Need help(10)

Toobit

Hi there I have an aunt that is in a caregiver home and she is becoming very violent. They call us at home when she’s having an episode. We are not sure what we should do and if we can find out from the doctor if she can be given a sedative. I am assuming things are going to get worse with her and what is the protocol that most people take given the situation. I’m not very clear what the care home is supposed to do either. Thank you

FloydSnax

Hey, good question. I was hoping to learn from the replies you got, but I see you just posted it. This place saved me when I had a question like yours so, you're in good hands. I can't believe your aunt is already in a facility and they don't know how to handle the situation. That truly sucks. Wait... My bad. She's at a caregiver's home, not a facility. You'll get some good advice here. Good luck

   

quartlow2

Maybe her Dr could prescribe a sedative PRN (as needed)? Or maybe her Dr could refer you to a psychiatrist with dementia speciality who could help? Psychiatrists can prescribe meds. A neurologist may also be helpful and would know if any Alzheimer's meds would help with mood swings. Just ideas.

M1

Welcome to the forum. She may need an inpatient psychiatric admission to get stabilized on medications that can help control the violence and aggression. Find out what hospitals near you have geriatric psychiatry wards and ask for her to be taken to the ER there. Be prepared that she may need to stay 2-3 weeks to get stabilized. I would talk to the care home about their willingness to take her back so that if they are not you can be making other plans. If you don't handle this proactively they could easily kick her out and then you're stuck. Good luck, I'm sorry you're facing this.

harshedbuzz

Hi and welcome. 

I am sorry for your need to be here, but also glad you knocked on the door of our online clubhouse.

I would be leery of any physician willing to sedate a PWD except situationally and then only and in conjunction with other behavioral approaches including non-sedating medications.

My first thought is that a geriatric psych admission is probably the best way to get some non-sedating psychoactive meds on board. It would be useful to find out which hospital in your area has an actual geripsych service and have a plan to have her transported there the next time the care home would find reason to call. You Area Agency on Aging should know which hospital this is; if you live in a remote or poorly served community it could be some distance away. 

Your LO may need a stay of several weeks to trial meds and it is possible she may be given a cocktail of a couple different things which allows them to treat the underlying emotions with the least amount of side effects. My own dad could be aggressive which was driven by anxiety; he took 3 different meds to dial this back and make him responsive to dementia-informed behavior strategies like Validation, redirection and fiblets (therapeutic lies).

What is the purpose behind the phone calls you are getting? Are they a routine "we took care of it, but fyi..." or more of a warning shot to start touring other places or are they expecting a family member to offer suggestions or come help settle her?

To that end, you may need to rethink the facility where she is now. A MCF might be a better choice for where your aunt is now in the disease progression. A good MCF will have staff trained in dementia care and will offer dementia-informed design, routine, and activities which can help your LO feel successful and secure in their space.

To that end, be careful with the words you choose when describing the situation with facilities. Is she truly violent or is she more agitated? Is this garden-variety sundowning with some aggression?

HB

caregiving daughter

A larger home may have psychiatry physicians that visit the home so it wouldn't have to be inpatient. Would depend on the clinical care plan and level of difficulty.

GemsWinner12

I would get her to a geriatric MD , ASAP, especially if you want her living situation to remain the same. If the caregiver/s become too overwhelmed, they may decide to give you notice that she will need to be moved if they can't handle her "episodes".  As others have mentioned, there are dangers involved with the administration of sedatives and/or mind-altering medications. Those dangers will have to be weighed against the risk of hurting herself or others with her mood swings.  Typical medications might be haldol, seroquel, or even pain medication if she is actually in pain/uncomfortable and unable to verbalize this to anyone.

towhee

Toobit, welcome to the forum.

Your first step is to get her an appointment with her primary care physician, ASAP. A behavior change is often a symptom of a physical problem that a person with dementia is unable to communicate. She could have a urinary tract infection, constipation, dehydration, pain from an unknown injury or a side effect from a medication. All of these can cause behaviors to be over the top.

The family member who has her health care power of attorney, or who has been with her to doctor appointments before, or the one who is her main family contact with the care home (whoever takes responsibility), needs to arrange this. If the care home has a physician who comes in on a regular basis, and that is her physician, then you tell appropriate care home staff to arrange an appointment, and a family member needs to try to be there if possible. If her doctor is outside the facility and does not come in, family may need to call and make an appointment. Most facilities will make appointments if you tell them to do so, but some will not. What the facility will do if left on their own varies. The next call you get might be that they are sending her to the ER, or that they can no longer care for her.

The second step is to get more information about the behavior. It can make a difference in what the doctor recommends if no physical problem is found. You need a good accurate description of the behavior, when it started, was onset sudden or gradual, how frequently behavior happens, what time of day it occurs, what is going on in the way of care when it happens, is there anything unusual going on at the care home, basically any easily identifiable triggers. Be aware that what looks to an observer like anger might actually be fear and anxiety. Are hallucinations or delusions involved? Does she calm down if family talks to her? This info will help the doctor to know if she needs a sleep aid, anti-anxiety, anti-depressant, or anti-psychotic.

Anyone can give information to the doctor on your LOs behalf. The difficulty lies in getting info from the doctor. If the physician comes into the facility, you usually have to go through care home staff to pass info to them (unless you can be at the visit). If it is an outside facility doctor visit info can be hand carried or sent ahead of time. Make sure you have info on medications as well. It is usually best not to suggest a course of action to a physician, just get them the information, ask them to evaluate the situation, and ask what can be done.

If this is a small care home they might not have many procedures in place to handle problems and family might need to be more proactive.

If a doctor is not available soon, you might have to take a trip to the ER, you don't want her hurting herself or someone else.

Minor edit 8/4/22