LO becoming aggressive

sjohnson

My mom is 91 and in a skilled nursing facility.  The staff are wonderful.  I really want mom to stay at this facility.  But she is becoming aggressive.  She is kicking, hitting, throwing things, yelling mean things.  I live an hours and 45 minutes away and because of COVID, I can't go into the building.  I can see her for outdoor visits; but those are very limited.  And now, she is in the "yellow zone" because her roommate (whom mom doesn't even know is there) was having symptoms of COVID.  So that means I can't have the outdoor visits for 2 weeks.  And it means that the chaplain that she loves won't be able to visit her.  I am afraid her behavior is going to get worse and that we will have to move her to another facility that is equipped with the staff to deal with her aggression.  I am a bit of an emotional mess.  I feel helpless.  I am doing Skype calls with mom; but those seem to make her more agitated.  She is very angry with me.  I don't know what to say to her or how to talk to her.  I mainly just listen and say things like "I'm sorry it is so hard for you right now" and "I love you" and "you are really upset about that".  Nothing seems to be helping.  The doctor did start her on Depakote, a mood stabilizer.  We are hoping that it helps.  Any advice on how to deal with aggressive behavior?  Thank you.

M1

Glad they started the Depakote; hopefully it will kick in.  Seroquel is another option that is usually pretty well tolerated.  It was almost certainly take medication of some sort to handle this.  Keep us posted---

sjohnson

Thank you, M1.  The nurses said that it might take up to 2 weeks before the meds will kick in.  I'm glad to hear of the other medication you mentioned.  I know we might need to try a few of these meds.

sjohnson

Got a call from the nurse at my mom's facility.  Mom has several scratches on her arms and now one on her shin.  She has very thin skin and it doesn't take much for mom to get a good size scratch.  These scratches are coming from her aggression.  She has been trying to kick anything and anyone that comes close to her; that is how she got the tear on her shin.   And the ones on her arms, she keeps pulling the bandages off.  She also won't let the nurses near her to clean the wounds.  I feel like we are just waiting around for the Depakote to kick in.  We might need to hire a personal aide to be with her.  We can't afford a 24 hours aide.  Again, feeling helpless.

MN Chickadee

First make sure her doctor has checked for UTI and other infection. Sometimes something as simple as a UTI (which are common in our PWD) can cause chaos and the only visible manifestation is acting out. Some PWD react more than others in terms of behavior. 

What kind of doctor is treating and prescribing right now? She probably needs a geriatric psychiatrist. This is the type of physician needed when a PWD is violent. They are equipped to tinker with meds and doses to find what works so the PWD can be cared for and have a better quality of life. She may require inpatient care for a while in a geriatric psych unit (not a regular one.) A geriatric unit is staffed by doctors and nurses who specialize in dementia and related challenging behaviors and medications to treat them. Most people stay a few weeks, and then should be stable enough to return to their previous home or facility. In my area the closest geri-psych unit is a few hours away but has been totally worth the drive and trouble for the folks I know who have needed it. Some folks have to be transported there by EMS because they are too dangerous to ride in a car with family. I would consult her doctor to see if you could arrange admission to one unless there is a psychiatrist that does rounds at the facility and can see her. 

sjohnson

I talked to the nurse today and they are doing full lab work on my mom.  They are thinking UTI and they want to see if the Depakote is getting into her system.  On some level, she knows that her brain doesn't work.  I was able to see her today for about 45 minutes.  And after she kicked me a few times and cried a lot, she was able to tell me how scared she is and that she isn't certain if she can do it.  It breaks my heart to see her like this.  But my visit seemed to help a bit so we will try it again.  

I talked to one of the directors about a geriatric psychiatrist.  She hadn't worked with one before.  There is an in house doctor and I a not certain what his area of emphasis is.  The staff is not giving up her and I am so grateful!  They seem very willing to try to figure this out.  I want to talk to the head of the nursing staff about the geriatric psychiatrist.  There's seems to be something besides just her dementia going on.  

Thank you to all of you on this site!  I honestly don't feel as alone as I did!