fixated and constant chatter

pookabera

Good morning everyone! I want to make a separate discussion post about my Dad's most challenging behavioral symptom that's happening at the moment and I'm hoping y'all have some insight!

My Dad (83) lives with my Mom (60) and my nephew. I've been coming over almost every day since we brought him home from subacute rehab. The visiting physician will hopefully be out next week to help us assess any medications, care plan, whether we should switch our focus to palliative care/hospice, etc. Everything with homecare visits got pushed back about a week because we all tested positive for COVID.

This fixation started the around night of August 2nd and has escalated into nearly constant chatter (unless he's deeply sleeping or I'm in the room with him). It's clearly a symptom of the dementia because of how repetitive/cyclical and almost compulsive it sounds. He'll start up with the same phrases and then after a while be like, "Okay, you're not gonna ___? Fine then." And then a few minutes later start the cycle over again.

He is obsessed with sex. I'm going to tiptoe around the specifics as much as possible, but: it's all directed at my Mom and is vulgar and derogatory. And it gets worse (in content, volume, and duration) at night. If he was already upset or agitated about something before winding down for bed, it is usually what we'd describe as verbally abusive.

At first it was just him chattering to himself (although it is usually, "Why don't you ______." "Come here and _______.", etc). He is now propositioning her repeatedly almost every time she goes into his room. She explains that she's working, that she's not going to do something, etc and it continues on and on and on.

If we go in to check on him he immediately stops the chatter. Just this morning I went in to see if he needed his urinal emptied while he was the middle of his chatter and he stops and goes, "Hey! Good morning! How are you!" I ask if he needs anything and as soon as I leave the room it starts up again.

When he first got home, we had his bed with the head of it on the same wall as the door. The wheel locks are only on one side of the bed and when he would go to get back in bed (using the bed rail as support), he yanked the bed across the floor. So we flipped the bed to the other wall, more stability, and now he can see out the door into the living room.

This is good because we really don't want him to just be excluded from the rest of the house, but is bad because if he's in the fixated chatter, my Mom walking from her room to anywhere else in the house requires her to walk past his doorway -- which then starts things back up full tilt. (This also happens if he sees me and starts up about me needing to go home -- which is fine hah)

Would it help if we told him we can hear him? It doesn't appear to matter that he knows I'm here.

Does he not realize he's talking out loud? Would it help if I sit in the chairs in the living room that he can see from his bed? Maybe then he'd just audibly complain about me always being at the house.

Should I be walking in every time he starts up again to "check on him", maybe that would distract him?

I understand he could be obsessively chattering about any number of things and that this is just a particularly difficult thing for him to be fixated on. We really wouldn't care if he wanted to do These Things on his own and be about his own business, but it's problematic when it's constantly directed at his primary caregiver who works from home.

And I also understand that dementia is a progressive disease, a month from now he may be displaying completely different symptoms. I'm just not sure how much longer this specific thing can go on for.

I'm also concerned about medicating him because there is this window of the day where he's friendly and My Dad. Will we lose that?

One more layer (because we all know there are so many layers with dementia): he is verrrrrrrrrrrrrrrry resistant to medical staff. And before he fell there would be some days where my Mom would need me to be at the house to keep an eye on my Dad (I'd tell him I was keeping my nephew company) and he would shut down and refuse food, not want to talk to me, say he was going to sleep for the night, etc. So, once we do get more in-home services coordinated (whether that's adding in PDN/respite care and/or hospice/palliative care), there's going to be probably need to be some tiptoeing and figuring out how to get him to even allow someone else to check on him.

He did suggest to my Mom last week that she could hire someone to mow their lawn for them, so we're brainstorming whether we could get him on board if he thought we were hiring someone to do housework in general who then gets to know him and could say things like, "Well, I made breakfast for everyone and have some left, would you like me to bring you a plate?"

loveskitties

This is a bit out there as a suggestion, but another member had problems with her triggering her DH into verbal outbursts ...do you think he would recognize your mother if she wore a wig and glasses/sunglasses or any other "disguise" when she has the need to pass his door, but not when she is actively assisting him? If he questions who that "person" is you could make-up any excuse...helping mother with her work, etc.

The other member was able to visit her DH in MC in disguise and all was peaceful for them both.

Other than that, medication might be the choice to look into with the doctor. It might help the visiting doctor if you had a recording of his outbursts.

SDianeL

Found this on NIH website: "Vocalizations are part of the spectrum of the ‘negative’ behavioral and psychological symptoms of dementia (BPSD). We describe a patient with moderate-stage mixed dementia of Alzheimer's disease and cerebrovascular disease and a left orbitofrontal lesion exhibiting vocalization. The use of ‘redirection’ has been demonstrated to be an effective nonpharmacological means of controlling BPSD, while reducing caregiver distress." They do grunting, chattering for comfort. So try redirection to stop the chattering. About the sexual comments: From ALZ.org UK "Lastly, although drugs have been used to address sexually inappropriate behavior, there isn’t good evidence that they work. Taking more medications increases the risk of side effects, and some drugs could make it harder for a person to communicate discomfort or distress. Drugs should only ever be considered if the behavior is very serious, and only as a last resort once all other options have been tried."