Medications?

Dogsaremylife · February 20

I hope I have the right group, if not I apologize. My husband, diagnosed 6 years ago, has suddenly descended into Stage 6.5 Alzheimer's. He requires full time care, but up until 2 weeks ago he was still fairly coherent and responsive. He is now under Hospice care here in our home, and because he has begun to be highly agitated at night the nurses have put him on heavy medication. he is on Seroquel, Haldol, Trazadone and sometimes they add Lorazepam. They have had to give him high doses because nothing less works. But now he is incoherent, having delusions and can barely walk. My questions: is this typical medication? They tell me it's safe that he takes all these together. Is the medication causing the delusions, incoherence, etc. or is it more likely the Alzheimer's moving quickly? Thank you for any help.

Iris L. · February 20

Due to the suddenness of the decline, was he tested for a silent urinary tract infection? Were the meds prescribed by a geriatric psychiatrist? It takes some time (days to weeks) to develop steady blood levels of psychotropic medications.

Iris

Ryansama · February 20

I have heard of “terminal sedation” used when a patient is extremely violent and dangerous. I am not sure if if is used as a tool in hospice care. Just speculation. I apologize if this is in anyway offensive.

trottingalong · February 20

I’m sure others would know far more than I do, but often in a really quick decline, the first thing I would look at is a UTI. The most recent one my DH had was unlike any previous. He went into a quick decline of confusion and unable to sleep. ER doctors did not believe me when I stated I was sure he had a UTI. After numerous other tests, they finally took a urine sample. UTI. I have since purchased testing strips for home use.

if your DH wasn’t on all these medications before, I would be a bit concerned. But that’s just the way I am. I like what Iris had to say.

Jazzma · February 20

My husband was also a steady mid-stage 5 for a long time, with a slow decline but always calm, cheerful and loving. Two weeks ago he went into the hospital with pneumonia and came out a hard stage 6 with extreme nighttime agitation. He is on Seroquel and Trazadone (in the hospital they added Atavan and Haldol). I was also told they are 'safe' taken together so Seroquel can have harmful physical effects (stroke, etc). I don't know either. He is going into memory care soon and I'm uncomfortable with how medications are used there, expecting they primarily want patients to be compliant. I wish I could help more. Please take care of yourself. This is a brutal period in a brutal process.

Dogsaremylife · February 20

https://alzconnected.org/discussion/comment/198979#Comment_198979

Yes, he was tested for a urinary tract infection and he was clean. They also did a complete blood workup and he is physically in top health (he is 78). I doubt it was a geriatric psychiatrist who prescribed the meds, but rather a general psychiatrist at the hospital where the testing was done. You make a great point that one of the nurses mentioned- that the meds need to build up in the blood. Thanks for your questions. I truly appreciate feedback because we have absolutely no one in our lives except the Hospice nurses.

Dogsaremylife · February 20

https://alzconnected.org/discussion/comment/198984#Comment_198984

Thank you for your kind words. I get the impression from all health care workers involved that they, too, are frustrated with the meds but they have no other options. We see so much negative press about psych meds so naturally we are afraid for our spouses. But I have to put this in perspective. When my husband is agitated he is suffering, so I have to keep a balanced thought about the help at hand. Again, thank you for your concern.

Dogsaremylife · February 20

https://alzconnected.org/discussion/comment/198981#Comment_198981

I can say for sure that all the nurses involved in my husband's Hospice care are wonderful, loving people. We truly lucked out that way. My husband's main nurse is a retired military man who really understands my husband (a career Marine). They have all been extremely careful in how they raise the dosing of the meds. They also have gone way above the call of duty in helping me when my emotions get the better of me. One night, at midnight, a nurse had to come to our home to adjust the meds up because my husband was horribly restless. After she gave him his new dosage he went to sleep, but she stayed another hour to talk to me and hold my hand. We have truly been blessed.

gampiano · February 21

Having been through this experience with medications,utis, hallucinating, agitation...the list goes on. I can truly say that in our case, the medications were necessary to off set the other behaviors. Hospice was a blessing, and the nurses were angels on earth. This stage is HARD. We can't second guess things now. The goal is for comfort when possible, and no drastic measures.

Wishing peace for both of you,

Maureen

jfkoc · February 21

I suggest you go to a site like drugs.com and check side effects of each drug. Then check for interactions. There are some major interactions that you need to be aware of.

Have you talked with your husband's neurologist about the drugs?

Lorazepam; "Occasionally benzodiazepines induce a paradoxical reaction marked by agitated delirium with emotional lability and restlessness". I know this first hand.

To answer your question...typical? I do not think so but the bottm line is using what is best for your husband.

Please continue to let us know how you and he are doing.

-Judith

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