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My husband has been in a geriatric psych unit for 3 weeks. Assisted living director suggested a placement to help adjust his meds - he was verbally aggressive during care, and getting worse. Upon entering, he was continent, ambulatory, and able to converse, even though he’s at a late stage. Now he is none of those things, and he is also physically aggressive during care. I am beside myself. Is this a typical experience?

Has he been evaluated for hospice? There may be help there.
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Reply to gladimhere
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Franklin2011 Sep 19, 2019
Happening today
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I am seeing much of the same behavior in the Assisted Living Memory Care Unit where my loved one resides.
It is a small community and most everyone despite being in varying stages of decline remained happy and optimistic.
Now the individuals are mostly unrecognizable.
Just In the past week she has developed combined
incontinence issues. Due to the sudden loss of control I am researching other potential causes. One of which may be
spinal stenosis.
In her twilight years, I expected mental decline and forgetfulness. After a serious fall, hospitalization and rehab her brain scans indicated she had a ‘perfect’ brain.
I now believe the ‘dementia’ May have been drug induced. She too was prescribed Ativan (PRN).
After being off the Ativan for more than a month she was administered a full dose.
Her blood oxygen level was dangerously
low. This too may be contributing to
her recent decline.
Based on my experience Ativan is harmful when prescribed to the
elderly. (Given a choice, she would choose Ativan and probably believes she is still having it prescribed).
Another good question is how the facility
handled medications when they return from rehab or hospital?
How they handle discontinued meds?
Are meds still on the med cart?
If med is PRN (and not on Med Cart) how
is it removed from premises so not
mistakenly administered?
If this is Assisted Living who is qualified to dispense meds? Full time, part time or temporary employee? Who is qualified to
order meds from pharmacy?
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Franklin2011 Sep 19, 2019
It is the hospital administering the meds and Ativan. Unfortunately he had declined so much he now needs nursing home care and cannot go back to assisted living. A month ago this man was walking two miles a day, continent, and conversational. He is now none of those.
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I agree with FrazzledMama. Have his meds re-evaluated. My Mom experienced something similar when she went into the nursing home for late stage metastastic cancer. After about a week or so, she became combative, mean, paranoid. She called 911 one day to report that something nefarious was going on in the nursing home and she wanted an investigation. (I removed the batteries from her cell phone after that.) It turned out to be the steroids they had put her on shortly after she was admitted. They took her off the steroids and she was back not normal. Sadly, she only lived another 2 weeks as the cancer spread very quickly.
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Franklin2011 Sep 15, 2019
He has been in the hospital for almost a month having his meds re-evaluated (geri psych unit) with no success. He has also declined tremendously
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It does sound like it could be medication side effects. I would push for a re-evaluation of his meds by the geri psych doctor, and explain the differences you've noticed in his behavior from before admittance to now. Different meds affect people differently, so they may have to try something else since what they've got him on now isn't helping. My mom went through so many med changes it was unreal. Some worked better than others, and some were downright terrible as far as side effects and had to be discontinued. ((Hugs)), it definitely can be very stressful. Hopefully they can find a med combo that works better for him.
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Franklin2011 Sep 15, 2019
Thank you
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My mom was in and out of memory care for psych assessment for a year and a half. The last time memory care would not accept her back, she was hitting, biting, yelling, banging her head on walls, etc. Couldn't blame them for not taking her back.

Mom was on hospice at the time and they recommended a smaller care home environment. So, hospice can help in these sorts of situations. The care home was a much better placement for mom and probably would have been from the beginning. But, we didn't know about them. The care home had a lower resident caregiver ratio and was cheaper. Mom also had private caregivers on and off for two years, yes it was private pay in addition.

Yes, it is a constant change of needs resulting from behaviors that, in mom's case, were often uncontrollable. Seroquel worked great for my mom, but ativan had the completely opposite effect as intended.

I would suggest that you ask about hospice evaluation, they may have some ideas that haven't been thought of. Don't consider bringing him home, that definitely would not work. Don't let hospital tell you that they cannot find placement. Stand firm in your knowledge that he needs more care than you can provide. It would not be a safe situation for anyone.
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Franklin2011 Sep 14, 2019
Thank you for the good tips.
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The behavioral challenges of dementia are what lead to many being placed in facilities

mom has been in memory care for over 3 years - she is fortunate in that we also have private aides with her
seroquel was prescribed initially for her but didn't help other than to make her sleepy so rather than increase it, we switched to risperdal which worked better for her -
at 96 and immobile, she still fusses but it is dealt with easily enough and she's been off Risperdal since early this year

I've seen many others walk in happy and pleasant, and within weeks, they're in a wheelchair - these anti-psychotic meds do take a toll
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Franklin2011 Sep 14, 2019
Thank you
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I am also caring for my husband at home. He has been diagnosed with Alzheimers. In the beginning before I could get him to a doctor, he was very verbally abusive. When I finally got him to go to see his MD, I sent messages to him about what was going on. He was prescribed Lexapro 20 mg. Then he was prescribed Aricept in addition and got out of hand again. The MD took him off the Aricept but later added it again with no problems. I don't remember how long it was but he began to be really abusive again and was started on Seroquel. Basically after the Seroquel, he calmed down again. But periodically the situation gets out of hand again and his Seroquel is increased. He now takes 1 white Seroquel in the AM and 3 pink Seroquel in the PM plus Aricept, AM and PM, Namenda AM and PM and the Lexapro just AM. The Lexapro and Seroquel are generics and are mainly for behavior. The other two are supposed to help with memory and have generics also. His MD says he's only trying to help keep him in the home. We have a Neurologist who usually doesn't do much but ask a few questions and charge a big fee.

Once I took him to the ER for shaking and jumping all over. I'm not sure what they gave him but he became very uncooperative, trying to pull needles out, get up etc. They gave him another shot and he got worse. They were talking about releasing him. I told them that before I brought him I could handle him but at that point, there was no way I could. They decided to keep him for a couple days. That night he was out of his head and and it took awhile for him to calm down.

If you haven't already, I would fight the release, talk to the doctor, tell them what's going on, but It sounds like the medications may have caused some of the problems and needs to be adjusted or changed. I'm thinking you said he was in Assisted Living. If so you probably need to talk to the assisted living director, as this doesnt sound norm to me. But, no case follows the same path. While my husband seems to be in the 6th or 7th stage, his body and other areas aren't. I think you said your husband was in late stages.

My husband is going on 6 years since diagnosis but started with the beginnings probably around 4 years before his diagnosis. He is still ambulatory, continent, eating well, but will not bathe, or dress himself, very confused, sundowns, coherent sometimes, sometimes not, doesn't know me or even family and still gets belligerent with me if I refuse to let him do crazy things. He doesn't know why he's doing things but doesn't want to be told not to. This last year he will go to the bathroom and urinate in the floor. At other times, he uses the trashcans, closet, its horrible. Luckily he still finds the commode for #2. Diapers are not feasable for now as I think he'd refuse them or still do what he does anyway. So I don't know if the inappropriate places he urinates has anything to do with incontinence.

I do think he would probably go down a lot faster and would again have to be put on more behavioral medications in a nursing home environment. I suspect this may be what has happened to your husband. I feel the medicine has caused some of it and they need to get him better so you can care for him. I don't know, but maybe he's reached the point that you can't take care of him. If so, I hope you can arrange for permanent care as I'm not sure I can when that time comes.

I would be interested in hearing what happens with your husband and do certainly wish the very best for you as I know how difficult it is for you! I pray for all of us as caregivers and especially those of us who are doing our best with husbands out there. My Mom had it also but this experience with my husband is even worse. But we'll make it somehow, Right?
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Franklin2011 Sep 14, 2019
Thank you - my husband was also diagnosed six years ago. I would guess he was in sixth stage and may now be in early 7th. He’s young, mid-60’s, and in good health otherwise. Initially the neurologist prescribed Valium for his anxiety/agitation and this seemed to work until about a year ago. At that time he upped the dosage. Think the Lexapro is similar. They haven’t tried seroquel, and I will ask about that. My husband had a similar bathroom issue - no longer recognized what was a toilet. Did put a lock on the closet door so he couldn’t go in there. In AL my husband did move from boxers to pull-ups after a few accidents. He didn’t seem to notice the difference. To him it was just underwear. You might want to try the substitution when he’s getting dressed. Before entering hospital he would say he had to go to the bathroom and if you brought him in, he was fine. He no longer understood directions, so if you wanted him to sit on the toilet to try to go before a walk or car ride, it would be a battle because he didn’t understand what sit was. After three weeks in the hospital, he’s totally incontinent. Yesterday Hospital had AL in to evaluate him for readmittance. Still daily incidents of verbal and physical aggression, so the answer was no. Since the hospital knows AL wants three consecutive days incident free, feeling like the hospital just wants to push him out.
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I am so sorry to hear of your situation with your husband. I work as a nurse in a gero-psych unit and have for 10 years.
While I cannot really know for sure regarding his situation without knowing all the details, I have some thoughts on it that may or may not be helpful.
Sometimes, a change in enviroment can really take a toll on a dementia patient's behaviors. Any change is an upheaval in their world and may be part of the problem. Sometimes, also, when readjusting meds it takes awhile to see positive progress and it may take awhile to get the right meds for a particular individual since everybody responds differently to different meds. I realize that it is frightening and heart-breaking to see your husband in this condition and I am so sorry for what you are going through. Always feel free to ask any questions of the staff at any time. They should be eager to answer any questions at any time for you and your family and you should feel like they are very openly communicating with you. You also can request to speak with your husband's doctor in a meeting if you feel that might be helpful.
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Reply to Rhiannonsdad7
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Franklin2011 Sep 13, 2019
Thank you. I understand that it takes a while, but they are talking about discharging him in a few days. I expressed my concern that he is worse during care than when he arrived. I also understand changes impact some people, but he was mobile and continent his first week. The answer when I express my concern about his loss of capabilities is the drugs have side effects. Concerned because the drugs are supposed to be addressing agitation/ aggression, but it is worse. The problem isn’t “fixed.” When I met with the doctor after a week, I was told there was nothing they could do and had I thought about hospice. When I expressed surprise since he was eating well, walking, talking, and continent, she changed her stance about hospice and then said they could do something. They have tried several different drugs and it seems that Ativan as a PRN is the default for grooming. Unfortunately, when it wears off he is very agitated. PRN is also not going to work in AL. I feel the worst decision I ever made was agreeing to this course of action. He has lost his essence.
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I don't know if this is normal, but it sounds like serious drug side effects.

I would talk to the AL and ask them for help understanding and getting him a more appropriate drug regimen.
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Reply to Isthisrealyreal
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Franklin2011 Sep 13, 2019
He’s in a hospital and under doctor’s supervision for med regime.
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