Agitation and agression

SuzyGail

Is it normal that my dh is getting almost hyperactive and often resists treatment for various like his diabetes?  What drugs are being used to help them?  I know about Ativan.

JJAz

Yes, start keeping a journal of symptoms and when you notice them.  Make an appointment with your neurologist to decide treatment.  Ativan is sometimes contraindicated in dementia and a neurologist will be in the best position to evaluate. Aggression should especially should be addressed immediately.  Ensure that all weapons are locked up.  Even the kindest person with dementia can become a danger to the caregiver.

Ernie123

I second all the good advice given by Jjaz. Keeping a journal with just a few entries a week is very useful in documenting slow changes that occur over weeks and months. You can then be accurate when discussing your LO with a doctor. My DW of 53 years became quite angry and delusional two years ago. I was unprepared when the first few incidents occurred. An referral to a geriatric psychiatrist helped immensely. He said when anger and violence develop as a symptom of dementia, it is very important to deal with the behavior immediately. He first prescribed Risperidone which helped for a number of months, but when paranoia and delusions returned he switched to Olanzapine. Calmness and contentment returned in two days. I was amazed at the speed and effectiveness of the medication change. Without going into detail about other meds and adjustments my recommendation is to seek the care of an experienced geriatric psychiatrist or neurologist with geriatric experience. There are several antipsychotics that are used “off label” with dementia patients. But due to individual differences sometimes a bit of trial and error may be necessary to find the right drug and dosage. That is why I recommend finding a doctor with geriatric experience. You don’t know what may lie ahead in your future as his condition progresses and it is good to have consistent monitoring by a doctor who can become familiar with his unique symptoms as the disease progresses.

Good luck, I know how hard it is to deal with these transitions. You will find support on this forum. 

Mint

Before I realized what was going on with my mom, I had googled mania in the elderly.  My mother will take no medication of any type.  Would not cooperate at all when in hospital.

NinjaWife

  Agree with Ernie123. 

DH has been in hospital since 03/21/21.  The day after his second Covid-19 vaccination, he woke up scared, cold, shaking, unknowingly wet the floor, and could not follow any directions, stand  or walk without losing his balance.  I called 911 and requested a welfare check on him.  They took him to the hospital on 03/21/21, and he is still there. 

The hospital tried to transfer him to a nursing rehab twice.  The first rehab center sent him back in 3 hours because of falling and agitation.  I blocked the second transfer because he had a BP of 179/81, elevated temperature, elevated Troponin levels and suspected infection secondary to aspiration pneumonia. The new COVID restrictions enacted for health care facilities here recently currently restrict me and my family from visitations. I was called one time to the first rehab facility to calm him down so the first responders could get him on a gurney to take him back to the hospital.

He has seen many doctors, nurses, PT & OT professionals, but the one who provided the most information for helping him through this crisis is the geriatric physician who saw him today.

The Geriatrician noted in his summary that "Family not ready for hospice, wanting subacute rehab though he is a very poor rehab candidate," (this is inaccurate, I requested palliative care first at home after rehab, but hospice care would be welcomed if rehab could not be accomplished.)  I left him a message today that we are most certainly amenable to competent treatment for my DH.  

Here is the Geriatricians summary and list of recommendations going forward:                             

In the meantime recommend nonpharmacologic techniques to help with orientation. Nonpharmacological interventions include:

-          Acknowledge patient's hallucinations without discounting them.

-          Facilitate a sense of safety for the patient.

-          Redirect patient as first-line treatment for any behavior issues, use medications as second-line treatment only when patient's behavior is negatively impacting care.

-          Encourage family visits to help with orientation.

-          Reassurance to family about the trajectory of delirium and how they can assist patient with their presence.

-          Ask family to bring in familiar objects such as family pictures.

-          Sleep enhancement interventions: maintain regular sleep awake cycle, keeping the nighttime dark and daytime bright and stimulating, avoid awakenings if possible.

-          Keep the patient hydrated, and correct electrolyte abnormalities.

-          Optimize nutrition.

-          Have patient sit up in chair for several times during the day.

-          Recommend early mobilization with PT.

-          Avoid benozdiazepines, narcotics, anticholinergics.

-          Avoid restraints.

-          Treat infection 

In addition he noted the patient did not receive his Zyprexa (Olanzapine) last night, spoke with nurse, recommend give now.  It is orally disintegrating so does not have to have intact swallow function.

Bingo!

 

ezy_priscilla

Hi Suzy,

This is a very common symptom in patients with Alzheimers Disease. From experience, its best to try to find ways for them to remain calm instead of arguing with them. If the agitation progresses, there are medications that can be given. You should speak to her psychiatrist to see if they are eligible for these treatments. If symptoms feel moderate to severe, a clinical trial may also be a solution. Sometimes treatments that are available are not sufficient enough to calm the behaviors. However there is a trial right now for patients with agitation. It is a free treatment given to the patients. If you are interested in more information, please feel free to reach out to me or give me a call at 786-483-8162.