Placement/Agitiation/Aggression

pagunke

My father has MS dementia. He acted out against my mother a few weeks ago and he is currently under a doctor's care at a local hospital.

The issue now is that no facility will take him if he is agitated/aggressive. He is under restraints at the hospital because he keeps attempting to take IVs/feeding lines out (he refuses to eat solid foods, and we now have a PEG tube in)

The doctors are trying to come up with a plan for what medication will help. But has anyone encountered the same problem? has any medication/treatment worked to help with aggression? I know that's a big ask and everyone reacts differently.

placement is hard enough but if they can't keep him controlled ; I'm concerned for him and my mother.

thank you as always

SusanB-dil

You can tell them that it is not safe for him to be released to your mom. (I'm not sure, but you might be able to refuse?? someone may be able to weigh in on that) Is he at a place he can get a geri-psych evaluation? A neurologist with this specialty should be able to help get the correct meds. Sometimes, a social worker can help to get him placed after they get the aggression under control.

Sorry you are dealing with 'this'. !!

pagunke

https://alzconnected.org/discussion/comment/246447#Comment_246447

thank you - we’ve been waiting to talk with a social worker!!

H1235

I think I would consider requesting a physic evaluation. If he is a harm to himself or others they should take him to a geriatric physic hospital were they specialize in this kind of care. I would not be confident in the local hospital doctors to figure medication out given the extent of the situation. A geriatric physic hospital would get him settled into to needed medication. It can take time to find the right one and the right dose. These medications have to be started at a low dose and increased gradually. It takes time. That’s what they do. I think the counselor would be able to help you with questions about this. Whatever you do, I would not take him home! He needs specialized care at least until they can get medication figured out.

ReneeC

My Father fell into a prednisone induced psychosis recently, not knowing what to do, we took him to emergency where tests also revealed light dementia. They gave him Haldal in the emergency room which rendered him in a violent delusional state, he had restraints and mitt's for nearly a week. Once the medication got out of his system he slowly came back to himself, but not without nightly hallucinations. I made the mistake of leaving the room for one hour and he became agitated and the nurse gave him a shot of zyprexa. This put him right back to a violent delusional state. My point here is that the anti-psych meds can exacerbate the situation. Once that was out of his system we transferred him to a rehab facility. He became very aggressive there, tried to escape etc. It was the evenings that it got very bad. The problem was he was up all night and slept all day, circadium rhythms were off. I begged the doctor for an anti anxiety med, they gave him trazadone which got his sleep regulated. Once regulated we could take him home. He's no longer on trazadone or any other anti psych drug for now. From my recent experience I take away the importance of sleep, 30 mins of direct sunlight before 11AM and get him off the meds they're giving him in the hospital. Another med I was recommended L-theanine200, natural and over the counter. He's ornery at home from time to time, but nothing like what I experienced in the hospital. I hope this helps. You are not alone!

harshedbuzz

@pagunke

I am sorry you are dealing with this difficult situation.

Why was he taken to the hospital and admitted? Is he in a med/surg unit or a psych unit?

Sometimes PWD (and other elders) develop hospital delirium in an inpatient setting. Sometimes PWD develop and an infection, usually a UTI or URI, and have a sudden change of personality often becoming aggressive and agitated. If this was why dad was admitted, it's possible he could return to a previous baseline once treated and back in his familiar routine.

It's also possible dad is more progressed than you assume or are being told. Food refusal is often a late-stage behavior. How long was he not eating? I, personally, would not sign off on a feeding tube for a PWD for a whole host of reasons. I found this book really helpful when mom and I completed her Advanced Medical Directive.

If dad's not being treated by a geri psych, it might be useful to transfer him to a geri psych hospital or unit for treatment once he's medically stable. From there, a social worker can help find an appropriate placement.

https://www.amazon.com/Hard-Choices-Loving-People-Palliative/dp/099726120X

HB