesn't change the course of the disease or what your FIL is going through. Actually that state of denial is a cruel thing to do to yourself and prevents you from making the necessary decisions. If this disease could be wished away my Mom, nor your FIL, nor any of our loved ones would have it. But it is a terminal disease with no course of treatment to make it better and no cure. That is the brutal reality of this disease. Then you have to accept that they are going to deteriorate at an unknown pace. We don't determine when the downward spiral takes place. We can hope for a period of time but in reality it could be now or later. It is what it is today and there is no promise of tomorrow. I have also learned to accept them for who they are today, not who I want them to be or who they were. I can still find joy in the person they are now

There are many that want to think they are immortal, will live long and healthy, and do not want to face illness or death. But that is not the reality of life. To face the death of a loved one is to look our own mortality head on. But we are all mortal and we will all die. Those will illnesses might know the time line a little better but none of us have a promise of tomorrow. Who says that FIL will go before those that are in denial?

Wanting, when it interferes with what is, is a problem. Nobody wants this disease. It is not a choice we make. It is something that happens. Many ask why my loved one? I tend to ask... Why not? It plays no favorites. It just happens. Ignoring does no good. You just miss the good times that you can have by accepting and moving forward.

Mom said in the beginning that it was better to die than to live this way. I was unsure. Now, even though it was not my choice of how to spend the last 13 years, I consider it a blessing. Yes, I am very accepting of my parents dementia. I is what it is and we have to deal with it. Yes, the relationships have changed. But in all that is this disease I truly believe I have become closer to my parents. I have also been able to give back to them some of what they have given me. When it is Mom's time, she will go just as Dad did. Until then I will live every day, and help her live every day, to the best that we can.

Nina, I hope this thing today is as you say temporary... but do not be surprised if these days occur more often until then are the norm sooner rather than later. One of the reasons this disease and it's progression is so hard to accept is that we do have those good days that are close to the old normal. We dismiss the not so good days as just temporary. Realistically it is the up and down roller coaster ride to the bottom. We never go up quite as far as we did last week and the downs get a little further down. It is not a steady decline which is confusing

Yep, it is difficult to change our thoughts and find acceptance of something as devastating as this disease... but in the long run it serves us well. It can give you the control you need to make the best of what is happening!

Love, deb

 
Old 09-05-2011, 10:04 AM   #12
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Re: Agitation

Deb, I know some people use conservatisim as excuses. It makes sense because in the old world long time ago, they didn't deal with this like hospice or comfort care. It is the old school as I talked about before.

Anyway, I am not saying I don't get used to it. It is always shocking to see him decline the first time! I went like oh oh it started! The timing is always surprise, not that I am not aware.
My husband was like is it the weather? He does change according to the season's change, but he does not know the weather anymore... It is the disease.

Nina

 
Old 09-05-2011, 01:05 PM   #13
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Re: Agitation

Part of the problem Nina is that it is all relatively new. In the old days they didn't have all the medical options we have today. They didn't have the extraordinary medical interventions to keep somebody alive longer. Many accept the new medical advances but not the idea of a loved ones death as it would be in the old days I truly believe Hospice gives us the option to go back to the old days.

I truly believe my great grandmother had Alzheimer's.... from the stories I have heard. She was said to be "touched in the head" in her later years. There is a story of her in a wheel chair getting irate and rolling herself swiftly off the porch going after somebody. Nobody understood why she was so angry and irrational. This from a lady that was known for her intellegence and sweetness. Yep, sounds like Alzheimer's to me She died of what sounded like pneumonia.... which was not as easily treatable at that time as it is today. There were no feeding tube options or psychiatric med options. Pain meds were minimal and antibiotics were elementary. Medical treatment was limited so her death was consistent with Hospice current protocol. She died at home being kept as comfortable as possible.

Love, deb

 
Old 09-05-2011, 04:01 PM   #14
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Re: Agitation

Deb, you are so right. Your great grandmother was going through it without the modern issues. It was natural. Sometimes medicine did bring lots of new hopes but also some artificial means.

We began to suspect my FIL was not talking because of the new drug. Sedating is the side effect. So we will talk to the nurse director and go from there. It is too early for him to be sedated to the point of no talking.

Nina

 
Old 09-05-2011, 09:41 PM   #15
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Re: Agitation

Don't be surprised if he doesn't start talking. Cause and effect is not always easy in this disease. Yes, sedation is a side effect but is that why he is not talking.... or is he not talking because he has reached a place in his disease where it is just too difficult for him.

Mom lost her ability to communicate over 2 years ago. She first lost her auditory perception ability so she didn't understand what was said to her and therefore could not respond appropriately. Then she lost her nouns, then other words. Now it is rare for her to string two or three words together.... and it is always a response to visual input and not what you say to her. This came with the behavioral issues and preceded the medication. The speech and behavioral issues are both common in the late mid stages.

It is all a balancing act and you have to try to see what works I hope this works.

Love, deb

 
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