Anxiety, paranoia and fixation

ThreeD

My mother lives in an ALF.  She still knows routine such as meal times and how to get around in the facility so the staff says she is not ready for total MC just yet.  There is nothing she can do for herself other than getting dressed, using her walker and hitting a button on her cell phone.  She has lost all processing skills and can not reason anything. She still knows close relatives but often mixes us up.  Our biggest issue is sundowners.  Her anxiety and paranoia kicks into high gear every day after supper.  She is fixated on her fears and calls crying and begging for someone to come get her.  She complains of being very depressed. We have noticed it is happening earlier in the day lately.  She will be in the activity center with other residents and laughing along with them but as soon as she gets to her room she starts in on the depression.  She takes an antidepressant and the Dr. has told us it can't be upped. It is hard to ignore her calls after about the 4th one every evening but we know she will be OK the next morning.  I am now thinking that she may not actually be depressed but rather fixated on it   How do I refocus her on something like this?  I can usually refocus her but this one has us stumped.

May flowers

I’m sorry you are going through this.

For us, antidepressants did not touch sundowning and agitation. The only thing that works for my FIL is an antipsychotic, and it is working very well. He still has breakthroughs but nothing like before.

Maybe you can talk to your mom’s doc about a different med (or class of meds) or get a referral to a Geri-psych. I am not sure they can work through med changes like that in the facility tho. I just recommend that instead of having them add on more and more meds, ask if she can wean off ones that aren’t helping and try a new one instead. We had a bad experience with doctors adding meds on top of meds until my FIL was a complete zombie. He is more communicative now in stage 7, than he was in stage 6 on all the meds they had him on.

jmlarue

In addition to exploring medication options, I would talk with the staff about something that she can do in the common areas of the facility in the evening hours. She probably feels too alone and isolated behind a closed door of her room in the evenings. Especially when most of the residents have also gone to their rooms and closed their doors. If there is a common area where she could watch TV, help the staff fold towels, or some other small jobs within her abilities, you might find the sun-downing will be less. Perhaps staff can identify another person who also feels lonely and could use a partner to watch TV with or an after-dinner walk through the halls. Offering her something to occupy her while in her room might also help. Are you familiar with Sirius-XM? It's a satellite radio broadcaster with a variety of music and other programs that might interest your Mom. There's 40's big band music, 50's rock & roll, and Old Time Radio programs like Burns & Allen, Jack Benny, and The Bickersons to name a few. Listening to a comedy show or just good old storytelling can lessen the feeling of being alone. You can subscribe to Sirius-XM and can access the programming through an Amazon Show device by simple voice command or an aide could help her tune it in. Personally, Id leave something like this turned on to play even when she's not in her room, so it's not silent in there when she does turn in. Maybe one of these ideas will help you find a distraction for her that you've been looking for.

M1

Hi Three, i see this is your first post. Sounds like she's ready for MC to me, I'm curious as to why they think not. It would probably provide the most straightforward solution.

harshedbuzz

Hi and welcome-

I am sorry for your reason to be here but glad you found us.

Reading your description of things, it sounds as though the AL cruise has sailed for your mom. Care level needs to be matched to your mom's needs at her worst-- on a "Bad day" or during "sundowning"-- not when she's doing pretty well. Staff in MC would be managing this, and you would not be getting nightly calls.

Another piece is that her paranoia may be somewhat based in reality. It has been my experience with an aunt placed in AL when she needed MC was that other residents there, who did not have dementia, did not want to be bothered by her repetitive talk and a few were quite mean about it. 

What doctor is prescribing her medication? Ideally, this person should be a geriatric psychiatrist as they are the specialists in psychoactive meds. It's possible she's on the wrong kind of medication for depression or might do better on a slightly different one or maybe she needs a different class of medication instead or in addition. Sometimes the getting "stuck", the paranoia/suspicion loop and delusions are best addressed with a low dose atypical antipsychotic.


HB

ThreeD

Thank you all for your very helpful responses.  Mom has started showing signs of agitation with staff and she takes off her depends and is having trouble making the right wardrobe decisions.   I spoke with nurses and they agree that she is ready for MC.  My new question is now how do I prepare her for this move.  She is becoming very aggressive in her thoughts of being independent.  The staff says she will probably transition easily but I'm just not sure.

Rndeavor

I have had the week from hell.  My mom was manic for 42 hours straight starting last Thursday and finally ending at 2 am Saturday morning.  She kept taking the blankets off her bed, and therefore she fell at least 3x.  She took her walker and walked backwards and fell again creating a significant skin tear and bruising. She was not able to settle down, after giving her an Ativan that did nothing, she continued this behavior until she finally fell out of bed and hit her head on the foot of the nightstand.  We never had experienced this behavior with her before.  When I went to get her up for a plane flight the next morning, she was unconscious with a huge hematoma on her head.  I called 911.  She spent 2 days in the hospital, never waking up.  She was exhausted.  I told them that she usually crashes after a busy day, but this was the worst.  The ER doctor told me I could have brought her in the day before for "delusional behavior"...Just and FYI for anyone reading this.  She was then transferred to a rehab for 24 hours when they called me to hire a full-time aide, because she wouldn't stay in her room.  She was very suspicious of me, she accused me of poisoning her. She did not know who we were, I think the falls had affected her even worse. The following day, I had here DC to a home setting ALF.  I love it...The caretaker is awesome, it is a home setting, she can get up and walk where she wants.  She is safe. I did hate to make this decision, but I know in my heart it is for her safety and for the best care.  I am a RN, but I have to tell you, when they reach these stages, there is not much you can do for her care. It was a toll on my husband and me, I know that mom would never want us to be in this situation.  I pray every Sunday, that my dad come and get her.  This is no quality of life.  I feel for her....