My brother and I help manage my grandfather's at home health care. My brother is his legal guardian. We will never put him into a nursing home. My grandfather has increasing dementia. Though he still recognizes his family, he's increasingly agitated with his caregivers. He does anything to sabatoge their help, by blocking doors or trying to fire them on his own. I do weekly assessments, to help manage the situation, but I"m not able to stop my grandfather's irrational verbal assaults on these kind helpers. He is unaware of its' consequences, in that it's all dementia-based. We've had Caregivers quit, because he can be so rude. We keep hoping some of the Caregivers will stick around, for the duration. Has anyone else had a loved one, who has had no control over his/her speech and has become verbally aggressive? How have you handled it? Thanks for listening.

Dear WMK

Many of us on this Board have had a similar situation. It is especially difficult when the patient is aphasic (unable to use speech normally) .. their frustration makes them even more angry and difficult to manage than the AD patient with normal speech.

I applaud your attempts to care for your Grandfather at home ... for as long a is possible. But please, do not rule out a nursing home altogether.

I was one of those people who said "I will never put my Mom in a home!"

Well, things just got worse and worse, and eventually she did land in a home. It was something of a miracle to all of us in the family that she adjusted to the NH so well. In fact in her delusions she thnks it is an expensive private club with a Swiss chef! She enjoys the activities and thinks her fellow patients are her oldest friends. In reality she hasn't been there quite 1 year yet.

She gets the best of professional care, and they have the techniques and ways of handling all the strange behaviors of AD patients. It is safer than being at home or with a family member. She is safe, warm, well fed, clean, all her health needs are taken care of, her medicines given regularly, she cannot burn herself (or the house down) or wander off and get hit by a truck.

Good luck to you - do stop to consider a NH - they are not the bad places we have in our imaginations based on those of many years ago!

Love,

Martha

We too have had this problem. I believe there is a trigger for this behaviour and that you may sometimes be able to discover it by talking to your grandfather, or the caregiver.

In one case the caregiver agency called me to tell me that my SIL had so badly verbally abused her caregiver that she was physically afraid to go back and hadn't stopped crying all day. This particular caregiver is one SIL has had for ten years - she knows her and loves her (not to mention the caregiver is twice the size of SIL). I was glad they told me so that I could follow up with both the caregiver and SIL. I was less than impressed when I realised the reason for the call was not to let me know what happened, but to get me to change SIL's behaviour so I could give them an assurance it wouldn't happen again.

In that particular case I was able to find out from SIL that the trigger had been the caregiver using a vacuum cleaner. I understand people suffering from dementia can sometimes be very sensitive to loud noise. BUT, of course - that is something we can't do a lot about. After all, the woman is being paid to do the vacuuming, and we can't have SIL sitting in a pile of dust.

As you obviously appreciate, you can't change his behaviour, and neither can he. You may be able to figure out what is causing it and that may be a help, or not. If, for example, the trigger is that he doesn't like having strangers in the house - then there is nothing that will change that. Or it may be something that you can act on. Stress and insecurity, in my experience, are factors.

I would urge you too though, to think a little ahead. This type of behaviour can sometimes translate into physical aggression. I know someone who was so opposed to putting her father into appropriate care that she thought it entirely understandable that he chased her sister down the street brandishing a broken bottle (it was her sister's fault - she 'answered back'). The police begged to differ on that. And, it was entirely understandable that her father punched a caregiver (because the caregiver had tried to physically restrain him from crossing the road). His doctor begged to differ on that and mandated him into high security custody for violent psychiatric patients.

As you know, neither you nor he can control this situation, and there may come a time where your grandfather is causing more harm to himself and others than is reasonable. So a little bit of foward planning may save you and your grandfather a lot of heartache in the future.

best wishes
Georgie

My brother and I have done all the above. I have weekly assessments, determining the triggers; etc. We have 24/7 at home health care, with a number of caregivers. In fact, we treat the environment like a nursing home, as much as possible, with all the necessary senior friendly furniture, beds or whatever else may be helpful. He has a driver. He goes on outings. I've researched dementia in depth, and I know I can't change his behavior, thus, I strive to find out what triggers it. It's based alot on anxiety and lack of control. He was a very independent man and refused to retire. He's very lucid with his family but agitated with anyone else. One trigger is that he's increasingly nervous about people coming up from behind, for example. Fortunately, we can afford the best of at-home care, but I just feel bad, when he irrationally criticizes his help and calls them names. Thanks for your support.

It sounds like you have everything under control.

In my case, we could only afford a home health aide for 6 hours a day which covered mOST of the time I was at work. Mom was alone for 3 hours, and I was crazed with worry abut fires, getting lost, etc. All night long she kept me awake, and then I had to get up and go to work.

The first 3 months in the NH were paid for out of her life's savings, and now it is all gone. Medicaid kicked in. I have to marvel at the way life works - at this point in her life, poorer than ever before, having lost all her money to her own health care, Mom is probably getting the best medical care of her whole life.

In the end it doesn't depend on money, but on how you deal with the circumstances, and making the best decision for you.

As you have seen, there is nothing you can do to change Grandfather's behavior. If anything, it may get worse for awhile, before he enters a passive stage where he is not a threat to anybody.

God bless you!

Love,
Martha

I hate suggesting medication because I'm a believer in not taking medications unless absolutely needed. But it sounds like your grandfather may need it.

I was reluctant to ask the doctor about medication for dad's aggression. Dad was on so many medications for different things. I didn't want to add to that. But the time came when I had to, for my own safety as well as his. He would punch walls and draw his fist up at me. I was his sole caregiver at the time. I became afraid of him. Finally, I gave in and told the doctor about his aggression and my fear. She prescribed an antidepressant for him. She told me that studies showed that anti-d's seemed to calm the aggression in AD/dementia patients. I was desperate. I didn't want to put dad in a NH but it was becoming more and more clear that he was going to be a danger to all if something didn't happen soon. So he was put on Zoloft. After a couple of weeks, the difference was clear. He should have been on it long before. No more fits of rage. No more fists drawn or walls punched. He was almost back to his old self. Now he's with my sister in another state. His doctor there saw no need for him to be on anti-d's and now he's back to where he was a couple of years ago with the aggression/agitation. Only he's worse now because the AD has been progressing.

If your grandfather isn't already on anti-d's, it's worth a shot to try a low dose of it and see if that helps. I know my dad was happier and to me, that's what mattered the most.

Love, Barb

Just another thought in case it is of any use - if he is being startled by people coming up behind him - might he be having a hearing problem?

regards
Georgie

His hearing is probably failing, but, I also think people approaching him from behind is enough to agitiate him. I try to put myself in his shoes and would also feel nervous about that too. Now, I try to encourage the Caregivers to walk towards him, even if it means taking the "long way" through the house. We have spoken to his doctor about anti-depressants and sedatives. He was on an anti-depressant for awhile, but it didn't seem to help. As of now, his doctor doesn't want to give him sedatives. I've recently discussed this with my brother, his legal guardian, and I'll probably bring it up again, since my grandfather's behavior is changing almost weekly now. When I'm so stressed out, I, then, feel so fortunate that he still knows who I am, but, his verbal assaults towards the Caregivers is a constant source of anxiety. Reading the other posts here helps me feel less alone. Thanks for listening.

I've heard that some people have had to change anti-d's a few times before they noticed a difference. We really lucked out that the first prescription worked for dad.

Try not to take the verbal assaults personally. I know that's easier said than done. Believe me I know. But if I let everything my dad called me and accused me of get to me, I would have been in the hospital from stress.

Take time to take care of yourself. I'm glad there are two of you to watch over your grandfather. You have each other for support.

Love, Barb