Gentle, caring DH has become combative - now what?

Daughter of a Marine

My sweet DH, 77 yrs old, diagnosed with dementia 14 yrs ago moved to MC in July. Staff loves him due to his gentle demeanor and concern for others. However, he has become more combative when approached for showers, changing clothes and when redirected from doing something that could hurt him or others. Today he hit two care givers when they attempted to change him. Tried stepping away and trying later but still combative. He is physically strong but no grasp of reality - very confused, not understanding what's being said. They want to schedule Ativan 3 x day - does anyone have experience with this behavior and what has helped? I haven't wanted him medicated for something that may or many not happen but I also don't want them to decide they can't manage him. If he realized how he was behaving he would be horrified. I just want him back. Thank you for any insights you can offer.

Chris20cm

https://alzconnected.org/discussion/72643/gentle-caring-dh-has-become-combative-now-what

DW was very hostile and paranoid 8 years ago around the time of, and continuing after the diagnosis. The gerontologist prescribed Zoloft and Seroquel and that combination has helped significantly since that time. I administer her meds twice daily as prescribed and that keeps us going.

SDianeL

my DH also became combative when he became incontinent and they had to change him or when he didn’t want to shower. They prescribed Risperidone and later added Depakote. Medication is the only thing that worked. It caused him to sleep most of the time. It broke my heart but there was no choice. They won’t allow him to stay if they can’t control the agitation and combativeness. They can’t risk the caregivers getting hurt.

Dio

This is exactly what happened to my DH. Try adding Depakote which was our game changer. Hope this helps your DH, too.

Mint

This is how I personally look at it. I want them to medicate my mother if she ever becomes aggressive or combative. To me I feel that means she’s not at peace. I want my mother to feel peaceful. I’ve not been able to have a normal conversation with my mother for years. Almost all my conversations with her include her delusional thinking and not much of anything else. So if she gets to the point that she starts becoming aggressive with the workers there, I think it’s best for my mom, the workers and me if we all can exist more peacefully together. If that means my mother sleeps more, I’m OK with that. When she’s sleeping, she’s at rest and that makes me more at peace. Then I don’t have to worry is her behavior going to cause them to ask me to move her. So that’s just my outlook. I know others may not feel that way

Daughter of a Marine

Thank you all for your input - so very appreciated. Today his hospice dr has recommended increasing Seroquel dose at night and adding a dose in the morning. Also mentioned possibly trying Depakote if this doesn't work. I too am concerned about his being snowed and sleepy but the alternative to to risk his hurting someone or himself so please pray this is the answer. Thank you all.

Jan

midge333

He will be sleepier for a while after his seroquel is increased. Sleepy is better than combative.

Dio

I'm afraid only the right combination of medications will help. Ativan only worked for a little while in the beginning to curb DH's anxiety so he could sleep. But that didn't last. Seroquel was prescribed to replace Ativan and DH is still on it now but didn't really help. Only when Depakote was added that the aggression and combativeness started to wane. It didn't work right away though. Still took 6 weeks. Hope they'll find the right combination for your DH.

CampCarol

My DH (stage 5, a little of 6) is still in rehab getting PT for his broken leg. He started to become aggressive here about 2 weeks ago during a changing as well. They now have him on Depakote 250mg 3x daily, as well as Xanax and Remeron at night. It’s been 2 weeks now, and it’s still touch and go. I agree with Mint, (and thank you Mint, I never thought about him not being at peace when he’s agitated - that makes sense to me). He’s so unhappy, restless, anxious, sometimes aggressive, etc., lately that if they need to medicate him a bit more for his well being and calmness than so be it.

Carl46

Mint, you are so right. The "chemical straitjacket" of psychoactive medications is so, so much kinder than the physical straitjacket the medications replaced.

Depakote helps a lot of people, but some find it makes them depressed and irritable. I'm sure the prescribing doctor knows that. With psych meds, we just have to try different things and see which gives good results, because no one knows for sure how they work and different people react differently.

midge333

Many times docs will give low doses of seroquel (<100 mg/day) and then try something else because it "doesn't work". There is one study that shows 100 mg/day is no better than placebo but 200 mg/day results in improvements in anxiety and agitation.

https://pubmed.ncbi.nlm.nih.gov/17316169/