Afraid Mom is going to get kicked out of Assisted Living for aggression

jenergee

My mom was diagnosed with Unspecified Dementia 3 1/2 years ago.  She's has been getting progressively more angry and physical with the staff where she lives.  It's gotten worse now that she can't walk or go to the bathroom on her own.  (She fractured her hip in October.)  I'm really afraid that she's going to get kicked out and I have no Plan B available.  Her last doctor and her current doctor would not/will not prescribe her something that will take the edge off.  The low-dose anti-anxiety meds quit working after the hip surgery.  I can't get her a medical marijuana card or purchase marijuana on her behalf (I'm her Legal Guardian.) since I'm a federal employee.  I think she may be in pain, but can't express to anyone what's going on.

I just don't know what to do to help her.  

Has anyone else had this experience and found something that worked?  Thank you for reading.

Jenni

Quilting brings calm

Are these doctors specialists or primary care doctors?  The medication  she needs can probably only be prescribed by a psychiatrist.  Preferably a geriatric one. Ask for a geriatric psych evaluation

M1

Welcome jenergee, you might ask the AL administrators if they have a geri psych they work with routinely, some do. Might facilitate getting her behaviors dealt with quickly. Good luck and keep us posted.

MN Chickadee

I would get a consult with a geriatric psychiatrist or a regular psychiatrist who has experience with dementia. They will be the best professional to find the right meds to get her to stop being combative so day to day care is possible. Also research inpatient geriatric psych units in your area in case that becomes necessary. Speak with the facility head nurse and the doctor about the possibility of that. For inpatient it MUST be geriatric unit, not regular psych unit. The geriatric ones are staffed by doctors and nurses who specialize in dementia and the purpose is to get someone stable on meds over the course of a few weeks to return to their home or facility. The one in my area is a few hours away but has been a life saver for those who need it. You might also try a hospice evaluation; if she qualifies they are experts at spotting signs of pain and treating it. The requirements are a bit different for dementia patients versus other terminal illnesses, and given that she has declined from a fall she may qualify.

anniew

Hi Jenni. I went through a similar situation with my mom several months ago. She became verbally and physically abusive with other residents and staff in Memory Care. She was on a low dose anti-anxiety medication for other stuff, but it was not helping with the aggression. I was worried as well, wondering what would happen if it got worse. I asked the Director of Nursing at her facility what would happen in that case. She was very reassuring and said that situations like this are not uncommon, and if my mom became a danger to herself or others, they would recommend she temporarily go to inpatient geriatric psychiatric care at a hospital. There they would try medication and therapy to get the aggression under control. This would be a last resort. Fortunately, my mom's doctor prescribed a low dose of Seroquel, an antipsychotic, and that has helped. My mom still gets angry with staff, and sometimes she's not very nice to me, but at least the physical aggression has stopped. I'm not sure why her doctor won't prescribe some kind of medication to help. I was worried at first that an antipsychotic medication might make her kind of non responsive and zombie-like (for lack of a better word). The low dose hasn't done that at all. I notice she is more fatigued since she went on the medication, but there are other things going on with her that could be causing that. I don't know if this provided any kind of solution for you, but I hope this has been somewhat helpful. I hope her doctor will reconsider trying some kind of medication to help her.

toolbeltexpert

I want to say thanks to jenergee for bringing this up. My DW isn't to this point but I am thankful for the insights. I am hoping your situation get resolved. Be blessed and hang in there.

Donnajoy

Before my sister went into memory care, she had terrible anxiety and depression, could become aggressive verbally.  Her psychiatrist was reluctant to prescribe anything other than the anti depressant and anti-anxiety meds due to side effect of increasing the chance of falling.   Neither med helped her;  possibly because she wasn't taking them consistently!  

She ended up breaking her ankle, and her daughter got her into rehab, and into AL from there.  She was getting her meds regularly then, but She did not adjust well, insisted she wanted to go to the "other place" (which had never come up) before.  I will say, she has had Her paranoid thinking, which seems to trigger and escalate her aggression.....was getting worse as well.

Anyway, she got transferred to MC when she kept leaving the AL and getting more verbally aggressive and threatening.   They prescribed Seroquel, but then changed to Resperidone, also an off-label antipsychotic.   That has helped with the physical aggression, which became an issue in memory care, (shoving, hitting, slapping).  It seems to havc toned down the more psychotic looking behaviors she was having as well (hallucinating, talking to people "through her glasses.")

Side effects for both of these antipsychotics are scary; but behavioral interventions just were not working 

She now sees the geriatric psychiatrist on a regular basis.  She is more detached, and she still gets oppositional, refusing showers, therapies, refusing to coming out of her room to eat at times, but generally, it has reined the troublesome behaviors in a lot.

I will say that when she started to decline in memory care and the aggression and oppositional behavior began to worsen, along with the paranoia, I did ask them to check for a UTI and she did have one......so a good look for physical issues might also turn up a contributing factor 

Good luck.   This is a tough symptom to work with, but I will say the staff seems pretty calm about it in her MC facility;  it is not unusual, I understand....

WindyY

my mom became quite aggressive and got sent to a Senior Behavioral Health unit at a local hospital.  It took two weeks but they completed an eval and had her start medication which has helped behavior a mood SIGNIFICANTLY! The doctors at the MC didn't want to experiement with this themselves because of possible other health complications.  She is back at her MC now and still as confused as ever, but not hateful or aggressive.  Thank goodness.  Maybe request a med eval somewhere like that?  Medicare is paying for it.