Talk to their primary doctor. Have an evaluation done. Yes, some drugs have very bad side affects, but some can be a life saver. And as with a lot of answers I have seen, it may be time for a move into a nursing home. Take a CNA class if you can and get trained in proper movement. But even with proper training, you still can get punched, kicked, scratched or bit. It is all going to depend on how much abuse you can take. And if it is too much, find a facility.
@seenypa..Do NOT feel guilty unless you have a crystal bally. You have no way of knowing for sure that the decline he had would not have occurred at the same rate. It may have been just his rate of decline and the medication had nothing to do with it. As caregivers we have enough on our plates without second guessing decisions that we make at a particular period in time. I am sure that all the decisions you made were the right ones at the time. So please do not feel guilty about it. Give yourself a pat on the back for being a kind and loving caregiver.
My dad wasn't combative, just more difficult and refused to listen to reason. He always walked out. At the AL they asked for a specific pill, Respiridahl, and the doctor initially prescribed Alzam. This calmed him down very quickly, but in hindsight I feel awful for agreeing to it, not knowing the downside to it. His muscles stiffened in leass than 10 months to the point where he could no longer walk and it has also affected his brain for the worse faster. I feel guilty and hate myself for what it's done to him. Maybe you could try a calming tablet, but be careful at the same time.
you can't change a combative person with dementia, run! Yep, run for the hills because it's just a waste of time. You just can't change someone like that, they need to be in a proper facility with staff who are specifically and uniquely trained to deal with these matters
You can put him in the hospital due to altered mental state. In fact, if this is something new you should do that to see the cause. Maybe he has infection. If physical causes are ruled out he will need medications to control his aggression--even in a nursing home this is a must because if he's aggressive they will hospitalize him anyway. If the aggression continues the nursing home will kick him out.
Just a quick thought. Whatever you do, if a person has asthma or other allergies, please be careful what you use or have in the room. My granddaughter is allergic to lavender, I am allergic to a lot of scents. One of my daughters is allergic to corn and corn products. This includes corn starch that my mother insisted on using on her when she was a baby. It caused huge boils on her little bottom. I couldn't leave her with mom because mom said she HAD to powder her bottom with something and she was allergic to everything.
Sorry, in my mean and selfish opinion, once they don't even know where they are, who you are, are bedridden and incontinent, and are now combative with dementia, their days of 'living at home' have come to an end. I would start looking for a placement somewhere. In the meantime, tell the patient's doctor and see if some calming meds can be given.
Be sure to ask your/their doctor if you are adding any "vitamins or drugs". You never know if it will interfere with the medicines they are taking. Good Luck!
I love Grandma1954's descriptions, thanks. I am a professional carer, and using limited but focused speech to explain the task, then just start with the movements and keep explaining - do all that is possible to make the weight transfer effective and safe. Use good light. Go one step at a time, do the movements, pause if someone is getting combative, and explain again, but in simple language, functional. I have always said things like, "excuse me, I'm sorry to touch you here, but I want to be sure there is no soap left behind, it is horrible to have an itch later. In my experience, elders accept the need for care in personal areas, they don't want to lie uncomfortable, or get a rash, or have an itch later. I can relate to my own experiences with such small but significant errors, to understand how to show them my goal is to functionally help them.
In terms of safety - I find this word is so broadly used, it has created much too much confusion around areas that are important. I agree totally, the need is first to keep oneself physically safe. That means not to bend or lift at an angle where one can hurt one's back. Not be in the way if an anxious person's arm or body can accidentally harm you. If someone is in an intense combative moment, tell them one will leave at this moment, and return in 10 min and see if they are more ready to help you care for them.
I don't even believe in having any gun in a home, why have potential permanent unchangeable harm accessible, for any reason? I would never live with one. Just remove any if there have been.
Verbal arguments are not the same as physical ones. Most combative behavior with elders is temporary and situational, even if it does come back again and again. One great asset about dementia, is that an elder can be upset and angry in one moment, and when you come back with a different attitude yourself, after both have had a break, they don't remember that they were upset. It's tricky, for they do pick up on OUR feelings, so if we feel resentment from before, they will pile on more. But I've said, "I'm not dealing with criticism right now. I'm helping, and I'm glad to be here with you. If you want to use this time to criticize me, I'll be in the other room, and I'll come back in 10 min, and see if you are more willing to work with me.
I think elders have their ideas on how communication "should" occur - and they lose the patience, and memory, to make time to relate with empathy to those with them, so they just bark out orders, and sometimes criticisms.
I do what I can to agree with the principle they are making, add humor, and explain again, that this hygienic cleaning task is important, and I want to get it done, so they will be clean, with no itches, and no possible rash.
Another thing that works well, I'd add to Grandma1954, is to ask them to hold on to some bar nearby, to help you by holding the bar, to hold themselves up. Then I put a pillow under body parts not to be cleaned, so that soft buffer holds them up into the position I need for cleaning. Asking them to help, telling them this is not easy and I need their help, is a way to give them a request and direction, so they usually do help, or even try - and I say thank you - and the process lasts no more than about 5 min, and I affirm at the end how good it is that they are clean and ready for the morning.
I hope that by combative you don't mean they hit you. If they aren't already on medications to reduce aggressiveness then please get them evaluated by a physician to see if drugs would help. Bottom line, if this person is strong enough to overwhelm you, a different placement might be needed. Good luck and God bless.
Would reading a book about someone who has been through this help? Get a copy of Elder Rage: Take My Father, Please. The author gives strategies for coping that might help you. It was written by Jacqueline Marcell. It surely has helped me deal with my mother's wildly changing moods.
As usual, all good answers. However, do NOT take any supplements without checking with your primary care person first. Some of them are as powerful as prescriptions meds and cause major health issues. My mom is in a nursing home and also has combative issues. She can also be very sneaky and that's what concerns me about your situation. The staff there tells me she will suddenly push her walker out and try to trip them. And, both my uncle and my father-in-law once pulled a knife on their spouses. Does your father have health coverage of any kind? Most I've heard of will provide help, even a home care person to come in a few times a week to help the patient bathe. If your father is at all mobile,Mia e him help you if he can. If he participates in the cleaning-up maybe he won't feel so "invaded". Good luck. I'm my hubby's caregiver and he can be verbally abusive.
To complement what Grandma1954 said, the worst thing that could ever happen is if the incapacitated person happens to obtain a gun and pointed at you while you're sleeping or hold the barrel against you and you happen to wake up to it. You'll definitely want to keep a hidden cell phone handy as whatever is necessary for self-defense if you insist on taking care of this type of person because believe me, you'll definitely need something to protect yourself with just in case. One smart move though would be to lock up any guns you have and hide the key or better yet keep it on you at all times. Another smart move would be to lock up all the knives and other sharp objects just to be safe. Only take these steps if you're absolutely sure you want to keep this person at home. Until you can get this person to a facility though, it would still be a good idea to take safety precautions now before they can have a chance to get a hold of a weapon. Please take these tips to heart and take them very seriously if this happens to be a physically combative person because if they are, they're a ticking time bomb, especially if they were previously diagnosed with paranoid schizophrenia
Oh yes, I forgot to mention in my post about the happy affect of the B--vitamin called inositol , it comes in a capsule filled with the powder or you can buy just the powder. It's easy to put a 1/4 teaspoon or a little more, in your food or drink. It is slightly sweet like a mild powdered sugar.
I am the most caring and compassionate person in the world, but I think I would probably skip this person an all natural holistic herb which might help to make them relax more.I take inositol powder which is part of the B-Vitamin group. It has a slight calming affect but most importantly it makes me feel happy. Not overly happy , but agreable and less agitated. I have many help problems, juvenile diabetes, heart disease, nerve damage pain, joint pain, and so many more, how can I not be cranky and agitated? But every morning I take 1/4 teaspoon of the NOW Foods brand of powdered inositol and it helps me be nicer through the whole day. I have let other people try this supplement and they have agreed that it is like a feel-good medicine without bad side affects. It also helps to make you sleepy IF you take it 30 minutes before bedtime. And it helps keep away charlie horses in the calf muscle of the legs. I am not saying this will cure the person , but I live with my 95 1/2 year old mother, who I Love dearly, and I am so incredibly blessed that the only thing wrong with her is she's loosing her hearing a little and has slowed down physically, but she can still walk around and do some yard work, but she is very stubborn and can be combative when it comes to anything that is serious and needs to be discussed. I am an extremely healthy eater and cook and thank God she like to eat healthy, and she learns from me about all the supplements I take and she started taking the inositol too. Within an hour I notice her personality changed for the better. So I hope this information helps you and gives you another option to help.
RareFind has made a very good point. It might be a good idea to describe the type of combative behavior that is occurring.
If you or anyone else in the house is at ANY risk of being injured then home is not the place. I have said that as long as I can SAFELY care for my husband I will keep him at home. By that I mean his safety and mine. If at anytime he became violent I know I would have to place him. That is difficult to say but I know the violence would only escalate and one or both of us would end up getting hurt. Even though he has lost weight he still outweighs me and is MUCH stronger than I am. I know I could not handle combative behavior. I heard enough stories at my support groups of wives waking with their husbands hand around their neck, or a knife being held at them to know that is not what I want. A facility is much better equipped to handle things like that. And it might take medication to make it safe for everyone.
Salisbury I wondered that too but I suspect it may be relating to continence or lack thereof and especially as it is a father it is relatively easy to see why he is combative. Despite what we all think about dementia and all of us would have differing ideas, sometimes, in some people, vestiges of memory of what is right and what is wrong linger long after the rest of the memory seems to have disappeared. If your Dad recognises that he may be very reluctant to let you anywhere near his private areas.
However I want you to really think about this because this is something I used during a training session for carers. Imagine you are in a hotel and the maid walked into your bedroom and tried to pull your pyjamas off you - what would you do??some people in the later stages of dementia the fear would be immense and of course they would fight cant use the inherent alternative of flight so that is all they are left with. Try soft music a slow talked through approach explaining why you need to do something and what you need to do Grandma gives a great explanation of how to do it so no point in me repeating it. Sometimes having a lavender smell in the room has a calming effect and soft lighting helps too Whatever you do DO NOT get close enough o get hurt. If you are hurt who is going to do the caring.
With that in mind it is not unreasonable to approach Social Services and explain that you need assistance or training in dealing with this next phase. Whatever you do please please don't put yourself at risk
I am not sure about the type of combativeness - short-term, situational, constant denigration and occasional physical attack? I had the latter combo, and kept things going for a couple of years, taking it, and gently responding. I realized that my mother was very unhappy, and as is common with people who are unhappy, there was anger, but rather constant. I reminded her that I was her daughter and that I loved her and was taking care of her, which worked for short periods of times. Mom thought I was a paid servant and she saw me as not doing a good job of keeping her happy, though her unhappiness derived from her disabilities. One tries this and tries that to address this and other confusing problems. I finally was unable to take more of the relentless abuse until one day it was just too much. I thought I had put a temporary pause to it by agreeing to allow her to go anywhere she wanted (calling her bluff), which she had been harping on - I told her that I would call a taxi and pay for it. Mom stopped talking for several days and then stopped eating and then drinking. Hence an EMT call, hospitalization, rehab, and now, dementia care. You may be somewhere on that path or on another. Trouble is, there are many unique paths and many moments of learning on the way. Though Mom is in a very good Dementia Care Facility, she is not a textbook example. I must "explain" her to her caregivers and her doctors so that they understand when she "plays opossum" and appears unresponsive. I am now her visitor, her advocate, and sometimes rehab assistant. I also have seen how medication can help allay anxiety, fear, and resulting anger and allow the person surface to a happier life.
Both could answers but we need to know more about what you mean by combative. Is this in a 'nursing situation" as the in the first answer? Or is this more emotional, verbal????
If you are in physical danger, then you must change the situation. Is that possible???
Simple, you don't unless you have very specific training that nursing homes have in the Alzheimer's wing. As an abuse survivor, I personally would never ever put myself or my family in such danger, that's what proper facilities are for. I just wouldn't deal with someone who's become violent. From your description, it sounds to me like the person may be in later stage Alzheimer's disease, which is definitely too dangerous to try to handle on your own. It sounds like you definitely need trained professionals on this one, don't put yourself in eminent danger
Ohhh been there done that! My husband was very resistant to being rolled to be changed. About 3 weeks into doing this he began to relax more and now I do not have the same resistance I had in the beginning. Talk to the person. Reassure them. Tell them exactly what you are going to be doing.. Give them a towel to hold onto, one for each hand if necessary. Use a "draw sheet" to hep you roll them rather than trying to pull or push the body. As you bring the draw sheet up it sort of swaddles them so there is a feeling of security as well as it helps to control the arms. If there is still a bit of resistance..stop and talk and calm them a bit. Take your time. It also helps you a great deal if the person is in a hospital bed and you can raise the bed up high enough that you are not leaning over. Great way to hurt your back while making the change. When you are done cleaning then changing a bit of lotion on the back and arms might soothe a bit, lavender is relaxing and the lotion moisturizing so it is a win-win for skin care. If you are using a Hoyer lift check out Lavin Lift Straps they can make changes a bit easier. They strap around the persons thighs and attach to the Hoyer and when you raise the Hoyer the legs and lower body are lifted off the bed so you can easily clean then slip the brief under them then pull the brief through the legs then lower the Hoyer to fasten them. Good luck.
As caregivers we have enough on our plates without second guessing decisions that we make at a particular period in time. I am sure that all the decisions you made were the right ones at the time. So please do not feel guilty about it. Give yourself a pat on the back for being a kind and loving caregiver.
In terms of safety - I find this word is so broadly used, it has created much too much confusion around areas that are important. I agree totally, the need is first to keep oneself physically safe. That means not to bend or lift at an angle where one can hurt one's back. Not be in the way if an anxious person's arm or body can accidentally harm you. If someone is in an intense combative moment, tell them one will leave at this moment, and return in 10 min and see if they are more ready to help you care for them.
I don't even believe in having any gun in a home, why have potential permanent unchangeable harm accessible, for any reason? I would never live with one. Just remove any if there have been.
Verbal arguments are not the same as physical ones. Most combative behavior with elders is temporary and situational, even if it does come back again and again. One great asset about dementia, is that an elder can be upset and angry in one moment, and when you come back with a different attitude yourself, after both have had a break, they don't remember that they were upset. It's tricky, for they do pick up on OUR feelings, so if we feel resentment from before, they will pile on more. But I've said, "I'm not dealing with criticism right now. I'm helping, and I'm glad to be here with you. If you want to use this time to criticize me, I'll be in the other room, and I'll come back in 10 min, and see if you are more willing to work with me.
I think elders have their ideas on how communication "should" occur - and they lose the patience, and memory, to make time to relate with empathy to those with them, so they just bark out orders, and sometimes criticisms.
I do what I can to agree with the principle they are making, add humor, and explain again, that this hygienic cleaning task is important, and I want to get it done, so they will be clean, with no itches, and no possible rash.
Another thing that works well, I'd add to Grandma1954, is to ask them to hold on to some bar nearby, to help you by holding the bar, to hold themselves up. Then I put a pillow under body parts not to be cleaned, so that soft buffer holds them up into the position I need for cleaning. Asking them to help, telling them this is not easy and I need their help, is a way to give them a request and direction, so they usually do help, or even try - and I say thank you - and the process lasts no more than about 5 min, and I affirm at the end how good it is that they are clean and ready for the morning.
It might be a good idea to describe the type of combative behavior that is occurring.
If you or anyone else in the house is at ANY risk of being injured then home is not the place. I have said that as long as I can SAFELY care for my husband I will keep him at home. By that I mean his safety and mine. If at anytime he became violent I know I would have to place him. That is difficult to say but I know the violence would only escalate and one or both of us would end up getting hurt. Even though he has lost weight he still outweighs me and is MUCH stronger than I am. I know I could not handle combative behavior.
I heard enough stories at my support groups of wives waking with their husbands hand around their neck, or a knife being held at them to know that is not what I want.
A facility is much better equipped to handle things like that. And it might take medication to make it safe for everyone.
However I want you to really think about this because this is something I used during a training session for carers. Imagine you are in a hotel and the maid walked into your bedroom and tried to pull your pyjamas off you - what would you do??some people in the later stages of dementia the fear would be immense and of course they would fight cant use the inherent alternative of flight so that is all they are left with. Try soft music a slow talked through approach explaining why you need to do something and what you need to do Grandma gives a great explanation of how to do it so no point in me repeating it. Sometimes having a lavender smell in the room has a calming effect and soft lighting helps too Whatever you do DO NOT get close enough o get hurt. If you are hurt who is going to do the caring.
With that in mind it is not unreasonable to approach Social Services and explain that you need assistance or training in dealing with this next phase. Whatever you do please please don't put yourself at risk
If you are in physical danger, then you must change the situation. Is that possible???
My husband was very resistant to being rolled to be changed.
About 3 weeks into doing this he began to relax more and now I do not have the same resistance I had in the beginning.
Talk to the person. Reassure them. Tell them exactly what you are going to be doing..
Give them a towel to hold onto, one for each hand if necessary.
Use a "draw sheet" to hep you roll them rather than trying to pull or push the body. As you bring the draw sheet up it sort of swaddles them so there is a feeling of security as well as it helps to control the arms.
If there is still a bit of resistance..stop and talk and calm them a bit. Take your time.
It also helps you a great deal if the person is in a hospital bed and you can raise the bed up high enough that you are not leaning over. Great way to hurt your back while making the change.
When you are done cleaning then changing a bit of lotion on the back and arms might soothe a bit, lavender is relaxing and the lotion moisturizing so it is a win-win for skin care.
If you are using a Hoyer lift check out Lavin Lift Straps they can make changes a bit easier. They strap around the persons thighs and attach to the Hoyer and when you raise the Hoyer the legs and lower body are lifted off the bed so you can easily clean then slip the brief under them then pull the brief through the legs then lower the Hoyer to fasten them.
Good luck.