Hospitalization for agitation-round 3

clarinetist

As some of you know, my DH spent much of last month hospitalized for aggressive behavior at his memory care. He spent a month at 2 different Geri psych hospital units, with a four-day break at his memory care between hospitalizations. This time he made it two weeks before getting sent out of his memory care for taking a swing at two residents.

At his last Geri-psych, he was switched from Seroquel to Risperidone. That seemed to tone down the aggression, but this past week it started ramping up again. We’re trying a new hospital. The good news is it has a Geri-psych unit that doesn’t turf you back to the memory care ASAP. The bad news is it only has 9 beds.

After a day and a half in the ER, my DH got a medical bed. They haven’t said whether he’s going to Geri-psych. They upped his Risperidone .5 mg. Yesterday afternoon he got very agitated, and for the first time, threatened me. They gave him an injection of Zyprexa, which seemed to help.

His current med regimen doesn’t seem to be working well, but they mainly seem concerned about over-medicating him. He doesn’t seem that sedated to me, and I’m more concerned about tamping down his aggression. If I can’t get a handle on it, he could lose his placement.

Today I stayed with him for three hours, but then came home. It doesn’t seem as though they’re taking his behavior seriously, so I wanted them to see how he is without me mediating. Hope that wasn’t a mistake.

I guess I’m mainly venting as I feel very discouraged about finding a solution to his aggression. Thanks for listening!

housefinch

I’m really sorry you’re having to endure this (as is your DH). I might be in the minority with this opinion, but what harm would temporarily over sedating him do? The alternative is him being a danger to himself, others, and possibly a PTSD diagnosis for you after finishing your caregiving journey. I’m being totally serious. I’m in healthcare, definitely not in geriatrics or psychiatry, and I struggle to understand this decision making sometimes. I mean, unless they think he will be so sedated he needs a ventilator to breathe. Please forgive my blunt response. I am sure they have a gradual dose increase in mind. As a parent of a child who has had aggression, I really feel for people on this forum who face these crises. Sending you hugs.

trottingalong

I’m so sorry for you. While reading this, I can’t imagine what you are going through and the responses from the medical field. We rely on them to be knowledgeable and to help. It’s very difficult to be dismissed or ignored especially when it comes to aggression issues like you have had to deal with.

ButterflyWings

I think you did the right thing to come home after 3 hours. You need some rest and a little distance and I believe you are right that they need to see what may unfold without you there to mediate his behavior (or possibly even take the blame for agitating him.) The lack of respect for concerns and knowledge of caregivers/spouses in the ER and hospital setting is a real problem. From one who knows.

So, please do not blame yourself if your DH struggles there while you are home getting a little shut-eye if you can. You matter also. And the medical team will have to make some decisions that will ideally stop this merry-go-round or roller coaster that he is on with the hospitalizations but no real solution yet. I'm so sorry for you both!

M1

I am dealing with some of the same issues in the hospice setting, not aggression so much as the seesaw between resistance to care, falls, and oversedation. No good answers and no good outcomes-except the blessed relief of death at some point. I am so sorry. Let them put him to sleep and then gradually wake him up perhaps. I keep myself sane by reminding myself of the absurdity of it all. If it were my dog i would have euthanized them by now. Sorry if that sounds brutal but it's true. No help in your situation though and i am so sorry....

Crkddy

clarinetist, I am so sorry this is happening to you and your DH. I can only imagine how difficult this is for you. My DW was extremely agitated January 2023 as I was providing caregiving at home. Our PCP referred us to hospice, and they agreed to come in due to her agitation. This may not be applicable in your case, but hospice immediately added Ativan to DW's prescriptions. She was also taking Zoloft at that time (and still is). The Ativan had immediate effect and made a dramatic difference in her behavior. DW graduated from hospice after 9 months and I was able to continue my caregiving at home because she was calm and cooperative. A lot of things have happened since then - a UTI, seizures, and related hospitalization. She is no longer on the Ativan but for some reason has still remained calm, for which I am very thankful. I hope you are able to find a solution for your DH.

clarinetist

https://alzconnected.org/discussion/comment/215965#Comment_215965

Thank you, housefinch. My DH has told me that he hates feeling anxious and out-of-control, and has asked me for medication to help him. Like you I would rather see him be too sedated than not sedated enough.

clarinetist

Thanks , trottingalong. I do feel dismissed, but I guess I’m going to have to speak up more, for both our sakes.

clarinetist

Thanks, ButterflyWings, for your support. I was able to get caught up this afternoon and relax a little. We’ll see what tomorrow brings.

clarinetist

Sorry to hear you are dealing with similar issues in hospice, M1. At this point, you should be able to do whatever you think is easiest for you and your partner. I hope you have a resolution soon.

clarinetist

Thanks for the hospice suggestion, Crkddy. I hadn’t thought of that, and will give it serious consideration.

FTDCaregiver1

Hi clarentist - sorry you're going through the merry-go-round, gone through 4 of these myself with DW in dealing with her agitation over the years. Talk about discontinuity of care. Referral into the ER, waiting for a bed, starting all over again with each new health care team, trying new medications. I've learned over the years to keep a small spreadsheet charting these stays, medications/doses and reactions as these MH providers (in my experience) do not share information with each other. During her last stay, I scheduled visits every other day during the week so I could assess how she was reacting and worked with the on-site social worker to call in once a week to speak with her team on their weekly team meetings to discuss her case as I wanted to hear from all of them collectively as to what they were seeing and what course of action they wanted to take. Couple of times had to halt use of both pregabalin and Ativan due to adverse reactions, pregabalin during her last stay as the team totally missed her parkinsonism reaction that rapidly took hold of her and told her psych to cease its use during the weekly team call. Horrible experience how they could've missed the rapid stooping of her neck, shuffling unsteady gait, drooling, and slight tremor of hands, all appearing within 4 days of starting that drug. Fortunately, a year later she's almost recovered totally form all this but was a nightmare. My heart goes out to you, hang in there, educate yourself on these drugs and don't be afraid to make decisions when you see something isn't right, no one knows your LO like you do. Wishing you the best.

clarinetist

https://alzconnected.org/discussion/comment/216024#Comment_216024

thank you FTDCaregiver 1. That’s a great idea about the spreadsheet. Already I’m starting to forget what meds and dosages have been tried. Will set one up tonight!