That wavering line...

mrahope

I feel as though I'm wavering each day as we wait for a possible MC placement. We visited a geriatric doctor this past Friday after a 6 months wait to get the appointment. My DS and I spoke very frankly with a social worker. We described incidents we've seen of unsafe behavior, but most of all I was able to tell her how frightened I have been on various occasions when DH has angry outbursts.

This being said, we then met with the doctor, social worker, my DS, DH and myself. It took courage, but I literally told the group that DH's rages were "freaking scary". The doctor recommended that he start on Lexapro, but also said he needs as close to 24/7 care as possible. What he doesn't say is whether that care should be at home or at MC. DH was really upset driving home in the car (an hour trip each way). He told me he felt "embarrassed" and as though he was "being told he's not a good husband". And he insisted he'd only had the rages twice in our 45 years of marriage, when I know it's happened 3 times in the last three months. DH also was pleading with me "not to put him in a nursing home", even though we have never discussed MC with him or in front of him at all. Is it possible he's got enough wherewithal to be actually "gaslighting" me? My whole family is definitely behind placement, but there are days (like today) where he's calm and peaceful, and his ADLs are still intact.

Thanks for allowing me to "think out loud" here. Has anyone else's PWD found benefit with Lexapro? Also, his MoCa score was 20/30 which the doctor termed "not bad". It's so tough when he has good days, but the bad days are so awful. And we've had so much trouble getting doctors to sign off on the MC form. It's still in process. Do they have doubts about their capacity to assess or doubts about placement? So hard to tell.

Belle

Just a comment about the MoCa score and placement in MC. Our family member who had Alz before my DH always scored high on the MoCa, well into stage 6. The other day I found a timeline I had kept for the year before they passed away. In January they scored a 21 on the MoCa, 7 months later they could no longer walk and barely speak, 3 months after that they went on hospice and passed a month later. The previous August I asked for MC placement and was told by professionals that it wasn't time yet. IMHO if they had been in MC before they lost their ability to ambulate it would have been easier on them and on us. Between the losing the ability to walk and MC placement we had wandering issues (yes, even though they could no longer ambulate they eloped a few times) and had to pay for a sitter so they wouldn't get kicked out of their current facility while waiting for a MC bed. I guess my point is to ignore the MoCa score and focus on how they are declining. I think that is a better gauge for placement.

harshedbuzz

@mrahope

A few thoughts-

Care needs to be titrated to your husband when he's struggling and his behaviors and symptoms at their worst— not on one of those days when he's doing fairly well. If people who care about you both are pro-placement, that's a huge flag.

MoCA. A score of 20/30 is considered "mild" and "not bad" is in the context of the medical world looking at dementia in a 3-Stage Model. A very intelligent and well-educated person can have enough cognitive reserve to score surprising well on things like MoCA and MMSE. My dad never scored as low as 20— his last MoCA was 6 months before he died at a time when he was already incontinent of urine. This was around the same time dad confused his Japanese-American urologist for my son who looks rather like Ed Sheeran. The man could still do serial subtraction like a machine. Dad bragged the whole way down to the valet stand about being off the charts and then got into some random woman's car at the valet stand.

Lexapro? I am not a physician, nor do I play one on TV, but given your DH's aggression, Lexapro might be like bring a knife to a gun fight. Dad was aggressive on a similar SSRI at a high dose; his geriatric psychiatrist prescribed an antipsychotic at a very low dose to help manage this. It wasn't perfect, but it did dial the worst of the aggression and agitation down which made distraction, diversion and validation possible to calm him. This enabled mom to keep dad home longer than I would have liked. We eventually placed him when he started ideation around him and mom dying together.

Lexapro is great for many with anxiety, but it can take 4-6 weeks to start to see what benefit you'll see with it. That may be unsafe at this point.

IME, placement is a family decision. Sometimes a long-term physician will recommend it if care is harming the caregiver, but I wouldn't count on it.

HB

Phoenix1966

In my opinion, since placement is such a personal choice, is to try and focus on the bad days as a gauge. I have no experience with a LO on Lexapro, so that might help in your situation. If it doesn’t, keep in mind the bad days can become more common as the disease progresses.

What I will add is my mother and I were a tag team pair taking care of my maternal grandmother 24/7 before I eventually placed her in MC. My grandmother was a devious person during her heyday and my mother also suspected that she was trying to “gaslight” us at one point. I can tell you from my personal experience, it was the disease. Just wanted you to know that caregivers can find themselves asking that exact question.

SSHarkey

My husband is on Lexapro, very successfully. We had to up his dose recently. The drug has a wide range of dosages available. So you have more leeway with it in long haul. He rages may very well be due to his fear and frustration over his losses. See if you can put words to what he’s feeling, validate his emotions. Let him know you’re having similar feelings of loss.

mrahope

Thanks so much for all of your replies. I was very reassured to hear @harshedbuzz and @Phoenix1966 say to use the "bad days" as a gauge. By that measure, my DH surely qualifies. Angry screaming and throwing objects and small furniture items (wastebaskets, chairs) around are simply not behavior I can keep up with. As it happens, the MC we have signed up for is about to have an opening within weeks. I'm just hanging on for dear life and doing the "walking on eggshells" that so many of us are so familiar with while waiting to see when/how we might ease the transition, and also how/if the Lexapro will work. Just taking it one day at a time for now.

Brokenhearted in Illinois

Brokenhearted in Illinois

My DH started having emotional outbursts and episodes of angry behavior. He was placed on Lexipro with one of the goals to stabilize his moods. It has worked very well.