Combative about hygiene

WhoWantsToKnow

I am taking care of my husband full time and alone since August, when I retired. He was diagnosed with early-onset Alzhemer's in 2014. I don't know stages--what I know is he is healthy and very very very active all day, walking and talking and moving things around the house. He is unable to communicate (though he talks a blue streak of what seems like nonsense but what do I know), and he is not typically unhappy though he is always restless and often agitated or anxious. So okay, I can work with that.

I used to shave him daily, then not-daily because I got pushback, and now never; he won't let any kind of razor or shaver near his face. Okay, I can let that go.

 He used to enjoy a haircut, in part because the ladies knew him and it was a little social event, but last time I had to abort as he kept putting his hand in the way and jumping up, trying to leave. These ladies don't get paid enough for that. (My son and daughter-in-law did get him trimmed at home with patience and in stages a couple weeks ago.) Okay. So that's hard but okay.

I used to brush his teeth twice a day and floss once. Then once a day. Now he won't let a toothbrush near his mouth. We haven't been able to brush his teeth for about a month now, except a couple of times that we brushed side by side, with him taking his cues from me. But now, nothing. So that's not okay. Since he can't communicate with words, I am very worried he'll develop a problem with teeth or gums. I'm trying to find a dentist who will 1) take my insurance and 2) do sedation dentistry. If he won't sit for a haircut, he certainly isn't going to sit or cooperate with a dental exam or cleaning. Is anyone else resorting to sedation dentistry? I expect to have to pay for the sedation, I just need someone who has some experience with special needs--I think.

Next problem is showering. I see that showering is an issue for everyone, so I get that. But he is so panicked and combative, even though we only shower once a week, and even though when we discuss a "nice hot shower" he agrees that would be nice. But once he's headed for the bathroom and suspects or realizes I'm trying to shower him, he fights for his life. Yes, it's warm. No, the fan is not on. He fights stepping in (no, there is no overhead water). He fights getting soaped. He grips my wrists like he'd like to snap them in two. My shoulders and elbows are both wrenched and painful. My back is tweaked. Once I hand him a towel and he steps out, he's happy as can be and humming, while I'm weeping in a corner and using my rescue inhaler. This is not okay.

He has also become this combative about removing jeans before bedtime. I need them off so he can have a fresh depends for the night. He acts like I'm trying to take his virginity. (Morning changing from flannels to jeans does not have this effect on him, btw.)

I've also stopped doing curbside pickup of purchases--except groceries, I have no choice as no one delivers to our rural address--because he becomes extremely agitated and combative waiting in the car for more than a minute. I end up circling the parking lot just to keep him from tearing at the seat belt and trying to open the door.

Our primary doctor prescribed Ativan (spelling? anyway, the generic) and suggested giving it to him 30 to 60 minutes before the changing or showering. I am uncomfortable medicating behavior but I'm desperate and I've been trying that for a week--to no avail.  He is on a short wait list for an assisted living/Memory care facility nearby, but I am very concerned that his combativeness, besides injuring one or both of us in the short term, will put his placement in the facility in peril. Plus I would really prefer that his last weeks or months at home are not a daily war zone. I don't know how to salvage this.

LicketyGlitz

This is so common, Who, most caregivers go through this. Do not feel guilt in trying different meds to help you both out. He's afraid, you're miserable, if you can find a med that will help alleviate some of that for both of you it's a much better situation. It won't get rid of combativeness altogether but it will help ease some of the battle fatigue for you two.

How long did the doctor say the Ativan would start taking effect? We used seroquel for my mom and it took about a month before we started to see real results. In that time we worked closely with Mom's geriatric psych doctor, adjusting doses and dosing times to get it right. Keep checking with his doctor if you are not seeing any improvement for help on increased dosage, or trying another medication.

Also, if you do have access to a geriatric psych doctor ask the PCP for a referral. These folks specialized in medications for elderly, often experts on meds for cognitive decline. The PCP may not, and should be happy to pass you on to someone who can work more closely with you and your husband.

One thing I had to learn with my mom is that the normal hygiene routine no longer applies! If I could sneak a shower in on a morning when she was in good mood I gave up on her routine of showering at night. If I could get a toothbrushing in even once a day before a meal, I'd consider it a win!

Oh, and a trick we used was getting duct tape about the same color as the car interior and we taped over the door handle! Mom's perception was pretty askew by then and she could not see the handle with the duct tape over it!

I do recommend looking at the stages of dementia to help you understand where he's at and what else might be coming your way. Here's the site I consulted the most through Mom's journey: https://www.dementiacarecentral.com/aboutdementia/facts/stages/

I found the Function Assessment and the Clinical chart below it to be the most helpful.

Hang in there! Hygiene is the absolute worst when dementia folks are going full-throttle into the rage stage! Keep looking for tips and trick, but don't turn away medication, you two need all the help you can get.

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Doityourselfer

Early onset Alzheimers disease is a nightmare.  My 62 old husband was diagnosed in 2016.  He was very active at that time, had and still has hallucinations about people being in our house which causes him to become agitated.  He is on Seroquel 300 mg, Zoloft 25 mg, Trazodone 50 mg, 10 mg melatonin.  

He is totally incontinent.  I dress him in easy to put on clothing only.  Every morning before his breakfast I ask him if he wants to take a shower.  If he says no, then we'll wait until the next day.  He typically ends up showering every other day.  Not always easy though.  When he's in a calm state I can shave him, cut his hair and clip his nails.   

The only things he can do now are feed himself (no utensils), and  walk slowly.  Sometimes he doesn't know how to hold a cup or water bottle so I help him with that, as well as brushing his teeth.  He's progressively getting worse and is sleeping more.  No longer goes to the dentist but he has great teeth, eats an apple and carrots everyday which seem to help clean his teeth because he doesn't let me floss them.

When he becomes combative I let him be until he calms down. 

It sounds like you have a good attitude though.  If you post in the Spouse/Partner forum I'm sure you'll find a lot of good suggestions. 

Battlebuddy

   “ He acts like I’m trying to take his virginity” 

   That made me laugh.  Getting that at home too. He won’t take his underwear off to shower because then he would be naked in front of me .  ( I’ve seen it all) So I place him in the shower in his underwear and when it gets wet I’m surprised . “ oh these got all wet so let’s take them off “and there I am pulling on them and he’s pulling on them holding on for dear life. 

    The crazy things we go through lol. 

KatieKat1

  hoWantsToKnow -- your husband sounds exactly like my husband and I can so understand what you are experiencing! Everything you mention was exactly how my DH was - but things are getting better and it has taken time.

My  DH appeared to come down with this disease that seemed overnight.  He was 78 - now 82, when he started having driving and memory issues.  I am the one who took his keys away but told him he lost his keys, and I always keep the house and car keys on me so he does not take them.  At this stage he would have issues trying to figure out which keys go to what and would probably break the keys or locks trying to jam any of the keys into a lock that was not meant for that key.

 It is getting more difficult to get DH into the vehicle these days.  I had to purchase a cover for the seat belt so he could not click it open (found on Amazon) and put tape on the passenger side door locks.  If I could get him to sit in the back seat there would be no issues but he will not do this...did it once and he will have no more of that.  I also have some small steps for him to put his feet on when he tries to get in the vehicle, but these days he will not get in or it will take half an hour to get him into the front seat.  If I am lucky enough to get him into the vehicle I make sure I have his favorite music playing and anywhere we go has to be quick.  We pick up the groceries that are delivered to our vehicle at the store, and if we go to the Doctors they have to take us quickly or he is out the door and will not sit for more than 5 minutes.  We are not doing some on-line visits with the doctor and I am thankful for that because it is a struggle to take him anywhere.  I know all about what you mentioned with trying to escape from the vehicle, and he likes to play with the electric windows and touch everything.  It is not easy dealing with this when we are the driver and being so distracted!

 We now have him on Seroquel and Celexa (but generic versions).  The Seroquel works some of the times and I think the Celexa has taken away much of the combativeness.  Husband was very combative and negative of me doing most things for him.  In his mind he must have thought he could do these things on his own since he was a man with an independent mind, but in reality he needed help with most things, and now he needs help with toileting (wearing adult disposable underwear), and we only do sponge baths in a chair with lots of towels (when he is in the mood). 

 I now look for the easy way to do most things for him because anything that takes a lot of fuss and can be stressful does not help either of us.  When he is sitting and calm,  I wash his hair with a clean and warmed wash cloth with a bit of no rinse foam soap, and I also cut his hair (that he does not have much of any longer) since he would never sit for a barber these days.  Sad to say, I rarely make large dinners for us because there are many times he just won't eat but a few bites and we end up with throwing out too much.  I have often resorted to Stouffers frozen dinners that are quick and can be microwaved, and some of them we can share if I buy the larger portions. The also have a meatloaf and other soft meats that are easy to chew since he no longer chews as well. Less time in the kitchen means more time I can keep an eye on him. 

 I do find that my attitude, as most will tell you on this forum, makes the difference when trying to help our loved one.  Whether I feel cheerful or not I have to put on that happy face...but not always easy.  Some days he is into everything and tries to climb our backyard fence to get out since I now have locks on all the gates (we have an enclosed fenced backyard).  Thankfully, we do have an enclosed yard that was for our dog because now it keeps the husband in one place without me searching for him.  He has a strong will and if he is not in a good mood he decides to not eat, not cooperate in any form, tries to escape and just does things that are frustrating for me.  

If I can get him to take his Seroquel with the Melatonin at bedtime than he will sleep through the night most of the time.  If I can put the Seroquel in a drink (not alcohol) or a snack around 3:00 PM it will cut back on his sun-downing,  He does not want to take any pills and so I have to hide them in food or a drink.  If I do not get the medication into him he can be very mischievous and irritable and the sun-downing will keep me on my feet for at least four hours while he moves the furniture around, carries lamps from room to room and sometimes tries to remove the toilet seat. I have found that if I can give him several small items to fold he will do this for a while.  I found multi-colored thin and cheap washcloths to give him for folding.  So far he still will do this and keep his interest for at least an hour.  

I have had my husband to a Neurologist for 3 years and they can do some scans but it is mostly about his physical and mental situations that are discussed, such as a watch for Parkinson's Disease (that DH does not have so far but his brother did), and how he walks, and what he can or cannot understand since he has Primary Aggressive Aphasia and so he cannot talk in sentences but he comes out with a word or two every so often that does surprise me.

We do not have a Geri-Psych doctor is in this area and would have to drive 5 hours to find one, and so between the Neurologist and Dr. of Internal Medicine, we are just focusing on the medications and husband's health/behaviors.  Disease gets worse with time but for now we try to not get him agitated, keep him on meds (especially at bedtime so we can get some sleep) and make things easy for both of us since I am still his primary caregiver and so far I have not had to have extra help, but our daughter is a registered nurse and has worked with patients like her dad and she will help out if I call upon her but have not had to do very often especially since she works and has three children.

I will say that if your husband will be on meds it is always the trial and tweaking of them, or changing them as he progresses because I have had to have this done a few times.  The doctor wanted to put him on Valproic Acid for the combativeness but so far we have not had to resort to this.

It often takes time to get things working for you both.  It has taken a few years to get it into my mind that this is the way it is going to be and I have to find some solutions that work for both my DH and myself with less stress.  

And as Lickety says - Hang in There -- Keep asking questions on this web site and everyone here is so supportive and will have suggestions and maybe solutions to get you and your DH through all of this.