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I recently hired a live-in aide to help me with my husband who has Alzheimer's . While I was out at a support group meeting, he punched her in the side of the face and came at her as if to choke her. She had given him a pair of underwear to put on and he snapped. First, it was cursing at her, then he took a swing. Fortunately , there are no bruises. She has asked for tomorrow night off to take a breather. I hope she doesn't quit. She has extensive experience with dementia patients and knows that the behavior is part of the disease. Any advice/suggestions/info on meds would be appreciated.

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Had I been a caregiver and somebody took a swing at me, I would have hung up the job.
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Mimi, with my mom we saw these difficult behaviors usually with sundowning. This was the time of day when we made every effort to be at home. The evening and bedtime routine was strictly adhered to if possible. It was very unusual for us to be away from home after 4:30 about the time she got home from daycare. This routine even caused my siblings problems; they thought my reports on sundowning behavior lies and exaggerations. Now mom is in a facility, sibs are learning that what I had been telling them was truthful and now hear reports from the director.

If you see these behaviors during sundowning then you need to make an effort for that time of day for everything to be very low key. Unfortunately that means it is the end to dinners out for the two of you, or with other family or friends. This does not mean it has to be an end to evening activities for you, sound like you have a live-in caregiver that would handle an occasional night so you can get out.
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Thanks for all your suggestions. The local police already knows about my husband's condition. My husband wouldn't tolerate a male CG, because he gets jealous of other men. Fortunately, the day after this incident we had an appointment with our PCP and he increased my husband's dosage of Klonopin. He had another meltdown yesterday and it was directed towards his brother-in-law, because BIL tried to restrain him in a chair while they were waiting for me to bring the car around. So it's not only the CG that he targets; when he snaps like that, it could be anyone. We're seeing a pattern here. The episodes are mainly between 4:30 and 6:30pm; classic Sundowning. We've begun giving him 0.5 mg of Klonopin every 4 hours, hoping to keep him on an even keel.
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I am a bit concerned that a seasoned CG with ALZ experience needs a day off already to have a breather. Maybe like others have said.. a male CG would be better. Our CG dealt with dad and his moods and never needed a Breather. She knew the score and just dealt with it. Or call the agency and ask if they are sending a replacement for the day? Our CG was not even live in... what are you going to do if she needs a breather every time Dad acts up?
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Mimijazz, I wonder if a male caregiver would work out better. But it all depends.

My Dad [94] would be assigned a male caregiver every now and then, and it depended on the age of the caregiver. One young fellow in his 20's, huge personality, Dad had no problem with him cooking and cleaning up.... but Dad said it felt strange having when a male caregiver in his 50's was doing the cooking and cleaning.
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While your caregiver knows in her mind that people with Alzheimer's can strike out it's quite a different story being on the receiving end of a punch and fearful of being choked. She knows it wasn't personal, I'm sure, but being physically attacked is very scary.

It sounds like your husband needs medication to control his behavior and I wouldn't leave any caregiver alone with him until you can find a medication that's effective in treating this aggression.
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Glad offered a wise suggestion I completely missed: let the police know that a man with Alzheimer's related anger issues is in residence. If anything happens to anyone else, or to a neighbor, the police would need to know this in evaluating how to deal with the situation.

Also, if there are any weapons in the house, remove or secure them where your husband can't access them.
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Is there anything specific about this aide's appearance that may set your husband off? For example, I had just started using a agency for my mom who was extremely prejudice when younger. She lived in Tennessee for a time as well and told stories of culture at that time that appalled her, separate drinking fountains, people of color to the back of the bus and more. So on the one hand mom was a very prejudice person, on the other the way people were treated was appalling to her. Strange.

The first caregiver the agency sent was an older woman of color. The first time went ok, not great by any means, but nothing bad happened. The second time all h@!! broke lose. Mom thought the woman was there to steal from her, and wanted her to leave immediately. This soon escalated to where my mom tried to physically throw this woman out of the house with the phone in her hand threatening to call 911. Many with Alzheimer's have problems if a caregiver's appearance is not acceptable to them for a variety of reasons. It is embarassing for us, but it is just the world of Alzheimer's. Agencies understand this and hear it often, very unfortunate, but it is a fact in their business that they will adjust to. If there is something you can identify in this caregiver that may be causing the aggression tell the agency so they can find another caregiver.

This brings up another important thing for you to do. The day that this incident happened with my mother I called the police department to notify them that there was a person with Alzheimer's living there that is not in touch with reality. I sure wouldn't want emergency personnel responding without this information. It could be dangerous for anybody there. So notify your police department.

Also, GA makes an excellent, strong recommendation for you to contact his doctor to see what med may be right to try. And that could be trial and error to find the right one as meds work differently in those with dementia, sometimes the completely opposite effect as was intended. Seroquel was a miracle drug for my mom, ativan was a nightmare for her as it had the completely opposite effect.

And it does not sound like a good idea to leave your husband with a caregiver at least until you get the meds figured out. And GA had another excellent recommendation that since your husband becomes extremely agitated a facility with sufficient staff/resident ratio might be the best solution. Was he ever abusive to others in his younger days? Old, bad behaviors return in dementia and most often intensified as the social filters disintegrate within the brain.
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Wow, I really don't know what to think but certainly share your concern as well as the difficulty of being in this situation. I think I would contact his physician first thing tomorrow to ask what are the best meds to control his anger, depending on what else he takes. I think it would be difficult for someone to make a suggestion without knowing that or what other medical conditions he might have.

But I wouldn't leave her alone again with him. It's too dangerous. Did she suffer any other physical injuries? He could easily have broken some bones in her face.

Is this the first time this has happened? If not, I think I'd be considering a placement where there are more people who can control and restrain him if necessary. Even if you really wanted to keep him at home, if he's in the violent and aggressive stage of Alzheimer's, his dementia and lack of control might be more than you can handle.

I'm so sorry for you - this must be so upsetting and traumatic for you and the aide.
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