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Old 09-16-2011, 03:47 AM   #1
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aggression

Hi Everyone
I have not posted in awhile although it has been a very hard year my husband has dementia at the age of 60. I am almost 50. He goes to an adult day care center during the day the anxiety was horrible. Went back to the doctors and new meds seem to be working for awhile. I have seen big changes in him as the meds no longer work the anxiety is coming back but the one thing I am having a really hard time is the aggression. This whole disease is so hard for me to handle and no support from his family. The adult day care center had to increase his serequel so that has seem to suck the life out of him. We did go away last weekend we have been going to the same place for the past 15 years or so. A few anxiety attacks but at least no aggression. We have another appt on Tuesday with the specialist about getting the meds under control to help him so he can keep going to the adult day care center. Wish us luck that the doctor can find meds that help him and me.

 
Old 09-16-2011, 08:18 AM   #2
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Re: aggression

Chris, it is the behavior that seems to be the worst for most. We can brush their teeth and clean their bottoms but controlling aggression and anxiety is more difficult. Hopefully the specialist will be able to help you.

I had to deal with this issue with both of my parents. Mom was the worst. But when I put myself in her place.... not knowing where she is, how she got there, why things are happening, and why people are doing what they are doing plus not having the cognitive ability to deal with all these scary issues... I can see why she was acting out. It took a while but we did find medication that helped.

I will forewarn you that there are medication that they claim increase the possibility of cardiovascular events. This is a small risk increase over the general risk of the elderly population. It is not a huge risk. When you weigh the benefits (him being able to maintain a relative content emotional state) vs this small risk of something happening in the future... I will take the meds! That is a decision you need to make for you and your hubby but don't let them scare you away totally because the risk percentage is not that big.

Good luck with the appointment and I do hope that you find a medication or combination that works for you hubby

Love, deb

 
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Old 09-16-2011, 08:23 AM   #3
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Re: aggression

Deb is right. My FIL who is in stage 7 has aggression also this year. Since he cannot walk anymore, he is very combative when they do his toileting. Thus starting 2 weeks ago, they gave him the antipsychotic drug. It turned out to be very good. Now I don't have to worry about him being kicked out for beating people up!! He is actually happier now as he is less worrisome. He has lost all his vital abilities and he is scared. So the drug helps. There is small risk of stroke and etc., but it is worthwhile because a big nervous breakdown can kill him too given his bad heart (he has congestive heart failure and he is 90.)

Hugs,
Nina

 
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Old 09-22-2011, 01:06 AM   #4
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Re: aggression

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Originally Posted by Gabriel View Post
Chris, it is the behavior that seems to be the worst for most. We can brush their teeth and clean their bottoms but controlling aggression and anxiety is more difficult. Hopefully the specialist will be able to help you.

I had to deal with this issue with both of my parents. Mom was the worst. But when I put myself in her place.... not knowing where she is, how she got there, why things are happening, and why people are doing what they are doing plus not having the cognitive ability to deal with all these scary issues... I can see why she was acting out. It took a while but we did find medication that helped.

I will forewarn you that there are medication that they claim increase the possibility of cardiovascular events. This is a small risk increase over the general risk of the elderly population. It is not a huge risk. When you weigh the benefits (him being able to maintain a relative content emotional state) vs this small risk of something happening in the future... I will take the meds! That is a decision you need to make for you and your hubby but don't let them scare you away totally because the risk percentage is not that big.

Good luck with the appointment and I do hope that you find a medication or combination that works for you hubby

Love, deb
Deb,

Just read your message to Chris. Would like to ask you some questions. My mom is 89, and her dementia is getting worse. Try to understand what is to expect. How long? What medications are ok for people of her age that might help without much harm? I am going through the same thoughts you expressed: what a horror not to understand what is going on, Sci-Fi is a children's fairytale comparing to that. If you do not mind to share details from your experience - much appreciate.

Bella

 
Old 09-22-2011, 02:01 AM   #5
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Re: aggression

My husband is on namenda twice a day. For the aggression we have increased the lorazepam two in the am and two while he is at the adult day care. Also has a seroquel in the am and a citalopram in the am. I was worried seems like a lot of medication to give someone. No aggression while he was at the center yesterday. Pretty sleepy when I picked him up yesterday. The doctor did tell me if made him too sleepy then we would adjust the medication. I will see after a few days if still too sleepy or not. Mostly the aggression was coming out at the adult day care center not too much at home. I do not have answers as to how long as the disease is different to everyone. I wish I did know how long.

Chris

 
Old 09-22-2011, 09:17 AM   #6
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Re: aggression

Bella, I am glad to share any experience I have That is what makes all I have been through worth while.

As for medications. I will say it here, as I have said it over and over, I am not a fan of Xanax or Ativan which seems to be the first medications that a doctor will give your Mom. They are anti anxiety medications which have a very short life. They create a roller coaster of ups and downs that are very difficult from a person with dementia to deal with. They also have side effects that are the very symptoms that we are trying to alleviate. Not only that they are very sedating. When given that medication my Mom or Dad would fall into a sedated sleep and wake up more agitated than before as they came down from the effects of the medication. After several really bad experiences, I refuse to let my parents take either of these medications again.... NEVER!

There is a range of medication beyond those. Anti depressants do help some. Yes, our loved ones are depressed. Their world has gone completely crazy around them. They think they are ok and everybody else is the problem. Their inability to control their world is depressing. Mom had been on anti depressants since 2003. She was never depressed before but I am sure this disease created the depression.

Beyond that there are anti psychotics. There is this horror created by the media that we should not give anti psychotics to the elderly with dementia. It is said to cause an increased risk of cardiovascular events. When you look at the research this risk is small as compared to the general elderly population. Many doctors balk at giving the elderly dementia patient these anti psychotics but there is nothing else out there to give them and the risk is actually very small. As Mom's Geriatric Psychiatrist said to me... You have to weigh the benefits vs the risk. I will take a 2% increased risk of cardiovascular events for Mom to be content. He was also the one that explained to me... we treat physical pain without a second thought. If Mom was in physical pain we would give her narcotics, even with the side effects. If Mom is in emotional pain, why would we not give her the medications that would stop the pain? Made sense to me If I lose my Mom to a heart attack or stroke in the future, it would be better than to have her in emotional pain for the last 2.5 years!!!

Mom, due to the hysterical emotional state she was in, was admitted to the geriatric psych unit. They picked a medication regime for her. I will say in the first week she was what I would call sedated. It was necessary for her. She was exhausted from her own hysteria. They also found the right medication for her UTI and put her on a maintenance dosage of antibiotics. They she began to "wake up". Know that it takes several weeks to know for sure what a medication will do. It is not instantaneous. She may seem sedated for a while and then come back to a level of contentment and activity. She may seem out of control and then as the meds build up reach contentment. I think that is what is so frustrating... you don't get any immediate answers.

My suggestion to you is to find a good geriatric psychiatrist that specializes in dementia behaviors. Not just any psychiatrist will do because demented behavior is not the same of psychotic behavior, even though they are treated with the same medication. Don't stop until you find a doctor that will work with you. Do not be scared off by a doctor's resistance to use anti psychotics because of the cardiovascular risk. Find one that is willing to do what is best for Mom. What is best for Mom is to get her emotional well being under control... regardless.

Ask any question you might have Bella and I will be glad to answer. I have been through this with both parents actually I just hope something will help you help Mom!

Chris, lorazepam is generic Ativan. That is where the sedation is coming from. I would adjust that out of the med list Understanding dementia explains the behavior at the day care center and not at home. Home is where he is comfortable and has a long term memory to work with. It is familiar to him. Day care is new and different with a lot of activity and stimulus. It is very typical for behaviors to manifest with a situation or location change This is one reason I recommend starting day care or in home help early when our loved ones are more cognitively aware and able to adjust. Adjusting take short term memory/learning and that is something our loved ones with dementia do not have. Yet help in care giving is necessary so we do what we need to do to help them adjust

Love, deb

 
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Old 09-22-2011, 10:11 AM   #7
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Re: aggression

Again I must say AMEN to every thing Deb has said. I was in a very similar situation with my mom as Deb is with hers.

Ativan, xanax...throw them out the window! Most in the medical field want to throw those to drugs at people with behavioral problems ...I don't think they understand the disease as well as they should. My mom had been on both of those and it did the reverse...ramped her up even more and it was as though she was on a roller coaster the way it whipped her around. Up and down and back again. People told me that I had to accept her behavior...that there was nothing I could do ...baloney! And as Deb said, doctors will not want to give them drugs that "might" cause other problems. Personally I told them I welcomed the other problems over the ones my mom was experiencing. The horror of it all. I finally went to mom's General Practitioner and pleaded for his help....I took mom with me and he saw personally the bruises all over her arms from the thrashing she had done...from the fighting off the aids who tried to bathe her or change her. In her mind they were attacking her so of course she fought them!! He listened and he was the one who prescribed her the cocktail of drugs that calmed her and gave her a peaceful existance the last 9 months of her life. And as an added benefit, he now prescribes it to others with this disease.
The day my mom died, my brother and I went to his office to tell him personally ..and to tell him how much we appreciated his courage to presribe what others were afraid to....and to thank him for listening to us.

I hope you get relief for him..and for yourself. We know how stressful this is.

Love, Meg

 
Old 09-22-2011, 11:05 AM   #8
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Re: aggression

Sorry the computer is so stuck that the post showed up 3 times???

Last edited by ninamarc; 09-22-2011 at 11:31 AM. Reason: computer err

 
Old 09-22-2011, 11:08 AM   #9
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Re: aggression

Quote:
Originally Posted by vorona26 View Post

Just read your message to Chris. Would like to ask you some questions. My mom is 89, and her dementia is getting worse. Try to understand what is to expect. How long? What medications are ok for people of her age that might help without much harm? If you do not mind to share details from your experience - much appreciate.

Bella
Bella, I am sorry your Mom is sick as well. My FIL is 90 and has stage 7 AD (Alzheimer's disease) and is in a home.
I had the same question about how long. If you meant how long they can survive... We asked the residential care director who is also a nurse about this, he mentioned that in general the AD elders live like 8-10 years, but no way we can have any specific years or time. There is a way to know how long each stage may last. I don't know if your Mom has AD, but AD has 7 clinical stages as indicated in the top messages. In this Fisher Center for AD website, there is an article about roughly how long each stage lasts. (Sorry I cannot write its website as a rule here, please google search for it.)
Usually the end stage is about 1 to 3 years.
However, everyone is different and we are not God, so we can only expect that they decline with which stage, but we will never know how long.

e.g., my FIL now cannot walk (still on a walker with lots of help) and he has trouble eating (on pureed food) but he can still talk some and join the activities and meal time... Maybe he has one or two more years because of his congestive heart failure and prostate/bladder issues. But this does not mean he may not live longer if he strives to do so. Frequently my FIL fought to get out of bad state so we never know.
He is roughly in the beginning stage 7.

About the medicine in general, it is really up to the doctor to deal with it. The doctor balances the med by observing the side effects and health conditions. There is no specific answers as to what kind of medications are OK.
Obviously the less the better, but the elders always need some med. My FIL is taking 9 kinds of med. Some people have 20!
My FIL now takes antipsychotic drug (risperidone) as well as antidepressant.

Hope this helps,
Nina

Last edited by ninamarc; 09-22-2011 at 11:42 AM.

 
Old 09-22-2011, 11:26 AM   #10
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Re: aggression

I posted the same thing twice. The computer is slower now.

Last edited by ninamarc; 09-22-2011 at 11:28 AM.

 
Old 09-22-2011, 06:31 PM   #11
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Re: aggression

How long... the only answer I can give is... "as long as it takes!" Some go quickly and some linger. You can find averages but that is just that, an average. It also depends on other medical problems. In 1998 when Dad was diagnosed I had no idea it would be a 12 year journey. Given his medical problems... being around for 12 more years was almost a miracle. Mom started showing symptoms in 2003, diagnosed in 2006, and in 2011 she is still going relatively strong. She's past her 8 years. Yet my grandmother only survived 4 years with the disease. Yes, I would like to know how much longer with Mom... but as Meg said in another post, it is what it is and I will deal with whatever for as long as needed. This disease gives us no breaks... we just do what we can

Love, deb

 
Old 09-23-2011, 08:34 AM   #12
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Re: aggression

The hardest part about this survival issue is that it takes a long time in the unknown stressful area... I know there is no 10 years for my FIL who is closing into the latest stage, but there may still be 2 or 3 years although someone would say one year is about.... The thing is not about how long I want to know, it is about planning.
But there is no planning on the survival. You never know. Certainly the money issue is also there - the NH is expensive and etc. Caregiving is stressful too. Handling my FIL's old house and etc. Lots of problems. I am not saying the end will help but it is something that I know will come.
It does not help at some point because it does not help the planning as no one knows how long really...

I feel all the families who are in this are really in great distress. The length of time is definitely one factor.

Take care, all of you!
Nina

Last edited by ninamarc; 09-23-2011 at 08:36 AM.

 
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