My Mom is having terror attacks around 1 pm everyday. She is in NH which up to this point all has been calm. No uti nothing showing in the blood work two day ago calmed with pain med and bed rest, got up was fine around 11 started getting agitated by 1 she has full blow Take me home why have you left me here terror so bad she shakes , begs ,pleads. Nh was frantic because they had never seen anyone this paniced neither have I with four I have dealt with. Of course she was ativaned to the max before she calmed down. Which was ok anything to help her. the Nh called me as soon as they saw her getting upset I have been with her for two days. I need ativan. She keeps saying she not going to make it if we don't take her home. Do you think she is experince the end? NO new meds except the ativan . aricept, namanda she is diabetic sugar ok bp ok heart rate 120 plus she has kidney failure and heart failure with meds for those.
I have had agitated parents before but nothing to this point and yes they too were in the nh.
Anyone know anything to help??????
The following user gives a hug of support to hillside6: ninamarc (03-27-2012)
Number one I HATE ativan... especially in high doses. Yes, it sedates them enough in the moment but then they come off the ativan and nothing has changed so you medicate them again. There are also the residual effect of the medication which actually causes more agitation.
I do think she is experiencing something but it may not be the end. There is a trigger somewhere even if it is in her brain. The desire to go home is a response to fear. It is not "home" as we think of it but "home" as a safe place away from the confusion, fear, frustration that she is feeling. She may be having delusions or hallucinations. Her accelerated heart rate indicates a fear reaction of some kind.... as does her request for the safety of home.
I would have her retested for a UTI. Even if the test two days ago was negative it still sounds like a UTI to me. I have seen the UTI behavior appear before the UTI test indicate positive. Ask them to also culture the urinalysis. You may get a positive there even if the quick test is negative.
If the kidney failure is advanced then the toxins can be causing delusions and hallucinations that will lead to the behavior. Pain can also cause the behavior. Watch for the nonverbal signs of pain. Furrowed brow, clinched fist, fidgeting, irregular breathing can indicate pain even if she can't tell you she is in pain. Check her legs she she is laying down for symmetry. Is one longer than the other or one leg twisted. That can indicate a hip fracture which might be undiagnosed. Check for bruises.
With the sudden onset of the agitation I am prone to think it is either pain related, UTI, or a fear response due to delusions or hallucinations. If it is the latter then she needs an A-typical Anti-psychotic medication to control the delusions and hallucination and not the Ativan which can sedate her and make it worse.
What stage is your Mom? I am assuming from what you have said that she is in the later stages. My Mom had similar angst in her mid stages. It was horrible. I needed medication myself But worst was what it did to her. She was miserable I was not a fan of the A-typical Anti-psychotic medications!! I had a total fear of Psych Units as well. But after weeks of such behavior I caved. Mom went to an excellent Geriatric Behavioral Med Unit for 10 days and came back with the right mix of A-typical Anti-psychotic medications. That was 3 years ago and she has been chemically content since.
If this behavior continues place ask the doctor for something other than Ativan or Xanax to control her angst. They are going to hesitate because of the box warnings that these A-typical Anti-psychotic medications do indicate a slight chance of cardiovascular events in the elderly. But this is a light chance when the major risk factor is AGE! In my humble opinion I would rather Mom be content and take the slight risk.
I do feel your pain having been there. Just know that there is a solution somewhere. Please recheck for the UTI first and then ask for something other than the Ativan and go from there My heart goes out to you because I do know how difficult this situation is. Keep us posted, keep venting, and hopefully a solution is close by.
Oh sweety if I could reach out though this computer and give you a hug I would, I have been where you are and they had a hell of a time trying to get my mom regulated, we finally got a placement but she never made it. my mom passed before this happened...you have recived such great advice all ready , I can not add anything. Just hugs
We have rechecked uti, they are doing culture, switched her back to remeron from paxil still have ativan. yes we are in the late stage.
Before we moved her in to the nh we had simliar actions with zyprexa but nothing compared to this she experienced full terrorthis weekend.
Just check she is alittle better this morning. I am not opposed to pys. I have been throught this with my step father/ my father in law/ my mother in law mod stage. My Moms dementia started after heart surgery . It is in the last two years everything has been going down hill. Even through the others where and are family.... Mom is mine. Maybe thats why I am having such a hard time with this. I understand with the med change that her condtion have change too. She just needs to be at peace and have comfort.
The staff has been very attendtive. There has been no new staff , room change or med change before this happened. Just out of the blue.
I assumed right then. You are not new at this but this one is different. This one is your Mom and the person you depended on and are the closest to. Now she is dependent on you and that roll reversal is life altering. I to went through this with my grandmother, my great aunt, several aunts, MIL, FIL, my Dad (which was the one that really punished me) and Mom (who I am still caring for).
What type of dementia was she diagnosed with? Vascular? It started with her heart surgery? Did it start there or was that just when it became acute enough for a diagnosis? Or was it a result of the surgery/heart disease? Dad was misdiagnosed with Alzheimer's for years but he had Vascular Dementia. Mom does have Alzheimer's and there is a difference between the two. Your comment about Mom's dementia starting after heart surgery is why I ask.
Alzheimer's runs a course that is relatively predictable. Vascular Dementia is random and has no set pattern. It is totally and completely tied to the cardiovascular episodes and vascular health. It also presents dependent on the part of the brain that is affected. Dad's short term memory failed him quickly but he maintained the ability to figure things out, read, and communicate. He seemed to decline, remain the same for years, then decline again... all related to heart attacks, stints, etc. I mentioned this because Vascular Dementia is prone to the delusions and hallucinations. They are vivid and real in their minds. Some are harmless, some are upsetting, and some are terrifying. When Dad deluded that his dead brother was there we assured Dad that his brother had already eaten and left for work which satisfied him. That one was an early delusions and relatively harmless. Those concerning his brothers as young children were upsetting to Dad but those related to WWI and being attacked were terrifying. There were other terrors that he never expressed but I could see it in his eyes. He too was on Remeron and a long list of other meds over the years. We changed his meds a number of times to give him relief.
"Just out of the blue" is always baffling!! We look for triggers or reasons. We want to assign cause and effect. But sometimes with this disease we exhaust all the possibilities and it is just about the disease and where it is taking us. I do hope your Mom finds relief and at that point so will you. Just know you are not alone. I will keep you and your Mom in my thoughts and hope to keep hearing from you.
My FIL never really had such bad attack. But he became combative last year when they tried to help him to get dressed or go to the bathroom. So the doctor gave him low dose of anti-psychotic drug. It helps. He still can strike back or get mad quietly but he is not that combative now. He is in severe stage. He also has congestive heart failure. Never tried antivan.
My FIL also has antidepressant. Maybe your Mom needs to take these drugs.
It has been a long week. Mom had vascular but her dr felt maybe since family history combine altz. She would have treated both the same.
There is a new lady who has come into the nh the Friday before attach and her dinning mate died thurs. so between the two maybe this is what set it off????? new lady repeats I have alz so do you no ones coming for me or you ,we are here in this damn nh cause our family left us to die here too. over and over. She is still mobil and walks around repeating this and even comes down mom hall when she can. Yes they are trying to some what confine her but she can't help it and she is on more meds than mom..... I don't know........ found this out the third day when i visited around lunch
And yes we have an uti with stage 3 kid. diease.
Today she thinks I am her mother and can she just go home pleaseeeeeeeeeeeeee.
then I went to mil to fill her meds she had them all out, different bottles different pills, tried to fill it herself her son forgot to take the pill box home.
I am the one who will be on the crazy floor.
I have run out of answers!
This is awful, I don't want to do this anymore. I ache from the bottom of my soul with such sadness.
thanks for letting me once again vent.
The following user gives a hug of support to hillside6: aras (04-04-2012)
Hillside take a big breath. Now as hard as it is take a day off. Stay home and have a gammie day. You are no good to mom when you are this stressed. The uti may be the cause of this behavior or maybe not but if you don't look after yourselfe you will end up sick. Do you have someone who could go in for you, please be kind to yourself. I have been where you are and you will be surprised how strong you can be when you have to. Perhaps when you arrive next your mom will have a wonderful smile waiting for you..
Sending big hugs
The UTI is probably the answer to what is going on with her. It can change the sweet docile little lady into a raging maniac. When there is a sudden change in behavior... my first thought is UTI and it's usually the right thought.
In Mom's unit over the last few weeks we had one that stopped eating and refused any assistance... UTI! We had one that cried all day and didn't know what to do... UTI! We had one that would hide and then smack the other residents when then came close to her... UTI!
The other resident with the rant may or may not be a problem. Even if your Mom hears her, she may not comprehend what is being said, or she might not remember it minutes after it happens.
Know that the desire to "go home" is a constant with just about anybody with dementia. Home is not the home you and I think of. It is a place of safety where they are not surrounded by the fog of this disease. Mom wanted to go home so the sisters insisted that she be taken back to her home of 53 years. Mom didn't even recognize it. While there she ask to go... HOME! So know it is just her insecurities and frustration with the confusion that resides in her head. She wants the fog to lift and this we can not do.
The pill issue is a nightmare. Dad would want to fix his pill box mid week or replace pills daily so he had no clue what he had taken or how many. Mom just put pills in boxes with no rhyme or reason. Even when we fixed the boxes they would manage to confuse them. I finally locked up the spare pills in a metal money box. They we discovered that Mom and Dad frequently took pills out of the wrong box! Her son HAS to remember to not leave pills there for MIL to confuse. You also need a med list which includes the color, shape, and imprints on the pills. Wish I knew the number of times Dad would swap pills between bottles.
Yes, there are times you will think you need a long vacation on the loony farm. It does help to keep in mind that they truly can't help the crazy things they do. They think they are ok. They when they get in the middle of a mess they truly don't have a clue what to do... except make excuses.
Know there are no answers There is just the best you can do in the moment with the information you have and the situation they give you. It is frustrating and difficult but it can be done. Hang in there. Hopefully tomorrow will be a better day and you can find something that will make you smile. Please do look for the good moments as they come your way. Hold on to the best there is and please take care of yourself That is not only physically but mentally as well. Give yourself those special moments of joy to counteract the effects of this disease. Know you can always vent here. We have all felt as you do now. Just hang on
I would like to comment on the lady mate there who told your Mom "we were to die here!"
Indeed it is hard when the mate tells Mom something is wrong.
Well in a way it is - they don't want to be in the NH! There was a guy in the NH where my FIL is, and he often said "something screws up" in the hallway. My FIL heard him once before he went to bed, got upset and told us. I just told him that guy was confused. We separated him from the other guy. My FIL has his own thoughts anyway so he was distracted.
I don't know if the lady stays in the same room, but you can just distract her or ask the caregiver to move your Mom so the lady won't bother her. The trick is to distance her from the person psychologically if possible. Make her realize the mate is "crazy" an ignore her.
oh sweetie it may be time to take stock of what is going on. Sometimes the cure is harder on them then anything else. You will know the right thing todo as most of us faced this and there were some really tuff choices that we made. follow moms cues as to how to go forward and what if any evasive procedures you do. Know that any choice that you make is the right one. I hope mom can have some peace and be pain free. My thoughts and prayers are with you that mom will come through this.
Sending positive thoughts your way. I know this is a very hard road to travel as I am on it also with my Mom. You will make it one minute, hour or day at a time. Just know we all support you and are here for you. Peace and comfort to you and your Mom.
no invasive measure, the labs were worst on fri potassium high she had to be hospitalized found most of this came form dehydration. Gave her fluids, had pneumonia gave antibotics, back in nh today.. smiles..... checked labs better but still Kidney failure she is or was when I left better. Thank goodness.
Sister not happy with hospital visit daughter who is a RN said she must go that she was just sick and she didn't have to die. Sister said let nursing home handle it but if they had she would have died .
lots of choices to now consider, but she is happy today eating and saying her prayers knows who she is if not us.
came close not making the right choice.
How do we or would we live with that?????
Hillside there are no right or wrong decisions. You will have as many opinions as there are people involved. One says you should have done this and another says you should have done that. You did what you did using the best information you had in the moment. You didn't change the outcome... just the timing. You do not second guess what happens. It is what it is. That is how you live with it.
You and the rest of the family need to sit down and discuss what to do from here. Do you give her comfort care or do you proceed with aggressive medical intervention? What are your Mom's wishes? Does she have a living will? Have you heard her discuss end of life treatment related to herself or others? What do you and your family members want? This is not an easy discussion but it will go a long way to solidify what actions need to be taken. These are questions only you and your family can answer. Once you set your course, then you have confidence that it is the right course for you and proceed. It is when there are doubts and multiple opinions that you start second guessing.
Know that no matter what you do, the prognosis does not change. That is why I say there is no right or wrong answers. The only difference will be the time line. An IV may extend life for a while but the basis cause of the dehydration is still there. Antibiotics may extend life for a while but the weakened immune system does not change. Despite all the medical intervention your Mom is still in kidney failure. The stress of hospitalization is difficult on those in fragile health. These are facts that you need to consider. Going in you will not know the outcome. Remember that hind sight is very different than what you see and know in the moment the decision is made. So please do not second guess yourself.
I went through this with my Dad. Perhaps hospitalization could have extended his life for a short time but I also knew (because he had told me in his living will and with his words over time) that he did not want extensive medical treatment. He wanted to be in his familiar surroundings with his family around him.... and that is what we did. We had the hard discussion and all came to a consensus. Perhaps he might have lived a little longer if only... but I do not go there. I know in my heart that we did what was right for him
So have that discussion with your sister and decide what direction you want to move in. Then whatever happens know it was meant to be that way Know I will keep you in my thoughts and prayers for the strength and courage you are going to need.