MC facility not communicating about anger issues

Jazzma

I have learned from my DH's staff at memory care that he has been in several altercations in the last month, always in the evening after dinner. He struck other residents and caregivers on several occasions. The only reason I know about it is from the CNAs who are on the floor. Neither the head of the nursing department or the administration have contacted me. I heard from one of the staff that they had been asked not to talk to me about it,

I am really angry about it. He could injure someone else or himself, it could complicate his ability to stay there, and (as they know) I am still considering bringing him home and I certainly need to know about issues that could come up.

His neurologist prescribed Xanax 'as needed' a month ago for evening agitation, but it sounds like some of the nursing staff are reluctant to use it. It's a very low dose and does not knock him out, just relaxes him. I'm asking his doctor about making it a regular part of his before-dinner meds rather than at their discretion.

Has anyone else encountered this? I'm otherwise very happy with the facility. They're small, locally owned, with little turnover in staff. I'm surprised that this became a problem.

Iris L.

Xanax is a benzodiazepine. This class of meds may exhibit a paradoxical effect in some older adults, instead of relaxing, causing agitation. See how his agitation is related to the timing of the xanax. There are other medications to use for agitation, if he needs meds.

Iris

​fesk

As Iris said - Xanax caused mood swings with my mother. Won't give it to her again.

Jazzma

Thank you for your advice. His neurologist agreed that it's an unusual prescription but thought it would work for him, and it seems to the times he's taken it. I will talk to his doctor about other alternatives also.

Dio

My DH was combative and struck people, sending a staff to the ER. Another incident caused staff to call 911. Police had to de-escalate. I can't explain why the facility didn't communicate to you. Mine did, but only on the more grave incidents. It took 3 male staff to shower him and these incidents were communicated when discussing how to adjust his care plan. Depakote was added to his meds and he reacted well along with seroquel. Hope your DH's doctor will find the right meds for your DH.

M1

unfortunately trial and error still come into play. My partner was prescribed Ativan (similar to Xanax) when she went on hospice. I was leery because I thought it would increase her fall risk, but it really takes the edge off her agitation. I do not like that they’re not being transparent in communicating with you however.

a04723

I am going thru the same thing with my DH right now. He continues to have a few good days and then a really bad one where he becomes aggressive and violent. He is currently in a locked down unit where they are better equipped and skilled to handle this type of behavior. They do not call me with every violent episode as they can usually handle it but for the ones that are a little worse they will call. Honestly, I appreciate not receiving a call every time - as there is nothing I can do about it and that is their job to handle it and as long as no one is hurt then they did their job. We are currently looking at his meds and Depakote is one that was mentioned. He is currently taking Ativan every 6 hours and Seroquel - which I honestly feel is causing some hallucinations as they upped his dosage. I myself believe that I may be a trigger for some of his behavioral issues as when he sees me he wants to come home and just wants to be with me and a violent episode is not too far from one of my visits. For right now, I have decided to step back and let the staff and doctors figure out what his cocktail of meds will be to address this behavior and to let my husband adjust to his new surroundings and the staff. This was a very hard decision to make, but I feel it is best for him and me. I know that bringing him home is definitely not an option - the last thing I would want is to have to call 911 because he was becoming violent and watching them take him away. I hope you find some peace and that the doctors can figure out what meds are needed to bring your spouse some calm during such a difficult time in this horrible disease.

Dio

https://alzconnected.org/discussion/comment/222913#Comment_222913

You are going thru exactly as I did. It was hard to admit that I was a trigger, and decision to curb visiting was even harder.

a04723

https://alzconnected.org/discussion/comment/222939#Comment_222939

Making these decisions I think is sometimes harder on us than it is on them. I know my husband does not always remember when I have visited and I know the MC knows what to tell him when he asks about me to keep him appeased for the moment. I have come to the realization that I need to let them do their job and I need to just be the wife/partner and do what is best not only for him but for me. We as caregivers often forget that we need care also and that we still have a life outside of the Alzheimer's world. Please be kind to yourself and do what you need to for you also. They would want us to be happy and it takes time to let go.

Jazzma

Thank you all for your comments and advice. I have realized that the MC nurses and staff are experts at this, while my only experience is with my DH. My job is to remind him that he's safe and loved, and to advocate for him. I talked this out with the head nurse and she explained what her plans are — to communicate with evening and nighttime staff and, if necessary, consult with his physician. I'm good with that. I did ask her to let me know when an episode occurs, and she seems okay with that too.