Aggression and Agitation

HappyCatCA

Hi, this is my first post. My dad was diagnosed with MIC in Spring 2021. He has declined quite a bit since then, though we have no formal diagnosis of dementia. We moved him into an AL/MC place last week. He has become quite agitated, tried to leave several times and even got aggressive with staff. All behaviors that we never experienced when he was in his home with family caregivers or paid caregivers.   He REALLY wants to go back to his house and is on a mission to do that ... thus the desire to leave the facility. He does have an alert bracelet that triggers an alarm ... so, thankfully, he has not gotten far. 

It's clear to me he needs to be in the MC portion of the facility, not AL. However,  the facility said that for him to stay, he will need to go on medication so he can calm down and be more open to redirection and have less agitation. I had a real negative gut reaction to the suggestion of medication, but want to be open to it as well. For those of you who had family members take medication to help with some of the behaviors I described above, how did it go. Did they help in relieving the agitation? 

Ed1937

Hello Happy, and welcome to the forum. Sorry you have a need for it. First I would ask if a doctor has seen him since the agitation started? Has he been tested for a UTI? A UTI can cause all different kinds of problems, including what you are seeing. Re: medications for agitation. Many people have had great results when medication was needed for agitation. I have no personal experience with it, but I know others here have had very good results.

dayn2nite2

While on the surface it seems you're being given a choice, you really aren't.  In order for him to be admitted to MC, which is the most appropriate setting, you need to agree they can try medications.

If you don't agree, you may find yourself receiving a formal notice that he is going to have to leave.

Rick4407

Dementia is a one way street, it only gets worse.  You need to get him on some medication to control his behavior.  It's not something you are doing to him, it is something you are doing for him.  My DW takes Seroquel and it has made huge differences in her quality of life.   Rick

M1

My partner also takes Seroquel with good results.  Let them try. But MC is probably what he needs, too.

loveskitties

My Dad was on Seroquel with good results, not only for the facility to give best care for him, but also for him.  

I would recommend you let them try it or other medication for these issues.  If you find it has undesirable results it can be changed or eliminated.

harshedbuzz

HappyCatCA wrote:

Hi, this is my first post.

Hi and welcome. I am sorry for your reason to be here, but glad you found this place.

My dad was diagnosed with MIC in Spring 2021. He has declined quite a bit since then, though we have no formal diagnosis of dementia.

The type might matter to some degree. Some dementias tend to have more extreme behaviors and medication can be informed by type. In your shoes I would make an appointment to see a geriatric psychiatrist to discuss medication. My dad's facility has an affiliated geripsych; does your dad's? Before that he saw someone in their office. 

We moved him into an AL/MC place last week. He has become quite agitated, tried to leave several times and even got aggressive with staff. All behaviors that we never experienced when he was in his home with family caregivers or paid caregivers. 

A couple of thoughts. Aggression and exit-seeking are super common in the transition period at a new care facility. It sounds as if you placed him in AL. This would generally mean the staff ratio isn't as high and that dementia-informed care and training may be spottier. A lot of PWD have an adjustment period after which they settle down considerably and a good MCF would know how to manage the situation. My dad took a cocktail of medications to relieve his anxiety and delusions that drove his aggressive behavior-- they improved his quality of life a great deal. We even increased one medication in anticipation of his move to make the transition go as well as possible. 

What behaviors/symptoms were you having at home that led to placement? 

  He REALLY wants to go back to his house and is on a mission to do that ... thus the desire to leave the facility.

This is an almost universal mid to late-stage symptom. Sometimes this pining for home happens when a PWD is in their own home of many years.

He does have an alert bracelet that triggers an alarm ... so, thankfully, he has not gotten far. 

My dad really bristled against the bracelet when he was in rehab about 18 months before he went to MC. The sight of the bracelet triggered him. This was less of an issue in the purpose-built MCF where wall and keypads were blended into the decor. 

It's clear to me he needs to be in the MC portion of the facility, not AL. However,  the facility said that for him to stay, he will need to go on medication so he can calm down and be more open to redirection and have less agitation. I had a real negative gut reaction to the suggestion of medication, but want to be open to it as well. For those of you who had family members take medication to help with some of the behaviors I described above, how did it go. Did they help in relieving the agitation? 

We made the decision for meds well before he went into MC. We even tweaked his antipsychotic to a slightly higher dose ahead of time as he was anxious, agitated and talking about how he was dying and my mom should go when he does because they do everything together. 

We managed the meds as a family outpatient, but the option exists to do a geripsych unit transfer for meds management and then return to the MCF once he's in a better place.

Meds helped my dad a lot. He likely had some mental health issues (per professionals) and did really well on a cocktail of Prozac, Wellbutrin and Seroquel. He'd been on Prozac for years. The first couple nights that the Seroquel was started or increased meant he slept really well (a blessing for mom) but he wasn't sedated. There was some breakthrough agitation at times, but he responded to redirection and validated while on meds. Not so much without. 

HB

HappyCatCA

Thank you everyone for sharing your suggestions and experience. I really appreciate it. This whole experience has been HUGE learning experience for me ... and quite the emotional wringer. Hearing from other people who have walked this path before me is very helpful.