Hates the caregiver

cdgbdr

Hello,

DH is 72 with vascular dementia (most likely). I work full time and don't want to retire. I have a companion with him all day while I am gone. This is 4 days per week with his brother and sister taking a day. He is very confused and thinks his brother is really a dead friend masquerading as his brother. He frequently mixes up me and his sister. He has sundowning now that may start early. Currently, he REALLY hates the caregiver. He thinks he is after me, taking our stuff, etc. He recently started on Trazodone at night and can have buspirone for agitation that can't be redirected. This does help. He has always been a big talker about fighting and kicking butts. He isn't going to hurt him but I worry about being able to keep a caregiver. This one has been with him for 8 months through this decline. I have toured 3 memory cares and if I do need that in the future, I feel like he would not fit in due to his age and how he would perceive it. We see the geriatric NP June 10. I'm wondering if other meds might be in order.

SDianeL

definitely talk to the doctor. Some medications take up to 2 weeks to start working. Have you discussed his hatred with the caregiver. Is he being aggressive with him? Has the caregiver mentioned it to you? I don’t think his age will be a factor in MC. Most people with dementia don’t reason that way. As the disease progresses it will matter even less. Good to have your plan B in place.

cdgbdr

I've talked extensively about the CG and so have his siblings. I have cameras on and check all the time. DH is a big guy and that is an important part of his self image, still. He tolerates me and his sister but I think part of it is that it's another guy here and he perceives that he's bossing him around. In fact, the caregiver is simply present and here for safety and any help he will accept.

harshedbuzz

@cdgbdr

I am sorry you are dealing with this.

In reading your post, a couple things struck me. The first is his medications and how they're prescribed. Given your description of his agitation and aggression (even if just verbal at this point), it sounds like he needs a stronger class of medication. He might do better on an atypical antipsychotic like Seroquel for managing his mood. It might also be better to medicate him proactively with a regular regimen than reactively when he's become agitated. "As needed" in this kind of situation is akin to playing wack-a-mole.

My dad had a lot of agitation and aggression; we found a geriatric psychiatry the most important part of the team as they we both able to keep him calmer with a cocktail of lower dose meds to minimize sedation and side effects. I highly recommend this route if available to you.

The other piece is that your Plan B may not be as robust as you think. Have any of the facilities on your list evaluated your DH to see if they'd accept him into their community? While anyone who has progressed to the point he isn't recognizing close family he sees regularly is certainly old enough for MC, there can be a bias against men who are physically big and strong. Some places are cautious about admitting someone who could potentially harm a staff member or other resident. FWIW, my dad wasn't accepted at mom's first choice and he was slight and a decade younger than your DH.

HB

cdgbdr

HB

I share your concerns about bias against younger stronger men. That is why controlling his agitation is a priority for me. He has a cardiac history and the NP was starting this way because other meds have cardiac "black box" warnings. I will need to better understand when benefits outweigh risks. Thanks for your comments and insight.

blueheron

My DH is 71 and in memory care. He doesn’t recognize that people there are older. It’s not too young for memory care.

harshedbuzz

@cdgbdr

I can appreciate how difficult it is to parse the risks of any medication much less one known to be associated an increased risk of stroke or heart attack. This information weighed heavily when we were in this position.

We also started with medications that had a safer side effect profile, but when they became insufficient to keep him safely at home or in a nicer MCF, we were forced to rethink things. In the context of him having later stage dementia, as I suspect your DH does, the risk seemed worth it to us. YMMV

Behavior is communication; he was the one living with the anxiety and confusion that drove the agitation and aggression. It seemed kinder to address that proactively and risk an earlier death in the context of him being in the late stage of a progressive terminal illness that can be particularly ghastly at end stages.

My dad's death certificate lists Alzheimer's/aspiration pneumonia/WKS as his cause of death. Since no autopsy was done, I can't know for sure that he didn't suffer a sudden cardiovascular event. But I still think the meds were the right choice. Seroquel kept him home with mom until weeks before he passed and it allowed us to place him in a highly regarded facility with exceptional staff.

HB

cdgbdr

HB

My feelings on the risks vs benefits are like yours. This is a terminal condition and I will not be doing anything that isn't to promote comfort and quality of life. Thank you for the affirming post. I see DH as Stage 5 and teetering into 6 right now. He's had deficits for years but for the last year has been in need of increasing care and assistance.