Aggressive behavior and alternative treatments

debbiep13

Good evening all, I am new here. My mother is 80 years old and newly diagnosed but we've known longer than we have admitted to ourselves. My dad, sister and myself did not have a good relationship with my mother prior to this partly because of her narcissism. For me caring for her is difficult, a challenge to care for someone more than they cared for you. 

My first question to the group. Will her anger and aggressive behavior always be worse with family that has baggage with the patient than someone new with new history? Or is there no rhyme or reason? I think we are the last ones that should be around her but it is difficult for us to find enough care. 

Second, has anyone had any luck with a more eastern approach to medical treatment? She takes seroquel now and boy can she fight her way through it. It is almost like she never took it and can go on for hours. At what point does one abandon one treatment for another? What about any holistic supplements? Is there no point of trying when one has so many medical problems and takes a ton of medications? 

Any advice would be greatly appreciated? I truly admire all you family caregivers out there that have been doing this for years. 

ImMaggieMae

Debbie, welcome to the forum. There is so much good advice here. Every case is different, so you get a lot of ideas and possibilities to consider.

My DH was not at all aggressive but he did have very strong repetitive behavior issues, sometimes keeping him awake all night. Things like brushing his teeth, cleaning his glasses, taking the garbage bins down to the street every 10 minutes. Seroquel worked for a short time, then didn’t Evan after increasing the dosage. Risperadone worked well, but did have to increase the dosage once so far. He sleeps all night and although he has some repetitive behaviors, they are milder and not constant. 

I don’t know the answer to your question about family relationships and dementia. I think it is so unpredictable. 

harshedbuzz

debbiep13 wrote:

Good evening all, I am new here.

Hi and welcome to the best place in which no one wants to find themselves.

My mother is 80 years old and newly diagnosed but we've known longer than we have admitted to ourselves. My dad, sister and myself did not have a good relationship with my mother prior to this partly because of her narcissism.

Mental health issues like personality disorders do persist well into the disease process. My own dad had mental health issues which exacerbated his dementia behaviors and made care more challenging.

For me caring for her is difficult, a challenge to care for someone more than they cared for you. 

This is a not uncommon sentiment. Care-giving for a person who wasn't there for you as they should have been is a special kind of suckitude. And it can feel isolating at times when others in support groups are expressing profound sadness over losing someone dear leaving you to feel even more broken especially when the standard answer to any unpleasant behavior by the PWD is "it's the disease talking". While that is true, it can feel dismissive if you grew up with the same soundtrack as now. 

My first question to the group. Will her anger and aggressive behavior always be worse with family that has baggage with the patient than someone new with new history? Or is there no rhyme or reason?

It's hard to say. IME, people with long-standing mental health issues and/or challenging personalities tend to be challenging as PWD as a rule. My dad, my sister, my older aunt were tougher than the average bear. My sweet auntie remained well-mannered, gentle and good-natured until her passing. My friend's delightful mom would sometimes get agitated when confused or sundowning but it was nothing like the aggression I saw with my dad. 

Ironically, in the last month of dad's life, he lost his edginess and I was able to see the sweet little boy his ancient aunts always described to me. Some people subscribe to dementia as a "regression" and in a sense dad did regress to a time when he hadn't yet developed the mental health issues that colored his adolescence and adulthood. 

I think we are the last ones that should be around her but it is difficult for us to find enough care. 

You could be triggering, but there is a responsibility to make sure she is cared for appropriately. There are books that might help you work through this.

Amazon - Taking Care of Parents Who Didn't Take Care of You: Making Peace With Aging Parents: Cade, Eleanor: 9781568388793: Books

Second, has anyone had any luck with a more eastern approach to medical treatment?

IMO, the intersection of mental illness and dementia requires a bigger gun. If your mother is not under the care of a geriatric psychiatrist for medication management, I would make that happen asap. They are the subspeciality most qualified to manage psychoactive medications in those with dementia. IME, PCPs and even neurologists tend to use a OSFA approach which neglects the underlying mental health needs. BTDT. 

She takes seroquel now and boy can she fight her way through it. It is almost like she never took it and can go on for hours.

Most prescribers start Seroquel for dementia at 25mg in the evening or twice daily. This is a much lower dose than would be prescribed for a person being treated for bipolar and way less than someone being treated for schizophrenia which is to say there is room to bump it up if she has some mental health issue. It's also possible that she'd do better on a different antipsychotic or with the addition of other psychoactive meds to her regimen. Dad took 3 meds-- an SSRI at a fairly high dose, Wellbutrin which is similar and Seroquel twice daily. Being on 3 allowed him to take lower doses and avoid side effects and sedation. 

At what point does one abandon one treatment for another?

I would get her in with a geripsych now. If you've already done that, I would check in with him or her and report that this isn't providing the relief she needs. My dad showtimed during his psych appointments, so I would record clips of dad acting out at home so his doctor could see the reality of his anxiety and behavior at home.

What about any holistic supplements? Is there no point of trying when one has so many medical problems and takes a ton of medications? 

I, personally, would not take this approach in so acute a situation. If you decide to, please work with a geripsych or pharmacist to make sure you aren't adding something that could make things worse.

Any advice would be greatly appreciated? I truly admire all you family caregivers out there that have been doing this for years. 

Geri psych. Dad's was the most critical member of dad's care team and made it possible for him to stay in his own home until about 2 months before he died.

HB

MN Chickadee

I'm sorry you are in that position. It shows what a good person you are to give care and aide to someone in need who should have been there for you and was not. Many PWD are able to hold things together around other people and save their worst behavior/criticism/anger for family ore whoever they are closest to. Just like little kids who can be angels at someone else's house and come home and melt down for their parents. Is she better with hired caregivers? 

Given that she has some mental health issues that pre-date the dementia I would get her to a geriatric psychiatrist asap. They are best qualified to figure this out. It can take some time to find the right med and dosage, but many people are able to find that balance that makes care better, dials back aggression, and gives the PWD a better quality of life. If circumstances change and you need to move her to a memory care facility they won't take her if she is aggressive so getting it under control is important for a variety of reasons. Some people have to utilize in-patient geriatric psych unit for a few weeks to get things under control, just depends how bad things are.