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Old 12-05-2011, 08:28 AM   #1
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please help with info

so yesterday my mom had another hissy fit in the morning, again, so this time they gave her ativan. I asked what happened, and they just said that she started getting aggressive and out of control and so they gave her some ativan in the morning and then closer to noon when it appeared not to be working or kicking in they gave her some more. now I have read that ativan is not the greatest drug of choice and i will be talking to her dr. this morning and I want to arm myselve with info on this so i can be reasonable. If i under stand this right, ativan is a quick fix and may cause more problems then it is worth, it acts like an upper and then the person crashes and then really can be in distress, worse then before. Can you guys tell me what has worked for your mom and dads. I feel like I swiming neck deep here, I need to do this but not sure what I need to do....I tried a search but there is so much info on this board and I need this , this morning, so please tell me your experiences with Ativan and what did you do..

 
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Old 12-05-2011, 10:08 AM   #2
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Re: please help with info

Ativan actually acts similarly to Alcohol. It has a depressive sedative effect to control the anxiety. It also has a short life. It acts quickly but doesn't last long. This is one reason they say they use it but that is not what a dementia patient needs. The med does sedate. This creates a fall risk and loss of cognition which you do not need with dementia. The side effect list is long. I had a doctor say recently that Ativan and Xanax should be taken off the market, especially for the elderly because the elderly are more sensitive to the effects and side effects of these meds. It can have what they call a Paradoxical effect. It creates the very symptoms that you want to eliminate. This happened regularly with Dad. This medication given to eliminate his anxiety and combativeness actually created more anxiety and combativeness which went away when the medication was stopped. It also takes longer for these meds to metabolize through the elderly system.

To be honest the anxiety you are seeing need to be evaluated not from your Mom's point but from the point of the care staff. How do they handle her when she is anxious? Are they creating the anxiety in order to get their task done? I know they need to get her changed and ready for the day but... are they forcing the task and therefore agitating her?

Let me explain. The aid goes in to get Mom cleaned up. Mom says no but it's time according to the aid's schedule. So the aid starts cleaning her up and Mom resist. This is demented behavior. The appropriate way to deal with it is to appease, distract, come back and do it later. But due to time restraints and schedules the aid presses on further agitating Mom. Mom finally strikes back. Mom is agitated and aggressive? Or is Mom just responding to the outside stimuli? Is the anxiety Mom's or is it a product of "getting the job done"?

A big problem with this type of med is that they may be sedating to compliance rather than actually dealing with the dementia. As a result you get sedation, fall risk, potential paradoxical effects (it gets worse and not better), lowered cognitive ability, and the roller coaster effect of an ativan drunk followed by an anxiety rush hang over.

Love, deb

Love, deb

 
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Old 12-05-2011, 09:37 PM   #3
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Re: please help with info

well the doctor finally called back while I was up at thehospital, took him to task about the ativan and told him that i did not want my mom having it and that we should be trying to figure out a maintenace cocktail, not wait until she has a meltdown. The doctor agreed with me, what else could he do, so we are now getting a S.O.R.T team to help figure out the best for my mom... I am not to sure what this is about but from what I can understand it is like a care team consisting of different people. this should be interesting....

The Seniors Outreach Team (SORT) provides services for individuals 65 years of age and over with mental disorders and/or age-related changes in behavior or function, I just looked this up, kind of closing the barn door after the horse is out, but it has to be a step forward...

 
Old 12-05-2011, 11:20 PM   #4
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Re: please help with info

Good for you Jags You did great!! It is easy for the doctor to throw a band-aid on a behavioral problem. It is up to us to know our loved ones and what they need!! This team is obviously designed to do just what you need. I do hope your Mom finds relief ... and you as well! Keep us updated! Just wish you had them sooner... but be thankful you have them now!

Love, deb

 
Old 12-06-2011, 09:06 AM   #5
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Re: please help with info

can't happen soon enough, was called up to the hospital late last night, mom was starting another meltdown, i got there before it got out of control and calmed her down and then put her to bed, she was so tired she feel asleep quickly, then I stayed for another 3/4 hour to make sure all was well . have not called yet this morning to see how things are...come on sort team bring it on...

 
Old 12-06-2011, 10:44 PM   #6
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Re: please help with info

Ativan is one of the many drugs prescribed by my husband's geriatric psychiatrist. It works well to calm him down when he's having a particularly difficult time. He will doze with it. He started it about a year ago. (At that time, he was still walking and he would have been a fall risk if he tried to walk while taking the Ativan.) It is only used by our NH in the periods of greatest stress and behavior problems.

Unfortunately, even the best facilities don't have enough aides to give patients one-on-one time to calm them down without medication. One of the aides in our NH could sometimes take DH to a quiet room and manage to calm him without Ativan. That aide wasn't always available, however, and sometimes the facility is having problems with more than one patient at a time. Some of the aides were afraid of DH's outbursts, and expressed fear for other patients. (DH did not adjust well to other patients coming into his room or invading his personal space. He was particularly angry about women patients who thought he was their husband.) In our case, Ativan became the difference between keeping DH and saying that the NH couldn't manage him anymore.

Personally, I am grateful that Ativan helps DH to doze through a periods when he's having a lot of stress. I'd rather that he be dozing than be anxious, angry and afraid.

 
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Old 12-07-2011, 02:22 PM   #7
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Re: please help with info

more from the other night when I was called to the hospital, one of the first things I asked my mom, after reassuring her, was did anything hurt, she said her leg hurt, I started to massage it and found that she had one of the worse charlehorse in her calf that I have ever seen, I get them on a regular bases, wow, it took 1/2 hour of massaging and many hot towels to ease the charle horse. I brought this to the attention of the nurses and told them although she said her leg was sore and they gave her some tyelnol that it had nothering to do with her hip replacement, that in fact she had an awlful charlehorse and probably had sat with this pain for some time... ugh!!!!!!!!!!!

today....
Went up to the hospital first thing this morning, thought I would change it up and keep them on their toes... anyway the Director of Patient Health care saw my mother and myselve in the cafetirea and came over and told me that the sort team would be starting their assesment later today.... they assess what kind of bed she needs, what kind of railings, what kind of care and so on.... this is a good thing, oh by the way my mom was a happy camper this moring. ya....i understand so well now that a good visit just makes it so worth it... i will take smiles every time...

 
Old 12-08-2011, 09:31 AM   #8
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Re: please help with info

I have learned that behavior is their communication. They can not verbally articulate emotional or physical pain so that is the first thing you look for when there is an acting out behavior. Sometimes you can't find the source but if there is a dramatic change in behavior I would put my bets on something hurting or irritating. I include in that the emotional distress. Losing independence, confusion, loss of abilities... that's enough to make anybody stressed and anxious!

I am glad the SORT team is on the job and hope they come up with a solution to what your Mom needs. Yep, those good days are what we hang our journey on. It is the good days that drag me through all the rest My wish for you is for more good days!!

Love, deb

 
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