Seroquel drug for dementia person's angry behavior in an assisted living facility?

Marie, we are in the same position with my Dad, who's in a Nursing Home facility, and also exhibiting angry/confrontational behavior with residents. We had to move my FIL, Dad's roommate away from him, because my Dad was bossing him about, and got backhanded for it. They have been screaming at one another, and generally upsetting the whole unit. One day I went in to visit, and thought something was desperately wrong with my Dad. I called for his nurse, had his vitals taken, etc. Come to find out, they had given him Ativan, prescribed PRN (as needed) to control his aggression. The result was extremely sedating, and he could barely walk. That was more than disturbing to me, but they told me nothing else worked. They had tried redirecting him, distraction, etc. So, behavioral modification wasn't working. I have seen his angry outbursts, and Dad prowling into people's rooms, or into an occupied bathroom. This is his third room change at the facility due to his behavior, which keeps him in constant trouble. And he's been standing on chairs, lately, trying to close window blinds, and they're afraid he'll fall, and they'll be liable. They tell me, "This is just the progression of his disease."

You say the drug they suggested your Mom take was not for those with Dementia. I read that about one of the medications prescribed for my Dad, too. (Can't remember the name of it, at the moment.) I told my sister about it, and swore I'd not allow them prescribing it for him. But the orders changed to something else. They can tap dance around anything, it seems. I'm always getting explanations by someone about something, explaining away their reasons for some action. It makes you wonder who to believe sometimes, and is generally frightening. Since I'm no Pharmacist or Physician, I have to rely on the "expertise" of others, who prescribe these things every day. I figure they know more than me about these matters. Nevertheless, when I research things on line, or read the package inserts, I too, am disconcerted by their warnings.

I asked a Physician about it. He told me that they have to report negative reactions by anyone who's ever taken that medication. These can be anything from headaches, to dizziness, nausea, earaches, toothaches...etc., and the list can be quite extensive. They say it doesn't mean that taking the med will necessarily cause these symptoms, but that it has in "some people, at some time." As for the "not for those with Dementia" question, I never got a clear answer when I asked it. So, I'm just as curious as you are. I've also been told that not all we read on the Internet is reliable. Now, who are we supposed to trust??? Good question!

For all they have tried, and for all they are prescribing, nothing has seemed to curb Dad's negative behavioral tendencies. Some days I wish he would progress out of the angry stage he's in, rather than play guinea pig to these failing experiments. And some days, I just want to cry for him. Alzheimer's and Dementia are not kind. A friend, who's also a nurse, told me that every behavior has a reason. It's our job to find out what they are trying to communicate through the behavior. But it seems the medical profession wants to treat the behavior, without always investigating or eliminating the cause.

Sorry to hear your Mom and family are strugglingwith this issue , too. Seems to be a common struggle... It's hard to see this happen to our loved ones, isn't it? And it's hard to be their advocate, when we don't have all the necessary answers.

If you read on line, seroquel is not recommended for dementia. However, I have tried everything, and seroquel is my last resort. I am a nurse and have been taking care of my father for almost 4 years. His vascular dementia, from 4 strokes, is getting so bad it tears my heart out. I almost hate to say it but the side effect, which can be death, is almost better than watching him suffer. I don't see the father i once knew. His beautiful blue eyes are filled with sadness. He can barely walk a few steps and is mostly in a chair or in bed. If i could see just a glimmer of happiness or hopefulness, it would be worth it. I'll keep you posted.

My mother has been prescribed Seroquel for her negative behavior, but it has changed nothing. When I voiced my concerns over having read the same thing on the internet (on the drug manufaturers website no less) - that it is not recommended for elderly with dementia - I got an attitude from the neurlogist and she said that every neuroligist treating elderly w/ dementia has som of those patients on Seroquel. what are we supposed to believe? Why is so hard to look out for our parents?

My father just went to an assisted living, dementia unit, last week. He gets extremely agitated and angry around 4 to 5PM. The professionals call it "Sundowners Syndrome". They have started him on Seroquel, but the behavior hasn't changed. In the hospital last week, they put him on Ativan and he was a zombie. That is why his doc changed to the Seroquel.
The visiting nurse called me yesterday morning and told me that he broke both of his big toes because of kicking doors after we left on Fathers Day. I cry all the time thinking about leaving him there, but I know that there is no other option. He threatened my mom and his in home caregiver, so we have no choice. I just keep telling myself that he knew this was going to happen because he went through it with my grandmother and that is why he bought the long term care insurance.

I understand your concern about medication and its effects. Soemtimes there is no other choice than to try a particular medication. My Dad does not have Alzheimer's. However, he was prescribed ativan for anxiety during a hospital stay. I discovered that the prescribed dosage for this medication can vary widely. Dad does very well on a very small dose. It relaxes him without other negative side effects. I suggest you ask what dosage has been given. See if they are willing to try a lower dose to try to control the symptoms. It may be that it with a little testing, a lower dose will help resolve behavior issues.

I hope this will help you. Please let us know how you make out.

jgoldhammer, my heart goes out to you in this situation. I grieve thinking of my dad in the nursing home. While still at home, he placed a plastic bag over my 7 year old's head (during play), and constantly threatened to hit mom. He was wandering the neighborhood, and acting out innappropriately with neighborhood women and children. Had to get guardianship, and took him to ER. They sent him to a Geri Psych unit for stabilization on meds, then placed him in a nursing home. Zombie-like is better than dangerous. As his Alzheimer's has progressed, he has mellowed, and the dosages decreased. Angry, hostile aggression must be curbed. Frustration can exacerbate that. We didn't have a choice either, unless we had a 24 hour bouncer to watch his every move. Still, it is so grievous. I hate losing my dad to this horrible disease. They simply can't help themselves when they get like this. Fortunately, the stages change, and he's compliant, now. However, he's declining in his abilities. So, be kind to yourself. I understand. Sometimes the meds are a necessary evil. Finding the right one, and proper dosage is an art. Pray for wisdom for his Doctor. And brace yourself. It's a tough journey, isn't it?

Thanks to all who have commented. Just got off the phone with his facility...he has now thrown the toilet tank top and cut his leg. The doc is suggesting seraquol morning and evening.

Seroquel is an antipsychotic and all of these are likely to aggravate or cause Parkinsonism (aka "extrapyramidal side effects") and sometimes at suprisingly small doses. That said, there are times when a SMALL dose in an elderly person is worth the risk. These should generally NOT be first choice for true anxiety disorder - if SSRIs can't be used for that, or OCD or other symtpoms persist, buspirone is also betterthan antipsychotics more often than not. A real key for the elderly - and actually for a lot of us who are side-effect prone - is instead of cranking up the dose, use the lowest at least partially effective dose, increase slowly if at all, and if side effects kick in, try a lower dose even if it seems just about homeopathic. My dad had to take a little tiny dose of haldol to combat disinhibited behavior. The usual lowest starting dose of an SSRI given kind of routinely in an ICU setting gave him serotonin syndrome though. If he had been really dperssed, I would have asked them to cut the dose in half. Half the usual starting dose for an elderly person is often just the ticket and that may just be the dose to stay on.

The other tip I can offer is that if antipsychotics are used, and some Parkinsonism results but the drug is really too helpful to quit, add a little Cogentin, just 0.5 to 1.0 mg twice a day adn that will typically help quite a bit. Some places I go to do consultations, we are forever treating increased falls and sawllowing problems resulting from overuse of these meds without good side effect awareness. Some docs are just horrid side-effect deniers, and it gets to be ridiculous sometimes - I have heard colleagues deny that there could be problems when the patient is reporting the top three things listed in the PDR! I guess you can tell which of us have ever had to take meds ourselves... :-)

PS - if anyone has tips on how to tactfully and effectively request that no one change ANY medication without consulting you first (my mom is ridiculously side effect prone and most of the the things docs would normally want to try for her various conditions are "been there done that" and we need a T-shirt that says "Never Again" or "No higher dose please!" Docs also forget that if someone if not on the usual first line med for something, there might be a GOOD reason rather than "geez - wonder why the first doctor never even thought of that... but I'll just go ahead and start some right away!"

if you google "whendoesthegladstart" you will find my blog, that I started in late Jan, with a fit thrown my my mother while on Seroquel. At that time there were many wonderful clever TV ads about the drug with the stern warning NOT FOR ELDERLY DEMENTIA PATIENTS. I finally paid attention and did research. My mother had most of the warning signs of dangerous side effects: total body rigidity (like a 2x4 board, she slid off the chair!), facial contortions, choking. She was put on it because of some episodes that happened in the hospital when they were testing for digestive disturbance. She'd have some nausea, and the doctors would come running to poke. She elbowed back with gusto. She'd sort of disappear into her self when she could not make sense of her Symptoms.

I got the doctor to agree to discontinue Seroquel (very low dose, too!), giver her a week and try something else. Ativan. That seems much less damaging on the side effect side, but eventually she had these weird agonizing bladder distention problems, urine retention. They were almost ready to eternally catherize her (and put her in nursing home), when my RN nurse happened to mention this was common side effect of Ativan. So we stopped that and so did the bladder agony. A withdrawal side effect might have been morning leg cramps. Anyway a few weeks of that, and they stopped.

Guess what? Mom has been off all psycho drugs for a month or so, and has had absolutely no delusional behavior...no "wanna die, just let me die" stuff, no DeadZone impersonations, no pulling of hair and gnashing of teeth. A friend's elderly mother was hospitalized for a few days and they gave her Ativan just in case, and she had paranoid delusions all night long. Just the opposite of what the drug is supposed to control.

Mom is "ok" now, nothing wrong at all, cept memory loss and boredom. She's learning to write again, starting with alphabet. She's just returned to a few days at the senior day care center. This has been a whole year of Mom's insanity... and now everything is FINE?? What the heck?

We've just started her back on small dose of Zoloft and one BP pill, and that's it. As I mentioned, I blogged about all the ups and downs since January in my whendoesthegladstart blog. just google the phrase and you'll find it easily.

Please run, don't walk away from Seroquel. It is a powerful anti psychotic, not a first choice for anxiety. I would never allow my parents to take this, nor anyone else I care bout if they would listen. I know b/c I have taken it myself.

I would try a tiny, tiny dose of Ativan or Xanax before I would remotely consider a tiny, tiny dose of Seroquel.
It messes with your blood sugar and cholesterol also.