Mid-stage Dementia : Agitation and Aggression

Medication does not need to make him a zombie. My mom is on anxiety medication not an antipsychotic. Think how miserable he must be with all this anxiety and anger. Medication can help him feel better and give him some relief. Without treatment these issues may escalate to the point that he needs to be hospitalized or he might hurt someone. These types of medication are usually started at a low dose and then increased very slowly. This prevents over medication. They can cause drowsiness, but are usually given in the evening and tend to help with sleep at night. The experience your mom had with her mom was probably a while ago. Could it be there is a better understanding of how to treat today. I would focus more on convincing your mom that your dad really needs medication.

I would not wait for a specialist. Moms pcp at her assisted living prescribed medication for anger and anxiety. I look at it like this. If he was in extreme pain you would not hesitate to give him pain medication, if he was diabetic you would want him to have insulin, if he had high blood pressure he would take medication. His Bain is not working properly. It’s causing him extreme discomfort. Medication can help.

In my experience the best doctor to prescribe is the one you trust the most and you can communicate with. Some specialists are extremely hard to get face time with or answers to questions. My mom's pcp was great at tinkering with meds and dosage with us and working with us, listening to us. However my mom didn't have extreme agitation like this; it sounds borderline violent. Sometimes with the more challenging dementia behaviors a geriatric psychiatrist is the best person to prescribe. But in many communities it can be very difficult to get in with one, or take months. If the PCP is willing to work with you I'd start there. It sounds like you are doing everything you can with learning about dementia communication techniques, and sometimes that just isn't enough. Meds shouldn't be scary. They are often the key to keeping people at home, keeping them and their caregivers safe, and improving quality of life for everyone involved. Care needs drive the decision making, and he needs to be bathed and change clothes so it's time to do what you can to make that possible. It all must be very hard on him too, and the right medication can help. My only other tips are to try a male aide or change it up in some way you haven't tried. The dynamics of having family bathe a PWD can be complicated. Modesty can be a big issue that the person can't communicate. We struggled immensely with it; my mom behaved just awful around showering. After she started attending an adult daycare we discovered they offered bathing services for an extra fee. We started having her showers done there while she was there anyway and she didn't fight it at all. She was so much more compliant for other people especially when her family was not around.

Ideally, the person writing prescriptions for psychoactive medications should be a specialist. The specialist this scenario is a geriatric psychiatrist. IME, Dad's neurologists were great for getting a comprehensive workup and diagnosis, but they weren't especially helpful beyond that. His geripsych was the most important person on dad's team after mom.

Alas, getting in to see a geripsych can take some time in which case I would weigh the very real risk of mom being injured and dad needing to be placed (with a record of assault, you will not have many options) with doing nothing. While you wait to see a geripsych, I would absolutely rely on his PCP for meds especially since it doesn't seem your neurologist was responsive to a fellow physician.

One option to fast track seeing a geripsych would be to have dad transported to the ER for transfer to a geripsych inpatient stay if his aggression rises to an overt risk to anyone including himself.

HB