Hello Everyone – I have a situation on my hands and I’m not really sure how to handle it. I’m hoping someone here can help. My dad is currently in a nursing home with Alzheimer’s. Within the past month he has become very agitated…to the point where he has hit a resident and kicked an aide. The nursing home told me that if this behavior continued, they will have to discharge him. When the first incident happened, I talked with his doctor and he increased his risperidone by half a mg. All was fine for a few weeks until the other night when he kicked the aide. Tonight he is very agitated and took a swing at the aide while I was there. Should I have said something to him right then and there? My feeling was that I didn’t want to agitate him further…. and what’s the point of getting on to him and agitating him if he is not going to remember later. My husband feels as though I should have said something to him and keep reminding him that he cannot hit or kick people. What should I do?

Any advice is very much appreciated.
Thanks in advance,
Marsha

Hi and welcome!

First of all, in my opinion, you did the right thing by not confronting your dad. Confrontation will usually onmy make matters worse. And you already know that repeatedly correcting him isn't going to work since he won't remember and may not always understand that his actions are not appropriate.

My grandmother was combative in the nursing home. My dad (alzheimers) was like that when we moved in with him. I've had my fair share of fists drawn back at me. His geriatrician put him on Zoloft. She told me that sometimes this drug works well in calming down the combativeness. Dad has calmed down a lot. In fact, he hasn't drawn his fist at me since then.

I'm so sorry you're going through this with your dad. Do you know if he has any new aides? If anyone caring for him doesn't understand (and I don't mean classroom understanding but hands on experience) AD and dementia, that could be part of the problem.

Bottom line, you did nothing wrong by not correcting your father. Please don't feel bad about the way you handled it. If you had corrected him, it may have made matters worse.

Take care of yourself and please post back. This is a great place for questions, moral support and venting.

Love, Barb

Barb – thanks so much for your quick reply. My dad is on Zoloft and when the doctor increased his risperidone, he also increased his Zoloft. The aides that are working with my dad are the same aides since he moved in on the 1st of June. There are residents with Alzheimer’s in the nursing home…so I believe they do have the ‘hands on training’ for Alzheimer’s, but none of them are combative…so maybe there is a lack of training in that area. The social worker told me that if they did discharge my dad I could place him in a facility that specializes in Alzheimer’s, and that may be the best place for him. But I don’t want to move him! He is 5 minutes from my house now…I’ve gotten to know everyone at this nursing home…and it’s top rated! I can’t imagine having to place him somewhere else, but I’m afraid that I may have no choice in the matter if his behavior doesn’t change.

Thanks for helping Barb,
Marsha
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Welcome MHAD .. first of all, sorry you have to be here, but at least you are amongst understand and friendly people. We have ALL been in your situation, of course in various forms, and, above all, remember, you are NOT alone OK?

Depending on what TYPE of Dementia your Dad has, his increasing violence could be because of that. Not that he WANTS to hit out and hurt people, but that's his frustration and his only form of communication. He's making DAMN sure, everybody knows he's not happy. Why? That's irrelevant in his world. He just knows he's not happy, but he DOES know how to get his point across.

Here in australia, we call it "chemical restraints" which is where they are medicated to levels where they are controllable. No, it's not done for everybody, because we all have our good and bad days, but it is done for the chronic violence. It has to be, for the Occupational Health and Safety Standards of the Residence for their staff, and for your Dad's safety as well. He could well hit out at something and hurt himself badly.

Maybe he is becoming tolerant to his antidepressant and needs a higher dose or a complete change in medication. My MIL was on Zoloft for 3 days and refused to take it (tummy ache) perhaps your Dad has a tummy ache and doesn't know how to express it, so he feels something is 'wrong' and he's frustrated and hits out. Perhaps he has an ulcer under a denture, can't explain it or even understand it, but eating hurts. His way of communication? Yep, you got it, hitting out. The nursing home MUST look at other avenues, especially if he has been a quiet patient before hand. He could be visiting other peoples rooms and taking THEIR medications!! (It's not unheard of) which means he could have a chemical imbalance.

Now, your all going to think I'm going loopy myself, but a full moon DEFINATELY does something to the dementia patient. My FIL's nursing home goes into immediate lock-down 2 days before a full moon and 3 days after. The Dementia residents go absolutely nutty. (This is, of course, killing FIL, who has almost all his faculties LOL -but he's another story). Having talked to nurses, doctors and staff at various nursing homes over the past few weeks, the moons phase has noticeable issues with their charges.

And .. by all means, if he hits out at you, say very firmly in a strong voice 'DO NOT HIT ME' .. do the voice, the facial expression and the body language. You will eventually get it down to a sharp "Ah" and he will (might) back down. Then again, if he's determined to hit, just make sure your out of range (this comes from me, having been hit, I have learnt to duck and weave and stand a respectful distance if it's going to even remotely happen) This isn't to say that you didn't handle the situation wrongly, you went with what you thought best. I don't know your Dad, but I would try being firm if it happens with you again. It can't hurt, you can only do your best, and that, my dear new friend, is what you are doing. Your best. Nobody can ask anymore of you than that.

Ugly? Yes
Will it improve? Probably not
What can you do? Learn coping skills from us
Choices? Not many, but I do emphasise pro-active communication with the residence and forcefullness on your Dad's wellbeing.

Goodluck, do let us know how you get on

Hugs
Sally

Mhad,

We have tried several medicines with my mother who still lives with my father. She has never been violent, but she was highly anxious until we recently gave her 5 mg. of Lexapro a day which really helps her calm down. She is a small woman (so she probably would need less medicine) and had never taken medicines until a couple of years ago when she started on a memory medicine. We have tried many medicines for her memory, anxiety and sleep and this finally seems to be helping (after two years of trying). I wanted to tell you that the risperidone (sp?) plus an antidepressant (Effexor I think) made her even more anxious, so we quickly took her off that. We wanted her to be less anxious without being groggy and we've been able to do that with the Lexapro. I hope you find something that works for you.

Deb

Could he be in pain? Does he have his own teeth? Something like an infected tooth or something internal could cause him to act out. I agree that something probably triggered this change in his. Do check to see if there is a change in the staff. I don't want to suggest that someone might be mistreating him but it wouldn't be impossible.
Correcting him won't help. He just can't process it.

Hi: I haven't been on the list long, but my mom - 4'5" all of 88 lbs. is VERY combative - has been for the past 3 yrs. and is in an ALF. She hates being bathed and this little woman actually pulled the handicap bars OFF the wall in the shower !!!! she has back handed me - for no reason - bitten - kicked - picked up a brush and beaten aides. She is not AS combative, but her condition is worsening too - sorry I probably wasn't much help, but I've been there too.

Eileen