calming methods?

odowd

Hi, brand new here. My 80-year-old mother is in middle stage dementia and has been in a nursing home for six months. Every evening, and lately many mornings, she asks when she is going home, why is she there, how is she paying for this room, why is insurance paying for it, etc. She is afraid they will tell her she has to leave and then she doesn't know how she will get home because she doesn't have a car. She worries that she will go to jail because she can't pay the bill. She gets nervous because she doesn't have any money with her, no checkbook, she doesn't even have a key to her house. The NH has had her on Cymbalta for depression for a long time now, and about a month ago they increased from 20mg once a day to 20mg twice a day, but they wanted to try that higher dosage before considering a separate anti-anxiety medication. We have a care conference scheduled in a little less than two weeks. But I'm curious about others' experience with anti-anxiety medication for PWD. When she calls I speak to her calmly and answer all her questions (I say she's there because they want to monitor her health and pain levels -- she has very limited mobility because of her knees). But sometimes I can talk to her for 30 minutes and tell her there's nothing to worry about, everything is paid for, she's in a safe place, and she's still crying and catching her breath. I have started to sometimes not answer the phone when she calls if I know it's that time of day when this happens. Are there any other strategies for calming her when she gets so scared? Note that I am a long-distance caregiver and am only able to visit every 6-8 weeks.

ButterflyWings

https://www.nia.nih.gov/health/tips-coping-sundowning

Welcome odowd. Sorry you need to join us. Others will come along soon with more ideas and experiences. Long distance caregiving is tough but there are strategies to put in place now, that can help. For now, please see the link on sundowning which should shed light on what you describe.  Keep reading and posting here on the forum. This was among the best advice my DH’s neuropsych gave us on diagnosis. 

Rose116

Hello, I was compelled to reach out after reading about your mother. I’m new here too.

My mother is 80 and has recently been diagnosed with Alzheimer’s moderate level. She cries all the time which she never used to do. She was always the strong woman taking care of everything and now she cries often. I’ve been at a loss in how to deal with it. So I put my arm around her and tell her it’s ok, she can cry if she needs to do that. I’m fortunate to live 5 minutes away but I’ve noticed she’s getting a bit worse. She lives in her own apartment and I provide her groceries and transportation although she has a car, she’s afraid to drive and uses a Walker for balance. She had some falls but unrelated to her diagnosis.

ButterflyWings

Here are a couple more resources for you both, regarding crying. My DH had a period where he would tear up and the waterworks would start at the drop of a dime, but he didn’t seem sad nor did he express any frustration or fears at the time. 

Sometimes favorite songs on the radio could trigger it. And he really could not control it- I’d look over and he’d be wiping his eyes for no apparent reason. Made me more sad than him. I think since I didn’t know what was causing it or how to help, plus it was very out of character for him. This was early mid stages. And, like most things our PWDs go through, it eventually shifted to another stage and set of behaviors. He has been taking the anti-depressant Sertraline started at 25-50mgs and now is at 100 mg daily for depression that started even before that though, right after diagnosis of MCI. It came with early stage dementia and was more like low key anger and anxiety not the sadness type of depression.

What you all are describing sounds different though — like your LOs are suffering, so hopefully these links may give you some ideas. Wishing you well. 

 https://www.webmd.com/alzheimers/alzheimers-depression

 https://dailycaring.com/14-ways-to-handle-screaming-and-crying-in-dementia/

sunnydove

My mom went through a phase where she worried about money all the time. Well actually, we have always worried about money. But she went through a period when she kept asking all the same kinds of questions your mom is asking, though my mom was at home with caregivers when I was working on the road. I made a big note for her to refer to (or for caregivers to refer her to) made with fat red marker so easy to read and it stuck out. It basically said you don't need to worry about money. You are fine. These are your golden years and I will always take care of you and I love you. Whatever words you think will ease her mind and comfort her. 

It's no longer a concern of hers and she doesn't have the capacity to worry about money anymore, but she occasionally will unearth that old note and read it to me and she still likes reading it. 

Jo C.

odowd; welcome to you.  It does sound as though your mother may be sundowning and she may does sound to be feeling insecure and frightened.   How close does the staff work with her and engage her and try to work with the time of day episodes?  Does she get wheeled if she cannot walk to go to the activity room where she can see and do a bit of socialization a bit or to watch the activities?   Does she get her hair done at the in-house beauty shop?  Is there constipation? Pain?  How is she eating?  When is the last time she had bloodwork to see if there is an unidentified system problem issue?  So much.  May be worth making a call to whatever doctor is driving the treatment train.  Is your brother close to where she is placed?  If so, how good is his oversight?

Any medication given must be ordered by a doctor; a NH cannot just give a med.  Before they start a tranquilizer, ask them if and when they took a urine sample to rule out a "silent" urinary tract infection.  Those UTIs are silent as there are no symptoms EXCEPT usually a significant change in behavior to the negative side of the ledger until the UTI is treated; it can be quite dramatic.  Need  to repeat over and over that Medicare is paying her bill in full.  In fact, if your brother visits, he can fake a letter from Medicare saying they are paying for the care.  If brother has an old key he can give it to her to put in her drawer; but that memory retention or losing the key may be a problem, but one wants to try anything.   Most important is to rule out that UTI.

Another thing to think about, could this be med effect. Cymbalta can indeed cause confusion; especially in the elderly along with other  side effects and can interact with other meds.  Why not look this up and do some reading on it, especially since she has had her doseage doubled within the last month.

Rose; I am so sorry for what is happening with your mother. Since you are not with her 24 hours a day, I would be wondering if she is not alot more compromised in some ways that you are not aware of yet.

She feels and knows she is beginning to lose so much of herself, of her capabilities and she lives alone - she may be deeply grieving her losses and she may also be feeling deeply insecure and fearful.  It may be she needs more than what she has by living alone and feeling at risk with the losses.  It is heartbreaking for her to be in such a state, I am sure.  It may be time to have a good specialist assessment, rule out that "silent" UTI, and perhaps begin to make plans to help her a bit more. 
 
 The Alzheimer's Assn. has a 24  Hour Helpline that can be reached at, (800) 272-3900.  If you call, please ask to be transferred to a Care Consultant.  There are not fees for this service. Consultants are highly educated Social Workers who specialize in dementia and family dynamics. They are very supportive, have much information and can often assist us with our problem solving and planning.  May be well worth making a call for both of you.

 Please do let us know how you and your mother's are doing; and I send warmest of thoughts from one daughter to two more,

 J.

  

odowd

Thanks for all the suggestions. Mom did have bloodwork done recently (they called regarding her high cholesterol) but I will definitely ask about testing for a UTI, which she has had a couple times in the past. I and the staff do encourage her to go to group activities, but a lot of times she doesn't want to, and they are all done for the day when her anxiety kicks in. I do plan on hanging up a dry erase board when I'm there next week to write some reminders of her most common questions (I asked my brother to do this months ago but he seemed to not consider it a priority). I also plan to tell the staff during her care conference about the particular hours when it's worst and see if they can try to head it off at those times of day.

live in daughter

Hi Odowd, my Mom had crying episodes and hours upon hours of wanting to go home. She would pack up her belongings and cry wanting to go home. As much as we tried non medication options such as calming diffusers with lavender, talking with her, holding her hand and explaining she was home it was often to no avail. 

We found that medication helped to ease some of her agitation and anxiety. We started with Seroquel but found better results with Risperidone. The timing of the medication needed to be before her anxiety and agitation started.

With this being said we also looked for factors that would trigger her anxiety/agitation. News programs, not having a well lite room, these would escalate her agitation.

Hope this helps. I will keep you an your mother in my prayers.

toolbeltexpert

Odowd here is a technique that is effective but it takes some investigating. Do you know some of your moms favorite stories of a good time. Listen she may be telling them over and over. When troubles come try to quickly weave in one of her favorite stories,that will bring her right back to a good time and you'll be there with her. It does take practice to remember the stories and the technique of using them. My dw talks about her dad and camping and how funny he was,he would tell little army stories. Or how he had really dry humor. He hated eggs,so every meal that had eggs,, he would push the eggs around the plate till that was all that was left. He would take them outside, dig a little hole put the eggs in the hole and bury them. Then he would pat down the buried eggs and smile and say"best thing that happened to eggs". She loves that story. When you learn enough of them that's seems to make using them at different times of trouble. Hope this helps I know how hard it is.