Is grumpiness, grouchiness and a bad attitude part of the progression of AD and LBD?


We moved my Dad to a nursing home on November 4, 2013. In the 3+ weeks that he's been there he's had good and bad days and nights. When he was still at home he would have periods of moodiness and irritability. It seems in the past couple of weeks, though, that his moodiness has gotten worse. Mom and I have visited him every day since the move, but we will be tapering off to about 4 days per week, mostly due to his attitude. He always seems grumpy, grouchy, irritated, doesn't want to talk, if he does talk it normally has something to do with a delusion he's having, is impatient all the time (he has always been this way, it's just worse now). When he is taken to the dining room to eat, if his food isn't served right away, he gets grumpy and impatient, at times deciding he doesn't want to eat, at times getting up and leaving the dining room. If one of us pats him on the shoulder or rubs his back he tells us to stop. Today the hospice aide, who he really likes, came in to shower and shave him, which she does 3 times a week. He resisted, saying he didn't want a shower, etc. She was finally able to cajole him into it just before we left. He's told us to "quit bugging" him. Sometimes he's in a pretty good mood and is glad to see us, but most of the time he is just plain grumpy and irritable. Is this a sign of the progression of the disease? Do patients typically become this way? He's not exactly hostile, but I wouldn't be surprised that he becomes that way in the near future. Or are we just seeing symptoms that we didn't see when he was at home because we saw him every day (myself) or lived with him (my Mom)? Mom has said several times in the past week that she doesn't know how she managed to care for him for the last 4 years as he got progressively worse, and that she doesn't know how she'd be able to care for him now, seeing him as he is during the couple of hours a day we've visited with him, if we hadn't decided it was best that he be cared for at the nursing home.

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Thank you all for your responses.

marialake -- It sounds like your MIL has the same stubbornness my Dad has. Once he gets his mind set on something he can't be diverted. I completely agree about the patient moving out of a certain stage. We know that Daddy will continue to decline, probably more rapidly now that he's in the nursing home. But what else can a person do? At least he's being taken care of night and day. My Mom told me the other day that she had hoped his sundowning, evening pacing, delusions, etc. would decrease with the care he's getting there. I told her that wasn't going to happen, he'll just be getting worse. She knows that but it's still been a difficult three weeks.

brandywine -- I, too, believe that it's best that we don't visit Dad as often. I've encouraged my Mom to cut down on visits, but she feels guilty that she had to move Dad to the nursing home. I've told her that's normal, others have told her that's normal, Dad's neurologist has told her she did the right thing because he could no longer be cared for at home. I think she's finally coming to the same realization, but I know it's difficult for her. The nurses and aides like Daddy and seem to take care of him well. I told Mom she's been running herself more ragged since he's been gone, running to the nursing home every day (along with me, since I take her there and visit a while or run errands), while at the same time trying to get their house back in order, clear out closets, etc.

pstiegman -- I'm sure you're correct about "showtime" in a number of ways. Actually there WAS one day that we didn't go visit Dad during the day because Mom was attempting to cut back, but I forgot about it since we ended up going anyway that evening. We got a call that he was very agitated and was trying to strike out at several people who were trying to calm him down; the evening nurse asked if we might come down to sit with him a while and try to get him calmed down. Mom and I went over just before dark and sat out in the "living room" area with him for several hours. He calmed down right after we got there (plus they had him in one of those chair contraptions made of PVC pipe which he couldn't get out of!) but he seemed delusional, saying the MPs were coming to get him, that someone was after him with a syringe (they don't use them at this nursing home!) etc. I've wondered since then if he acted out in this manner because we didn't visit that day. And I guess I worry that if that's the case, he might continue doing this when we cut back on our visits. He has also had the nurses station call one of us several times in the evenings to talk for a minute. Mom has specifically wanted to visit him at lunch time because she's afraid he's not eating enough (his IS losing weight and not eating as much as he did at home, where she was able to get him to eat sometimes when he wasn't interested, but what can you do, you can't force a person to eat!). But I've spoken with the aides and have been assured he eats a good breakfast (usually pancakes and coffee, sometimes bacon or sweet rolls); when we ask him about breakfast he says he has eaten it and usually remembers what it was. The primary aide assures us that if he has problems with the utensils that he is receiving help when Mom isn't there for the other meals; she also says that he manages to eat just fine when he's by himself! Usually when Mom is there he seems more "helpless". But he also seems to get agitated when she tries to help him (which I've told her she shouldn't be doing!).

Oh well, such is life. Again, thanks for your replies. It helps to talk!
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Some of this is manipulative behavior, attention-seeking to get his way. He will assimilate better if you cut your visits to once or twice a week. I'm willing to bet that when family is not there to manipulate, his behavior is completely different. I am familiar with group home settings, and I can tell you that when family shows up, it's Showtime.
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VH, I have been there, done that. To answer you question, I think it is the natural progression of the disease. You could have been writing about my mother. I think it is good to taper off visiting him. You have to take care of yourself. That is what I have done. The aides and the nurses get paid to take care of them and so I let them. I mean paid lots of money, lots.
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My MIL (alzheimers) has lived with me for six months and she is getting nastier as the days go by. I was very happily married to her wonderful son for 34 years until his death from cancer 3 years ago. These days, she insists that my house is her house, my dog is her dog, that my husband was never married to me, the list goes on and on. Because it's "her house" I have to do whatever she says etc. Correcting her is a losing battle so I keep biting my tongue. She drives me crazy with the stuff she fabricates and I really feel like I'm living in the twilight zone. Honestly, I hope that she move out of this stage soon - even if that means that she is declining rapidly.
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