Combativeness and Agitation Out of Control

Daughter of a Marine

My DH was diagnosed with dementia 15 years ago and his decline has been very gradual but very definite. He's been in memory care for a year, cannot communicate and doesn't understand when I ask him to stand up, sit down, take a sip, etc. He is also incontinent. He is extremely combative and agitated with memory care staff resulting in significant bruising on his arms and hands. It takes 2 of them to shower him and sometimes they just can't. Getting him ready for bed is a nightmare as he holds onto his pants with a vice-like grip - still very strong at 6'1" and has a good appetite. He is so very difficult to manage which requires me to be there at bedtime to help manage him. I have also been with him at lunchtime every day but am realizing I can't continue to be there twice a day every day. I am bone weary and grieving the loss of him brain cell by brain cell. He was always a mild mannered easy going guy - I miss that person with all my heart. I am a widow whose spouse is still alive.

Wondering if anyone has any suggestions on how to manage these combative shower and bedtime behaviors. In the morning he gets Seroquel, methadone (for severe arthritis), and Lasix. Bedtime he gets higher dose of Seroquel, Melatonin, Methadone, Trazadone and Ativan. Even when given Ativan before showers, he is still very combative. I would be very grateful for any suggestions. Thank you and may God help us all.

Eloise0304

My husband is combative and aggressive and won't listen to me if I ask him to do anything, and the shower time is the most combative of all, Ativan does nothing. I have no clear suggestions, but saw your post and wanted to let you know that I am experiencing the same behaviors

Altho he is lucid most of the time so I still struggle and want to take him home

CindyBum

We’re nearing the end of Stage 5, moving into stage 6 and my DW has largely been compliant so far, though her sundowners were something else until we ramped u her medications.

I feel like I have a rather unique geriatric psych. He has prescribed Gabapentin to help manage my DWs anxiety and agitation. It makes her sleepy and pretty darn compliant. I’ve never seen anyone else here giving their LOs this medication, but it seems to be working for us so far.

Iris L.

Ativan can have a paradoxical effect on some older adults and cause agitation and aggression. It is best to consult a geriatric psychiatrist for medication to handle behaviors related to dementia.

Iris

jfkoc

Adding to Iris;

Ativan (lorazepam) can cause or increase feelings of anger, agitation, and aggression through several mechanisms, including paradoxical reactions, dependency and withdrawal, and emotional blunting

. While Ativan is typically prescribed to reduce anxiety and promote calmness, some individuals experience the opposite effect. 

My husband could not tolerate Ativan! Please have his Dr change this med.

Please check with drugs.com for interactions.

Metta

My DH also had a paradoxical effect from Ativan and became aggressive and physically violent when the hospital used it to “calm” him. I agree to see if there is improvement if you discontinue it for a week or two.

Chammer

@Dio 's DH dealt with significant aggression and agitation and he greatly improved with a change in meds. Hopefully she will see this and let you know what that cocktail is.

marier

My DH was extremely combative on Ativan and seroquel. He is no longer on those medications. I agree with the advice of having a geriatric physc. evaluation.

midge333

I, too, wonder if he would do better off the ativan (lorazepam). How much seroquel is he on? I have a suspicion that doctors give up on seroquel long before reaching a dose that works. There is one study that shows 100 mg per day is no better than placebo and 200 mg/day is quite effective. My wife's geriatric psychiatrist slowly titrated her seroquel dose up over the course of a year and when she hit 225 mg/day it was magical and has remained so for over 5 months..

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

Daughter of a Marine

https://alzconnected.org/discussion/comment/251874#Comment_251874

Chammer, do you mind sharing what meds your DH was changed to? Thank you!

Daughter of a Marine

He takes 100 mg of seroquel in the morning and 200 mg at bedtime. He is under the care of hospice at this time and I'm going to explore these med suggestions with them. Thank you! He is currently in stage 6.

midge333

It sounds like he is on a good dose of seroquel. Good luck!