My DH is getting increasingly aggressive and hard to handle

Palmetto Peg

My DH is very restless and agitated, and always wants something to do. The problem is, when I can't go out with him - ex. at 6:00 a.m. today he wanted to go for a bike ride - then he gets loud and aggressive and says he will go anyway. Today he started for the door and said he was going. He gets lost in our apartment building and there is no way he can be out on the street alone. I had to stand in front of the door, lightly push him back and say no. This is not the first time this has happened. He wanted to drive the other day, and went in my purse and got the car keys (which are now well hidden). Again, I had to wrestle them away from him. He didn't resist much, but I did end up cutting my hand on one of the keys. Today I convinced him to go down to the game room and shoot pool, but I'm not always successful in redirecting him. Obviously, my concern is that we are getting close to physical contact that may not end well. He is in stage 4, I would say, and has no short term memory to speak of. He has had some delusions, and can get very ugly with accusations of infidelity, or that I am selfish and don't want him to have any fun. At times he wants to go back to work, and again I am accused of not letting him go. After our most recent discussion about work, I finally said I was just going to go to bed, and we would talk in the morning. Obviously I was hoping he would forget. A half an hour later one of the neighbors brought him back - he had left the apartment and was wandering around in nothing but his briefs! Any suggestions about how I can calm down both the restlessness and the aggression? He is on Lexapro - 20 mg. once a day and 5 mg. twice a day of Ativan. Thank you all so much - I get such good information here!

dayn2nite2

Is he seeing a geriatric psychiatrist? If not, can you make an emergency appointment with one? When conflicts get this physical, I always recommend calling 911 and having him transported to a hospital with a psychiatric unit for admission and stabilization. You do not want more instances of him wandering in his underwear or someone else will call the police, which is a danger to him because he will not follow any order they give if he's agitated, which can end up in a physical confrontation, handcuffs and possibly escalate to tasing or shooting.

midge333

I recommend seeing a geriatric psychiatrist as well. I think there are better medications than ativan for controlling his behavior. In the meantime, if things get physical - protect yourself and call 911. Your DH may need inpatient psychiatric treatment to get control of his aggression/agitation.

M1

So sorry you are dealing with this Peg. But I agree, he probably needs an atypical antipsychotic at this point, like Seroquel or Risperdal, and it may well be that he is going to need to be hospitalized.

This sounds urgent, frankly. If the neighbors are finding him wandering unsupervised, they may call in adult protective services. There is no way I would let him go to "shoot pool" unsupervised—-the next thing you know he could be in the street.

If you haven't already done it, I would at least urgently research which hospitals near you have geriatric psychiatry units, and look at nearby memory care facilities. Meanwhile call his doctor, urgently, and be honest about what is going on. It may well get to the point that you are not going to be able to handle him by yourself. That is what happened here, for sure.

Palmetto Peg

We do have a geriatric psychiatrist and I will call her. We live in a continuing care community with Independent Living, Assisted Living and Memory Care. The staff here is aware of his issues, and would contact me and not the police. The advice about shooting pool is good - I have been letting him go because it is directly below us, and I thought it would be okay. But I will accompany him in the future. I am concerned that I won't be able to handle him by myself soon, and yet I know how miserable he would be in memory care so I try to keep making things work. I will call the doctor today. Thank you for the suggestions - they are good ones that I am going to follow.

Quilting brings calm

I would talk to the director about memory care. Since it would be in the same place, you’d probably be able to escort him back to your apartment for an afternoon whenever you wanted.

Just because he currently wanders on the grounds does it mean he won’t wander off them. Nor does it mean that other residents won’t complain or report a man wandering around in his briefs to the police. My mom wandered from their independent living apartment to another one ( misdiagnosed UTI) in 2019 and that resident called the police.

M1

Peg it's so good that you have that community to back you up. I had forgotten that….but it does sound like it's time to use those resources. It's so hard to pull the trigger, I know….I've been there. It took our doctor looking me in the eye and telling me that I just couldn't do it any more before i took the necessary steps. To you on the inside, I know what it feels like to think that you can continue to hold it together….but there will be a next crisis, and you don't want to have waited too long. To anyone from the outside, it sounds like he needs 24/7 supervision from someone other than you. I hope the doc is helpful when you call.

Dio

Peg, so very sorry you're going through this. My DH was also on lexapro and ativan…they seemingly worked until they didn't. We switched/tried so many variations of meds but finally I had to face the reality of memory care. It wasn't too difficult a decision because I didn't feel safe anymore and the aggression was getting worse. I knew I had to find a solution for both of us. Yes, guilt may gnaw at you, but I hope you can find it more bearable to view it as protecting the caregiver, aka YOU.

suzanneryman1

https://alzconnected.org/discussion/comment/210051#Comment_210051

there are no psychiatrist for Alzheimer’s patients anywhere near me 30 mile radius of San Antonio

Palmetto Peg

I actually got a call from Security today and they want him moved to the locked Memory Care Unit. I also spoke to our doctor here and she agreed that we should try to wait for a neuropsych eval, but acknowledged that it may take too long. So, we are in limbo here. I am to double the Ativan and see if at least it keeps him a little calmer, and then wait to see when I can get an appointment. This is so hard - this educated man is reduced to not remembering walking around in his undies! I will keep you all posted. Thanks so much for the support -boy do I need that!

M1

It's so hard.…but glad you have the resources there. Don't do anything that might endanger your own living situation. I think the comment earlier that you can always plan to bring him out for visits once he's stabilized is a good point. MC is not the end of the road....

trottingalong

https://alzconnected.org/discussion/comment/210121#Comment_210121

our nearest one is 2.5 hours away.

Iris L.

Ativan is a benzodiazepine. This class of medication may have a paradoxical effect in some older adults, causing them to become agitated instead of calmed. A silent UTI should be ruled out when there is a sudden onset of new behavior.

Iris

Palmetto Peg

Thank you for the information about Ativan. I will call the doctor today - and see if we can get in to rule out a UTI. He is pretty calm today, and sleeping a lot, so we may have a little time before the next crisis. I certainly hope so!

jfkoc

Peg….please go to drugs.com and read all you can re Lexapro and Ativan. I could not take Lexapro and Ativan sent my husband over the cliff. Please note the dosage levels. Please discuss the drugs that have been mentioned above. They are commonly used for what you are describing.

Your husband needs to be under the care of a neurologist who specializes in dementia. He need a diagnosis that follows protocol.

Suzanne….your neurologist can refer you to a psychiatrist. They are the experts in "drugs". It does not need to be on with a sub specialty.

ButterflyWings

https://alzconnected.org/discussion/comment/210123#Comment_210123

If he is a wanderer, Security is correct, he should be in a secured unit. For his safety (and yours) even if you wait for an eval. Why wait when the behavior is already telling you what you need to know. I believe Actions speak louder than Evals lol. I do not think you can wait (said she who lived/lives with a top-notch eloper/wanderer).

Re Ativan - we were advised and had the unfortunate experience that this med can have the opposite effect from intended calming. Especially if given after noon-ish or 1pm. My DH gets very agitated if given that drug in the afternoon. It sends him into early sundowning on steroids.

Seroquel was the solution for us. Titrated up a lot, and pretty quickly, to 300 mgs a day. (100 morning, early afternoon, and bedtime). It does not sedate him and he is not a huge guy by any means. Geripsych and neuropsych should be able to help with the meds but in the meantime I think you need to follow the advice of your community team (awesome planning btw) and get him into a safer, more secure location in your community. Another resident could absolutely bypass the plan and escalate to police or APS if you don't. I'm sorry you are going through this, but also it allows you not to be the bad "guy".

Palmetto Peg

As hard as it is to accept, I think you are right and I have a call into our doctor here about either trying a new drug like Seroquel while we are waiting for the Geripsych eval, or having him transferred. He is so confused and I really can't manage him alone much longer. Thank you all for giving me that push to do what I need to! I will keep you posted.

ButterflyWings

https://alzconnected.org/discussion/comment/210363#Comment_210363

(((Peg))) hugs - I recall how this feels. Hold on! You can do what is needed. Also, we had good results from temporary use of liquid melatonin any time of the day for DH's agitation. It slowed him down and mellowed him out just enough for me to breathe, keep him from taking off on foot, and from cursing or threatening. Did not stop his hallucinations or delusions at the time, but it chilled him out enough not to react or show any anxiety or anger at all. Whew! I could put up to 10mg via the dropper, into a small glass of water or juice and leave it nearby if he was in such a state that he would not take it from me. He invariably picked it up and drank it while I pretended not to be looking. Very quick acting, melatonin liquid was a lifesaver many days.

His neuropsych approved this technique as well as the dosage amount. 3mg did nothing at all. and I was told up to 10mg - and the timeframe between doses if needed again soon. A 2nd one wasn't needed that I can recall. He might catnap or might just sit down quietly and look at a magazine (sometimes upside down…he wasn't reading lol), But he suddenly wasn't raging either. This helped redirect him many a day in mid stages. Can be grabbed OTC at any pharmacy, possibly convenience store, or delivered with your Whole Foods or other grocery order. It was a big help to have "in case of emergency" during these days esp when I had to wait before our former PCP got back to me and then still might have to wait since he was not on the same page about care goals after dementia was finally diagnosed.

It is worth trying or at least asking about while you all are in this red alert status right now. Liquid melatonin was like liquid gold for me back in that phase.

Palmetto Peg

I will definitely purchase the liquid melatonin and give it a try. Thank you so much for the suggestion!