Combativeness and Agitation Out of Control

Daughter of a Marine · August 27

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 · August 27

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 · August 27

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. · August 27

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 · August 27

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 · August 27

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 · August 27

@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 · August 27

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 · August 27

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 · August 27

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 · August 27

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 · August 28

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

Chammer · August 30

@Daughter of a Marine there is a member here @Dio whose DH struggled with aggression as well. She describes her story in beautiful detail in her profile. The med that brought relief for her DH was depakote recommended by his MC director.

Dio · September 2

Chammer,

https://alzconnected.org/discussion/comment/252152#Comment_252152

thank you for remembering my journey!

@Daughter of a Marine Adding Depakote doens't work for everyone but it's been prescribed for "extremely difficult behavior" in dementia patients. Please check with his neurologist, especially given all of the other meds he's taking. Ativan worked briefly in the beginning for my DH, but even that stopped working. He was weaned off, put back on, and weaned off again. My DH is now on melatonin to help him sleep, donepezil for cognition (although I never saw or understood its effects), and quetiapine/seroquel in addition to depakote. Best of luck in finding the right meds for your DH.

Daughter of a Marine · September 23

https://alzconnected.org/discussion/comment/251857#Comment_251857

Daughter of a Marine · September 23

Thank you, dear friends, for the information you've shared regarding Depakote. My struggle is due to the inconsistency of his behavior. There are days he cooperates with the shower aid and does not resist getting undressed at night. But they are temporary and he always returns to trying to flee the shower while soapy and wet, and to refusing to let us get him undressed at night. He can be sweet and so happy to see me (I'm there every day) and can fight me to getting undressed to the point that i know he does now recognize me. I struggle with the idea of Depakote since his behavior is so inconsistent.

Dio · September 23

https://alzconnected.org/discussion/comment/254297#Comment_254297

I don't think most PWDs are "consistently" aggressive. My DH only got aggressive during showers, diaper change, changing clothes and taking away his dirty clothes to laundry, and whenever his roommate was in the room at night. It's triggers that we don't quite understand, but he fought tooth and nail, as if he felt people were trying to harm him or just angry that they were invading his space. I hope your DH will begin to stabilize. My DH may be suffering from LBD, which fluctuates more than other forms of dementia. Our experience has been that he'll be in a certain state for a while, a phase if you will, and then move on to a new set of behaviors. However, his aggression and combativeness didn't allow for this "phase" to ride out. People were getting hurt. DH was faced with possible eviction if we couldn't get his aggression under control. Hence, the mcf director insisted that DH got depakote from the neurologist, who resisted but relented due to possible lawsuit given people were getting hurt. Hope the staff at your DH's mcf will know how to help him under these episodes and ride through this phase without incident. When my DH refused to be changed at night, staff just let him be. At least, he was clothed and not running around naked.

Combativeness and Agitation Out of Control

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