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I’ve been primary caregiver for my grandmother for the last 3 months. According to other family, she’s had dementia or psychotic episodes of increasing frequency over the past year, but we moved her to my house 3 months ago and it now the episodes are daily. She is confused during the day, telling me to get ready because we’re going to visit her mom (she’s 94 so obviously her mom passed many years ago) and she will start calling out for her husband and ask where he went (he also died years ago). There is no answer that satisfies her, whether the truth, white lie, or no response at all. Distraction can work for a few moments, but the fixation remains and she knows I’m avoiding or distracting and she gets agitated with that too. Over the last week we’ve had nightly battles where around 5pm she gets this look in her eye and it usually turns into a psychotic episode complete with delusions, fear, anger and general agitation. She knows who we all are but is convinced we’re holding her hostage or abusing her or something and she has faked sick so that we take her to the ER and she tells the doctors she faked sick to get away and go home. She’s pretty much impossible and my mom and I are as educated and as patient as they come. I’m at a loss on what to do to avoid her getting agitated.

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I'm sorry that I misunderstood your post about the ER visits; I thought that those were INSTEAD of primary care.

Who is prescribing the Seroquel and how long has she been on it? Hopefully, these will quiet down her delusions. Wishing you easier sailing!

Something to remember if there is a "next" admission; with three days of hospital admission (not observation, so make sure that she's admitted) you can usually talk to the doctor about scripting "rehab" in a facility.  Discharge planning will tell you where there are available beds.  You go and look and pick out the best available option.  She may need long term care by professionals at this point, and rehab is a good way to get access to a facility. 
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I understand your situation 100%. My Mother is 81 and becomes very upset. She thinks I have no heat at my house, no food, and thinks my husband beats me. She wants me to divorce him and live with her. I am trying to help her stay at hed house as long as possible. She was prescribed medication for delusions but refuses to take it. She also refuses to go to the doctor. There are no easy answers. I have been told she has delusional disorder. This was given before she refused to go to the doctor.
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We’re hoping the seroquel will mellow her or a bit. The ER visits were simply out of necessity. She plans elaborate escapes where she complains about some terrible pain that she has to go to the ER. When we get there she tells the doctors and nurses we are holding her hostage and she faked being sick so she could get away. She becomes physically aggressive and unsafe so we really had no choice. We’ve fallen for it twice and the second time she refused to go home with us when they found nothing wrong, so they had to admit her anyway for 3 days. One of the doctors commented that they gave her enough medicine to sedate a horse before she actually calmed down. The only reason I questioned dementia is because I’m sure she’s had untreated mental health issues her whole life. But perhaps now the dementia/Alzheimer’s is manifesting whatever mental health issues she’s had in the past?
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Sounds like your grandma is in a very difficult stage and sadly there is really nothing that you can do with your behavior to change what is mis- firing in her brain, and more sadly, this may only get worse and can last a long time

I'm not one to advocate for anti-psychotic drugs but in the past several years I have learned there is no memory care, but there are drugs

My mother is 94, has atypical dementia and is now immobile but two years ago she was screaming out in the street for the neighbors to call the police as there was a thief in the house

Perhaps with the right meds, she would have been more accepting of caregivers and would have been able to stay home longer
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Taking a dementia patient to an ER is not a particularly effective way of getting them treatment for their dementia.

Does grandma have a geriatrics doctor well versed in dementia? Does she have a geriatric psychiatrist or behavioral neurologist who understands the psych meds that can keep a sundowning   dementia patient less agitated in the evening hours?

It frankly feels like you are treating this like a series of acute episodes, rather than a chronic condition.

With the right ongoing medication management, you may be able to keep her home longer.
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She has been to the ER and doctors a number of times and they have ran tests and found no infections if any kind. It almost seems like she spends all day in a certain mindset, usually expecting us to take her to some destination. Then by the time she starts getting agitated in the evening she usually begins by berating us for not taking her where she wanted to go (home, to see her home, an appointment, etc) and her anger just grows and manifests into these delusions. We’re trying some different meds now so maybe it will get better. But I hope it gets better before my mom and I kick the bucket from the stress.
Has anyone had good success with placements? My family is very much “keep them at home” but if my grandmother cannot mellow out and she is a physical danger to herself and us, I’m not sure what to do. We looked at some care homes but the residents all seemed so slow and quiet, which is opposite of her. She is lively and spunky and putting her in a lock down place just seems like it will kill her quickly. And everywhere that boasts memory care does not have memory activities and socializing and engagement, they seem like just a lock down unit. Not to mention everything is entirely unaffordable
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It doesn't sound like atypical dementia or mental illness. It sounds exactly like dementia. Agitation and delusions are unfortunately a big part of several types of dementia and the thing that makes it so hard to be a caregiver. Always check for a UTI. But then ask her doc about one of the atypical antipsychotic medications like Seroquel. It can be quite helpful. For more support, check out alz.org and call their 800 number.
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It sounds like sundowners but please have her tested for a UTI as that can cause dementia to increase.
Also moving her place of residence increases dementia. If it is a UTI please know that she most likely won't have symptoms except for increased dementia. So don't automatically rule it out. A visit to the urgent care can take care of it, or her primary or you can even pick up a test at the pharmacy. You will need a prescription for an antibiotic.
As I'm writing this I'm Remembering that you took her to the ER so perhaps they ran the test? I always request a test if I'm noticing new behavior with my aunt.
Next see if you can get her into a geriatric psychiatrist to have her meds adjusted.
Read on this site about sundowners and see if that helps you understand what is going on.
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