Stage of Vascular Dementia and Depokote

CateM

Hi All

I have posted here although infrequently. My 95 year old GMA has vascular dementia and mom and I and a small team of caregivers care for her in an apt she shares with my uncle at a senior living community. She gets the best care we can provide to her.

Grams mobility is limited. She can walk with assistance, no longer speaks, is incontinent yet is still able to feed herself.

Gram is in the midst of extensive confusion and combativeness now. Her doc recommended removing some of her meds and moving her into palliative care.  Last Monday she had a major combative episode throwing things, smashing her walker into her caregivers, biting, hitting. By the time I got there she was sitting eating bkfest but clearly still very agitated. After she was done she picked up her bowl and threw it at me. Plastic so no biggie. I finally after an hour decided I needed to get her to the hospital. We called 911.  The hospital took good care of her as we helped and they admitted her. Her ammonia levels were sky high  -  from the Depokote. The ER doc said that likely is what caused the extreme behavior(note she does get combative at times but never like this).

She's now on Seroquel. She's much calmer - and her elevated ammonia levels are back to normal. NO MORE DEPOKOTE.  We actually thought she might have a UTI.

We know she is clearly in stage 6. The NPRN made her visit on Friday and examined gram and made some other adjustments to her meds.  She approved of the use of Seroquel. Gram usually sleeps a lot - that hasn;t changed.  BUt she's sleeping more. The nurse indicated this is normal regarding the drug and her disease progression. But it's really frustrating not to know her life expectancy at this point.  And how much quality time for her can we expect. I probably sound like a broken record and echoing what almost every person here feels or has felt, but it's just so frustrating and sad.  I'm at the point now where I am worried about my mom who spends every day with Gma.  she has excellent caregivers who are with her all week.  I just want my mom to take a break but she believes Gram will be gone soon and doesn't want to separate.  Does anyone here have someone in their life they can't pull away from the care. Both mom and I are caregivers for Gma. I am with her 2 days a week  - mom was 2 days but has taken to being their daily now.

Stuck in the middle

Don't worry about your mother.  She's about my age or a little younger, I'm guessing.  Nobody told me how often to visit my mother when she was 95 and had VD.  If your mother wants to visit her mother and brother every day, what does it hurt?  

Good catch on the Depakote.  Depakote helps a lot of people, but it makes some (like your mother and my son) really cranky.

M1

Cate M, the only thing you can know for sure is that your grandmother's life expectancy is pretty short.  I agree with Stuck, you can't control your mom.  And that was a good pickup on the Depakote, the Seroquel ought to be a lot safer for her.  If she's too sleepy, you can ask them to decrease the dose by half or give it less frequently.

CateM

Oh thanks I appreciate the input. Mom has high blood pressure and I worry about her own risks with VD. Gram also had high blood pressure. 

I don't know Grams life expectancy/ I guess no one really knows until they reach end stage.  The past year especially has been a fairly huge spiral down. The combativeness is scary not really because of hurting us but herself. She stomps out of the bathroom with no walker and then stands on her tip toes for example and we are all so afraid she's going to hurt herself. yet our of combativeness emotions, she walks bent over using her walker.