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DILAnn Asked August 2019

Mother-in-law has angry, violent episodes. Any advice?

My mother in law, age 78, diagnosed with moderate dementia, has never been a very happy or particularly pleasant person. She lives in her home with my father in law, who is in his mid 80s. They have never had a very 'happy' marriage, but never had more than an occasional verbal spat in earlier years.


For about a year now, MIL has fairly frequent episodes that go like this: FIL says something that she takes offense to, and she works herself into such a state that she is crying, shaking, and will start pulling her hair and hitting her head against the wall. FIL then calls one of the kids for help, and they come to calm her down. She will make statements like 'he hurts me' (referring to her husband), or 'I just want to die' or 'I want to leave'. Eventually she calms down but has to be worked with, distracted by being taken out to lunch, etc. She has had some episodes in the car with FIL where she has hit at him while he is driving, which is horrifying to us.


One interesting note: MIL used to hit her forehead against the wall during the episodes, but after being asked by people why she had bruises there, she switched to hitting the back of her head now. So she does have some 'control' apparently.


She has been diagnosed with mild/moderate dementia, and was taken recently to her doctor, who was alarmed at her behavior and has scheduled a psychiatric appt that is happening this week.


There are also some other behaviors that she has developed or that have worsened over the years. She no longer bathes in the shower or tub, but will use only a washcloth at the sink to clean herself. She has always been overly concerned with maintaining neatness and order, but now has become obsessive about it, constantly picking up specks of dust from the floor and emptying trash as soon as any item is placed in the trash can. She and my FIL have NO hobbies or interests, and all they do is go to church on Sundays, watch TV, go to the local McDonald's to eat, and sit on the porch watching neighbors. She can no longer drive but FIL does.


Many of her behaviors are sort of 'cut off your nose to spite your face'--we think she stopped bathing because FIL needed to help her in and out of tub, and he probably commented about it at some point, and her response was 'fine, I just won't bathe in the tub anymore'. FIL is a nice person, but is somewhat annoying in that he never shuts up and comments on EVERYTHING. He never wants to be alone. MIL on other hand has always been more introverted. FIL can really get on anyone's nerves and we think he unintentionally pushes her buttons. However, she can't really be trusted to be alone for very long, because she will end up doing something she isn't supposed to do, like getting on stepstools, etc. so it isn't really possible to take him away for more than just a short time.


She has had diarrhea for years and claims she cannot eat normal, nutritious foods and subsists on mainly sugary things. Refuses to take the medicine that controls diarrhea and eats/drinks very little overall. She is very tiny and has lost much weight over the years due to poor diet.


Her doctor says that the above described behavior is NOT normal for just moderate dementia, and I know we will get more answers after some psychiatric evaluation, but here's what I am wondering about: MIL had a very unhappy childhood based on her past statements, and married my FIL merely to escape an unhappy home life. She went from being an unhappy teenager to a mother of 4 by age 26. Never really had a time in her life to just do what she wanted. We suspect that what we are seeing now in her violent outbursts is unresolved psychological issues coming to the surface; issues stemming from an unhappy life. Could unresolved issues be bubbling to the surface now at her age?


Has anyone else dealt with a parent with similar behavior? Did you get any answers? I would appreciate input.

Countrymouse Aug 2019
Lealonnie, I recognise your description of the goings-on in the memory care unit. Forgive me, but I then couldn't help smiling when you warmly recommended the OP to find one for her mother. It's the way you sold the place :)
lealonnie1 Aug 2019
I know, right? :( But the care givers at the AL really DO know how to calm the residents down quite beautifully and quickly redirect them toward some other activity. While Memory Care places aren't perfect, they do beat the heck out of us trying to manage our loved ones' behaviors on our own.
NYDaughterInLaw Aug 2019
"...She would only be held for 72 hours..." That is incorrect. Emergency detentions can be from 3 to 5 days and vary anywhere between 24 hours and 20 days depending on the state where you live.

Step away if her own children are unwilling to do what is right and necessary. Let them suffer the consequences. I wouldn't waste any more time trying to push this rock up the mountain.

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lealonnie1 Aug 2019
I work in a Memory Care Assisted Living community as a receptionist. The East wing houses people with mild to moderate dementia, who are considered pretty okay, not too difficult to handle, etc., while the West wing houses those with severe dementia who are considered very advanced, and difficult to handle, etc. Let me tell you, the residents in the East wing can be heard screaming at the top of their lungs, throwing chairs, and getting very angry sometimes. I don't know why your MILs doctor was 'alarmed' to hear of her behavior, which tends to be quite common with any type of dementia. One of the 'easier' residents wound up breaking a care givers jaw not long ago, after punching her in the face while she was being helped. All bets are OFF with dementia, as everyone is quite different with the behaviors they exhibit. Many dementia residents, including my mother who's always disliked sweets, LOVE sweets now, and tend to choose those types of foods exclusively....nothing unusual there. As far as bathing goes, many, many dementia sufferers fight bathing.......they argue it tooth & nail, nothing odd there either. There are medications that can be prescribed to help with the behaviors, so maybe MILs doctor can look into that for her.

Now is the time to start looking into Memory Care Assisted Living communities for your in-laws, before something terrible happens to either one of them. They will be cared for properly, by trained care givers who know how to handle them when the going gets tough.

Best of luck!
shad250 Aug 2019
In other words "imprisoned"
NYDaughterInLaw Aug 2019
Regardless of her childhood, her behavior now is what you need fixed.

You can have her Baker Acted for up to 72 hour involuntary hold in order to get her on antipsychotic medications.

The next time it happens call 911 and capture everything, including the call to 911 for an ambulance, on videotape and keep your FIL safe. When EMS gets there tell them she is a danger to herself and your FIL. They will take her to the ER where she will be put on Baker Act. Do not accept discharge to home. Let things unfold as is long overdue and necessary at this point of crisis.

You are doing her no favors by allowing this to continue. Yes Baker Acting someone is unpleasant but she needs professional inpatient psychiatric care. Depending on how she reacts to the medications, she may or may not be able to live at home. You will just have to wait and see how things unfold.
DILAnn Aug 2019
None of her children are willing to have her taken in on a mental inquest. She would only be held for 72 hours, and she really needs more than that! When she had the most recent episode, we took her to the hospital ER we'd been told to take her to by her doctor, only to find out hours later at almost midnight, after being in the ER since noon, that they didn't have a geriatric psych unit and could not admit her! So back home she went, and will have the psychiatrist appt this week and a trip to the appropriate hospital that can admit her if there's another episode.
Countrymouse Aug 2019
Yes, unresolved and/or repressed issues are even likely to emerge, because normal social filters break down with dementia.

Yes, I hoped to help my mother achieve some peace of mind and found her a very nice, very level-headed therapist with what I thought was exactly the right attitude. Mother saw her once, and emerged from the appointment *incredibly* angry. I suppose uncomfortable questions had been asked. I didn't push it again.

Untangling any of this becomes even more difficult in a person with dementia. Dementias cause all sorts of changes in mood and behaviour, as do other kinds of disease; and how do you distinguish between a person with a depressive personality becoming demented, and a person experiencing depression caused by vascular dementia - just for example.

But actually - your FIL is being assaulted, and that can't be allowed to continue. Of course, by all means, try to get your MIL the help she needs for her benefit, but meanwhile her physical abuse of him has to stop. How does your FIL feel about her possibly being removed from his care for his safety and hers?
DILAnn Aug 2019
We are very concerned about the abuse of my FIL and are trying to find some way to stop it--but he does not want her taken anywhere and does not want to be alone, just because of his personality and dislike of solitude. He is able to live alone but hates it and has been resistant to her being put in for a psych evaluation.

However, the plan is to take her directly to the ER for an assessment and admission to the nearby geriatric psych unit when the next episode occurs. When she had the most recent episode, we took her to the hospital ER we'd been told to take her to by her doctor, only to find out hours later at almost midnight, after being in the ER since noon, that they didn't have a psych unit and could not admit her! So back home she went and will have the psychiatrist appt this week and a trip to the appropriate hospital if there's another episode.
freqflyer Aug 2019
DILAnn, eating sweets is very common with older folks because as we age we tend to lose our sense of taste except for sweets items. I remember my Mom's grocery list was filled with Hostess cupcakes, ice cream, apple pie, chocolate chip muffins, etc.

freqflyer Aug 2019
DILAnn, have your Mom-in-law see her primary doctor to check for an Urinary Tract infection. Such an infection can mimic dementia in older people, and also cause them to have loud outbursts, etc. This can be treated with antibiotics.

As for elders not wanting to bathe in the shower/tub, it all has to due with exhaustion. I even find myself being very tired after a shower and I am in my 70's. There is also claustrophobia, plus the fear of falling. If Mom is doing a good job doing a "bird bath" type of washing, let her be.

As for diarrhea, does Mom drink milk, eat ice cream, cottage cheese, regular cheese, anything else with dairy, then she might be lactose intolerant. That happened with my Dad. I put Dad on Lactaid milk and Lactaid ice cream and that cut down the diarrhea big time.

Again, have your Mom checked for a UTI.
DILAnn Aug 2019
Thanks, She did have a UTI at the last appt but doctor still recommends psych evaluation. We have decided not to fight the bathing battle since there is so much else going on and it may simply be as you said--it's too difficult for her and she does not want help. Not sure about lactose but I do not think she drinks milk or eats much of anything except sweets.

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