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Alzheimer's, Anger, Aggressive Behavior, and Ativan.   What are some alternative suggestions for dealing with inappropriate behavior?

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my mother just recently died in a nursing home. she was constantly given Ativan to calm her aggitation and aggressiveness. i have suspicion that she may have been over-medicated and this contributed to her demise. What can i do to find out if this is true or what avenue due i need to pursue to address this question?
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My Dad was diagnosed with Alzheimer's Disease several years ago. We didn't know it until much later. We found out he had been taking Aricept since 2003, and also Namenda. We did see some quirky behavior, but brushed if off. His behavior became bizarre, at times. Then Mom started reporting Dad threatening to hit her, and exhibiting catastrophic reactions during our visits. Things began unraveling and escalating in their home. There were 911 calls and hospital visits, along with wandering and becoming lost while out walking, and while driving. Walking into people's homes became a cause for alarm, and then we received phone calls and visits from neighbors complaining of Dad's inappropriate behavior. A call to his Physician sent him to a local hospital for an evaluation, then an admission to a Geriatric Psychiatric Unit, to "stabilize" him. They transferred Dad to a Nursing Home. We stood by helplessly, and in horror, wondering what could be worse.

Then, Dad contracted a very serious UTI, and was hospitalized again, losing mobility. He couldn't even feed himself. It was frightening! Some mood altering medications were causing some terrible side effects, which subsided somewhat, when removed. Dad was sent back to the Nursing Home with a slight improvement, but was still in poor condition. I suggested he be moved to a nicer facility, closer to me, which was granted.

I had such high hopes, thinking this would be an improvement for Dad. Instead, he was bedridden and anti-social for the longest time. Staff tried everything, and even treated him for Depression. During this time, I witnessed two separate seizure episodes, while visiting. I was told it was all "part of the disease process, and would continually become worse."

But one day, Dad improved. He started coming out of his room, and joining in activities. We played games, and enjoyed activities together. Staff was amazed at his transformation. He was their "poster child," and "exceeded their expectations." We had some wonderful visits together, and some laughter and tender moments. However, this did not last indefinitely.

Gradually, the laughter faded. Then Dad started being aggressive with a male on his unit. Eventually he was moved to another hallway. He then began struggling with people wandering into his room, and then with his roommate. That was my Fil, who became so upset with my Dad's behavior, was relocated to another unit last week. And my Dad was given Ativan, and referred to Community Mental Health for an evaluation. What a sad and horrible experience Dad has had to endure with his AD and decline. Staff has tried everything they can think of to help, and are at a loss. The Ativan sedates him, and immobilizes him. I wish there were a better treatment plan.

What can we expect from CMH? And what have others done in this type of circumstance? I wonder what awful things may happen next, and feel so helpless at times. It seems the Nursing Home, Physicians, and Social Workers don't know what to do either. Any suggestions from those of you who may have had similar struggles with a loved one??? Thank you for any input.
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I'd like to add, that I don't think "drugging" my Dad is a good solution for controlling his behavior. This breaks my heart, especially seeing the negative effect it has on him. As my parent's Advocate, I am new to this role, and new to dealing with Physicians, Social Workers, Psychiatrists and Psychologists, etc. Dealing with the Nursing Home setting was not our desire, but necessary, though sad. We try to be as positive and supportive as possible, but that is a challenge, at times. I have no idea what to expect from CMH involvement, and would appreciate any helpful advice from those of you who may.
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Just found out my Dad's on Ativan, and Depakote, and Celexia, and Seroquel, too. This seems outrageous to me. Soon he'll be seeing Community Mental Health, per State protocol. I am grieved for him for all he has to go through due to Alzheimer's Disease (perhaps Lewy Body Dementia type). This all seems so inhumane. What's a daughter/Guardian/Advocate/loved one to do to help her Dad?
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My husband has Alzheimer's with lewy bodies. He does many weird things during the night. He urinates anywhere when he awakens. Gets into everything, tears up the house etc. He is in the terrible 2's at this stage. He will not stay in adult day care. I am 73 and my physical health is poor. His is good. My house is not as neat as I would like but he requires so much care. The house will have to suffer for a while. I love him but am worn out.
Thanks for reading
Pat Drake
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Dear Pat, thank you for writing. You are an angel Caregiver, and your fatigue is quite understandable. My house and personal interests have also taken a back seat, as we have three elders we are responsible for. Thank God Dad is in a Nursing Home. He could not be elsewhere, due to the progression of his disease. Same with my FIL, who is also in the Nursing Home. Both are wanderers, and lack judgement. My Dad rummages, threatens people when angry or confused, and can no longer communicate effectively, or dress himself. Is suffers from incontinence, occasionally, too. My Mom was constantly calling, complaining or worried about him. Her own physical, medical and emotional limitations prevented her from caring for him or herself, adequately. She was hospitalized more then he was, from stress, over-medication, etc. So, my heart goes out to you, trying to care for your husband at home. Sounds like you could use some help. Burnout prevents us from being at our best, and we suffer the consequences. Is there anyone to help you? Have you considered alternatives, should things decline further, or your needs increase? Do you have the support of family, friends, or in-home care? Have you ever considered greater respite care for your husband? Hopefully, you'll find some relief, soon. Take care of yourself, as possible. Let us know how things are going.
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Some things I have learned in 3 years caring for my mother who has dementia:
1) Walk daily....we walk a lot, outside, inside,does not matter. Walking is great exercise- helps with wandering (which Mom does not do any more) as it gives her activity to do something.
2) Socialize - we visit friends and family regularly - safe places that can handle her if she is having a bad day - but getting he out and about is good. We are able to eat out regularly, shopping,etc.
3) Allergy testing - find out food allergies and respect them.
4) Manage blood sugar - some meds cause high blood sugar which will make things worse as high blood sugar causes so many problems
5) Diet in general - lots of vegetables, etc. Heart healthy stuff.

Before I began caring for Mom my sister did. She had given up on Mom and wanted to put her in nursing home. Mom does better at home,and although she can be difficult. It is easier to keep her busy doing a few things - like the walking and social stuff - than deal with "bad" behaviors. When she is difficult, she typically has a UTI. We are managing those much better by using a mixture of Pedialyte and water as her only beverage. Worked for five months so far.
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This is a very difficult process both for the person dealing with the illness and his loved ones. Sometimes all we can do is sit back and watch, and for many of us we are left feeling hopeless. The key here is to do what you can to remain positive for your loved one. Believe it or not, your behavior can have a significant impact on your father/mother. Just being there with love and understanding can go a long way in calming your parent and correcting their behavior. When surrounded with a calming and nurturing environment negative behaviors will lessen. In the meantime, make sure that you are doing what you can to stay healthy and remain calm. Sometimes just managing our own reaction to a situation is enough. Your loved one does not expect you to solve their issue, just having you there to experience it with them might be enough. Lisa, LAPC
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