Aggressive behavior w/ Aides

Kincade

Hi everyone - I posted a message a few months ago re: my 96 year old Mom threatening one of her aides.  At that point she had not put her hands on anyone.  At the suggestions of some in this group, we put her on Risperidone and 50 mg Trazodone.  She seemed to be doing better, but lately she seems to be entering a new phase as she does not recognize me, my wife or sister.  The confusion is getting steadily worse.  This past weekend she put her hands on one of the aides which has my obviously really concerned.  She has 24/7 aides and 2 aides do 90% of the hours and then a few others fill in over the wkend.  The agency is starting to have a hard time finding the aides to fill-in on wkends b/c they cannot handle my mom's confusion/delusions.  Now that she put her hands on one of the fill-in aides, I am not sure what to do.  I do not know if the aide is going to report this to the agency, but regardless I am concerned that we might get to the point where the agency says that they cannot provide aides anymore over safety concerns.  We could put her in a nursing home, but it breaks my heart to think of her sitting there alone and probably being pumped full of meds to make her behave/sleep.  But it seems like the only alternative is to keep her at home and pump her full of meds so she behaves/sleep which is also very sad.  If we do try to keep her at home, has anyone had experience with stronger meds that can calm her down?  I just dont know what to do anymore.  Every day gets more and more sad.  Any suggestions/advice?

dayn2nite2

I think caring for her at home has come to an end.  And BTW, they don't have to "pump her full of meds" to keep her from attacking other people.  Might she need a geropsych admission to get meds straightened out?  Possibly.

While it may break your heart, the safety of the people being brought into the home needs to be taken into consideration and really, if I'm an aide and had the choice between 2 assignments, 1 where the patient is fairly compliant and 1 where the patient is aggressive, guess which one I'd take?

King Boo

Taking a lot of medication is sometimes clinically indicated.

But the term you use 'pumping full of meds' tells me you perhaps have taken a little too close to heart a tale of a bad nursing home, or someones bad experience.

The proper 'cocktail' of medication in the hands of the correct prescribing physician specialty (Geriatric Psychiatrist MD) is a game changer.  It is not only to make care safer and easier for aids; it has an impact on the quality of life for your mother.   It is miserable for her to be angry and striking out.   Medication can also soothe her moods and increase her quality of life for the better.  

Reframe medication as a good thing; reframe the prescription of such medication with a geriatric psychiatrist so you have peace of mind they know their stuff; reframe things as it can take time to determine the appropriate dose/mix of medications.

Reframe things - if this is not addressed, you will loose your aides.  If this is not addressed, it will be hard to find placement.  If this is not addresssed, there could be liability.

Above all - don't blame yourself for this disease that happened to Mom.

Good luck.

PS-Anti anxiety medication was an amazingly good thing for my LOWD.  He benefited, I benefited, his caregivers benefited.  

Kincade

Thank you.  The "pumping full of meds" comment referred to a two week stay my mom had in a nursing home after a bout with pneumonia.  I dont recall what they had her on, but she was basically sleeping most of the day and seemed like a zombie as did most of the other patients.  We do have an appt with her doc to discuss other possible meds but we really have not had much luck with medication

harshedbuzz

Kincade wrote:

Thank you.  The "pumping full of meds" comment referred to a two week stay my mom had in a nursing home after a bout with pneumonia.  I dont recall what they had her on, but she was basically sleeping most of the day and seemed like a zombie as did most of the other patients.  We do have an appt with her doc to discuss other possible meds but we really have not had much luck with medication

I would suggest 2 things. Make an appointment with a geriatric psychiatrist- they are the specialists with the most expertise in prescribing psychoactive medication in the elderly/PWD. Often they will approach behavior with a cocktail of medications at lower doses to avoid side effects and sedation. 

I would also encourage you to tour some MCF and SNFs. What you are describing in terms of zombie patients isn't typical of any SNF I have been to. There will be certain patients who are very sick, actively dying and in end stage dementia, to be sure, but there should also be people who are ambulatory and doing rehab of various kinds. 

HB

Fairyland

I feel the need to gently add that someone in their 90’s (or anyone) with pneumonia would and SHOULD be sleeping a lot, even with no meds. It’s normal and necessary to recover from illness.