Dementia patient showing increasing aggression.

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I am hoping someone else has had experience with this. My mother has moderate- to severe-dementia and has been in a NH for a year. I received a call from the NH Social Worker this morning informing me that mom has become increasingly combative, verbally abusive and has begun throwing objects at the nursing staff. The last incident involved her being found standing over her roommate's bed in the middle of the night, with a pillow raised over her head as if to suffocate her in her sleep. Of course, the roommate and her family are alarmed - and I am too. We are going to try medications for her to reduce the anxiety (or whatever is causing these outbursts), and I've asked to put her on a waiting list for a private room. But I am terribly concerned that someone may get hurt while we are trying to address this. Mom has been difficult and non-compliant for years, but over the past six months she has slowly escalated to actual physical aggression, and while she is frail enough that she requires a walker for ambulation, I believe that she has enough strength that she could injure another person. What can I do to help the facility help her? Should I follow up with the nursing supervisor to ensure that something is being done to address this problem? Should I advocate for a medical evaluation before we start experimenting with medications? Frankly, her behavior has become bad enough that I am less concerned with over-medicating her than I am with the possibility that she could hurt her roommate. Mom has a history of inappropriate behaviors throughout her life, and the dementia seems to have removed any filters that might have kept her from hurting people in the past.


I hope others around here can give you some ideas. I haven't had that problem with my loved one, but I think that I might have her admitted to a psychiatric hospital or wing in order to have her evaluated and to get her medication adjusted. I would do it sooner than later. I'm not sure how that works, but i would imagine that her doctor and the facility would be on board.
My father was very agressive the last few weeks of his life.. up all hours, fighting everyone.. we had to admit him to MC so we could just regroup and get some rest. Good luck with this.
I'm with Sunny. Is there a geriatric psychiatrist who is overseeing mom's psych meds? If so, i think you should be talking to her/him about psychiatric admisdion or a senior behavioral clinic, which is a sort of specialty facility for eldrrs with these sorts of psychiatric issues.

Your mother is seemingly a danger to others. I would have a frank talk with the FON and the director of the facility about the possibility that they may need to call 911 to have her removed at some point. It would be much better, in my opinion, to err on the side of caution and remove her safely to an appropriate facility before some dreadful happens. What if she were to attack a visiting child, say?

I'm so sorry you're going through this. Let us know how it's going!
Thanks everyone for your input. It was a relief just to hear some other voices chime in.

Mom's in a rural area: the facility has no onsite psychiatrist and no nearby senior behavioral clinics (the closest would be about 1-1/2 hours away), so we are kind of at the mercy of the facility's MD as far as psychotropics go. I am supposed to hear from the social worker today on what type of Rx they will start (I am open to anything at this point, given the safety issues); tomorrow I'll be there in person to talk with the DON about any other environmental changes we can make. Currently my mother's roommate has an alarm on her bed to mitigate against another night-time incident, but that's not really an answer for the broader problem. The administrator is already involved (roommate's family went directly to the admin after the last incident, understandably), so I feel like everyone is working toward the same goal at this point. Babalou, thanks for the suggestion about setting a protocol for calling 911 - I will definitely bring that up when I see the DON tomorrow. Will keep you posted. And thanks again, everyone, for your comments.
Glad to hear back from you! Hoping to hear some good news soon.
Thought I'd just update... Mom is now on Xanax daily and Ativan if needed, so the aggression seems to be under control. She has been brewing a UTI (probably the fifth or sixth in the last year), which also explains some of the behavior.

Today was a rough day though. She asked me tons of questions about how she got here and how long she's been in the NH, and before I knew it, she had sucked me into a discussion about why she needs to be here vs. alone in her own house, 400 miles from me. I know better than to argue - but I feel like I fell head-first into a trap this afternoon! She's distraught now, because she has been planning to go back home every day now for the past year - wish I could replay the afternoon over again: I'd just change the subject or offer her a refill on her coffee, instead of trying to answer her questions. The only comfort I have in this is that tomorrow our conversation will be forgotten.

Too bad it's Lent - I'd have a martini right about now.
Thanks for the update. I hope it's working out for your mom. If the aggression is under control and she seems more at peace, then perhaps she is being properly medicated, but if not, then I would arrange to have her evaluated at a proper hospital, even if it is a 2 hour drive. Ambulance transport she cover it.

I haven't read a lot of good things about Xanax and Ativan being used long term with dementia patients. I would ask why the MD thinks it's for best. I'd also be careful of falls when on these medications.

I would have the prepared answers ready and then try to to change the subject on why she's there. Seldom will the answers be accepted or absorbed.
Thanks Sunnygirl1 - you are so right about changing the subject when those impossible questions arise. I knew better than to engage - I just got sucked-in for a minute!

I'm not sure that they are planning for long-term use of Xanax; I know the Ativan was a 15 day supply only. We're fortunate in that she's in a facility that is cautious when it comes to prescribing - we moved her last year from another place that was not so careful and nearly killed her by over-sedating - so I'm hopeful that we'll settle on the "best" approach for her. For now, the aggression is under control - not entirely absent, but at least not physical anymore, which is good news.
1Lone, I could have written your posts. My mom is like yours. She scored 15 out of 30 on a mini-mental status exam about six weeks ago, which puts her in the "severe cognitive decline' category even though she can still perform most ADLs. She had been in assisted living for about five years and was moved to a memory care wing last week. She has absolutely no short term memory. Over the past three months she has become increasingly angry and aggressive. It started with verbal aggression, primarily to me, but then progressed to physical stuff. She has spit at another resident, hit another resident and thrown her walker across her room.

I have tried everything I can think of. I took her to a psychiatrist (who did nothing for her), appealed to her PCP (who wanted me to look for things in her environment that might be upsetting her), and finally got a neurologist who had tested her six years ago to start a new med (Seroquel). After five weeks there was no improvement, so I changed to a new PCP who upped the Seroquel and added Ativan about one week ago. So far there has been no improvement. I asked about having her admitted to the psych unit at the local hospital, but the doctors there will not admit her. I guess she does not meet the criteria for "a danger to herself or others", so they cannot admit her against her will.

She demands to go back to her hometown (small town 100 miles away with no good facilities and no one to help her). She wants me to find her an apartment in the small town because she thinks that she can take care of herself. She yells at me that she will not stay in this "jail", and says she is going with me when I leave. She threatens to take poison or stab herself. I also have to think fast to avoid getting sucked into a discussion about moving. After consulting with the staff, I have decided not to visit her for at least a week since my visits just seem to cause more agitation.

I don't have any suggestions for you, but just wanted you to know that you are not the only one dealing with this. I hope the meds will help or that she will progress out of this stage into whatever the next stage holds. This is so hard.

akdaughter, I've done the same thing - cutting back on visits - thinking that I might be a trigger for her. Although the change in schedule hasn't helped her behavior in any way, it has helped me to relax a little. My husband "spots" me each week, going to visit her on his own so that I can take a break, and then I go one other day. Once or twice a month I add a visit so that I can bring my son to see her, which she seems to really enjoy. The added structure has kept me from feeling like my own life is spiraling out of control right along with mom.

I too am hoping that there will be a transition soon, out of this phase.

Hang in there.

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