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My grandmother was recently diagnosed with vascular dementia and has become increasingly difficult to care for. She is on the younger side (only 71) and has lived independently her whole life. She is in denial about the health challenges she’s facing (dementia, COPD/2 packs a day smoker, and heart issues including a mild heart attack a few weeks ago) and thinks she is perfectly fine. Since she lives alone at home we were able to get her a home health aide 7 days a week, 4 hours a day. She also has limited mobility due to long-standing back issues and had a fall that hospitalized her for a month in January, so she needs to use a bench shower chair. As such, her HHA is to help with shopping, light cleaning, cooking, and bathing.


We are having several issues in caring for my grandmother. She has become viciously angry and agitated, yelling and being verbally abusive to us and to her HHA. These attitudes come out of nowhere and can’t be diffused once she gets started. She now says that her HHA doesn’t do anything all day, which is untrue because we’ve seen her work. She also doesn’t allow her HHA to do certain tasks, for example, if her HHA wants to vacuum, my grandmother will unplug the cord and then call me and complain that her aide won’t vacuum. I have caught her in this lie many times, I’ve heard the interactions where her HHA will say “OK, I am going to vacuum now” and my grandmother will say “no you won’t” and then call me 10 minutes later saying her HHA won’t vacuum.


She also has suddenly decided to remove the shower chair in her bathtub and refuses to put it back in. We reinstalled it and she removed it again saying that she doesn’t need it and will be fine. This is a huge health risk to her because she has fallen and been unable to get herself out of the tub. She won’t allow her HHA to assist with bathing and waits until she leaves, so we are concerned.


Then comes the money issues. She has serious hoarding tendencies and has spent $500+ on groceries in the past week alone. For a while we would shop for her given her high risk of contracting COVID-19 but she now complains that we don’t get her the right things and it became too difficult to argue with her on what she has. She forgets what she has in her pantry and fridge, and in some cases can’t recognize what items are. She made the HHA throw out the food she just bought in order to go buy more of the same thing two days later. She is on an extremely limited income and her recent shopping trips have taken more than half of her monthly budget. I did just order her a TrueLink prepaid debit card and will load that card with a fixed amount of money because we can’t risk her spending so much or falling victim to scams, etc.


The main challenge we are facing is there is no reasoning with my grandmother. She just screams and yells and says we are wrong even if what she is saying makes no logical sense. It is wearing on us all, myself, my mom, and her amazing HHA, to be yelled at constantly when we are just trying to protect her and keep her in her home independently as long as possible. How do we handle this combative behavior while continuing to care for her? Her neurologist recently increased her dosage of Aricept and we will follow up next month to see if it helps her horrible moods. We are just all at a loss on how to navigate this situation. I am trying my best to be empathetic but it’s really hard to maintain composure when you’re getting screamed at. Any words of advice are very much welcome!!

I'm not arguing, just asking - what's Aricept supposed to do for vascular dementia?

Ellbee, this is no more than a guess - there are instances when a person emphatically, adamantly insists (by accident) on the *opposite* of what they actually mean to say. They then become extremely annoyed when their friends-and-relations attempt to comply. You can just imagine how it goes - !

Hot/cold, left/right, yes/no (alas!), take/bring can get switched about. If your grandmother has vascular dementia - which I personally came to think of as the Whack-a-mole of dementias - it could be that there is some very faulty language/communications wiring at play here. That, and the loss of filters/self-control, and the despair and anger that go along with clinical depression.

Step back and see if you can get a clearer perspective on the "ideal" that she is seeing. She wants to be left in peace - so at least counsel the HHA not to get in her face. She then accuses the HHA of being bone idle - this is not because she thinks so, it's because you might then fire her and grandma will get what she wants - no HHA in her house.

It could be she wants the vacuuming done in a different way. It could be that she hates the noise (hearing can go wonky, too). It could be that... crumbs. Could be anything.

So, what happened when she fell in the tub? Obviously she got out somehow. What was the answer?
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ellbee May 3, 2020
Her neurologist told me that the Aricept may or may not help with her memory/cognition issues.

I think you’re spot on with your idea around words being switched around. She gets very aggravated if I ask her a question for clarity (mostly to make sure I’m doing something right) and will repeat the wrong thing but when I say what I think is the right thing, she’ll say “yes, that.”

And I think you’re right, she is saying all of these things about her HHA and complaining about her thinking that we will agree to having her removed. Luckily her HHA is excellent, knows when to be firm and knows when to just let her rant and rave. In fact her HHA has had to tell me multiple times to take a deep breath and remember it’s the dementia talking. I pray we don’t lose her HHA!!!

The tub fall—luckily, my mom was in her house when that happened. My mom nearly threw her back out lifting her up out of the very deep, pre-war tub. A fall a few weeks before that led to a month plus of hospitalization and a stint in short term rehab at a nursing facility.

thanks for your kind words and advice!!
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You can't get her placed into an ALF or SNF because she smokes 40 cigarettes a day! While she likely DOES 'qualify' to be in a Memory Care ALF, I wonder who'd take her with such a smoking addiction, and likely needing oxygen as well, which is a fire hazard. This is too much liability for a facility to want to bear. Some places allow residents to smoke outdoors..........but again, with a 2 pack a day habit, she'd be living outside in all weather conditions, which is not realistic.

You can't reason with dementia, period. The more you try to, the more obstinate they seem to get. My mother LOVES to argue. If I say black, she says white, and then I'll agree, so then she'll argue it's black. You can't win NO HOW. Stop trying.

Grandma may indeed have a UTI...........we all say this around here 24/7, but sometimes it's true! You cannot believe the level of aggression and psychosis that can come about as a result of a simple UTI!!! Get her tested, with a urine culture, asap.

Medicine CAN and often DOES also create unbelievably horrible behaviors in people with dementia. You can say that my 93 y/o mother has a 'sensitive system', because when she was put on a Scopolamine patch (after I was begging the neurologist) for chronic vertigo, it was like a switch was flipped. She started seeing mice scurrying along the hospital floor! She was trying to stuff her clothing into the utensil wrapper on her food tray, saying she was 'packing to leave'. She was incoherent. To a degree that I called my cousin to come say goodbye to her..........I felt sure she was dying!

But she wasn't. She was just having a particularly bad reaction to the Scopolamine patch.

And to Cymbalta? She was insisting she lived with me and I had to go 'pick her up' from the Memory Care ALF where she lives. She'd call and leave message after message about OMG IT IS SNOWING HOW AM I GOING TO GET TO YOUR HOUSE?

So, as you see, medications can be good or they can be very, very bad. Consider the Aricept as your #1 potential problem for Grandma's new & insufferable behavior. Call the doctor and have a chat, tell her about my mother and her horrible behaviors after the introduction of new medications to her 'sensitive' system. And then look into the UTI matter as well.

That's a great start.

Wishing you the best of luck dealing with a very ugly situation. You have my condolences.
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ellbee May 3, 2020
Thanks so much for your well wishes. She does not need oxygen. If/when the time comes to move her into an ALF, she will have no choice but to quit smoking. She doesn’t drive and we wouldn’t purchase for her. Post hospitalization she was in short term rehab nursing facility and went more than a month without smoking and was just fine, actually the most pleasant and lucid she had been for a while.

She was on a high dose of cymbalta (90 mg a day) for a while, started while she was hospitalized and in the nursing facility. We tapered it down because her PCP couldn’t see a need for it. I wonder if that was actually beneficial for her.

thanks again for your words of advice!!
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So, you need to call her again and explore whether it's the Aricept causing the problem ( by reducing it) and if that does work, perhaps trying a different med.
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ellbee May 3, 2020
Thank you!! I will do that
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Does the doctor who prescribed the Aricept know about the agitation?
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ellbee May 3, 2020
Yep, we told her about the agitation and she upped the dosage to 10 mg.
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"Aricept Proves Ineffective for the Agitation of Alzheimer's. ... Symptoms include anxiety, irritability, and restlessness, often leading to behaviors such as wandering, pacing, shouting, or aggressive behaviors"

It may be the Aricept that is causing the problem.

Don't expect too much from Grandma. She is entering a world of her own that there is no escape from. At this point, she probably no longer has the abilities to reason, process or comprehend. No empathy so don't expect to be thanked for you efforts or appreciated. They become self centered. Like a small child only their short term memory loss keeps them from learning anything new. Also remember from one minute to the next. There mind just goes from one thing to another. There will be paranoia.

For 71 your Grandma has a lot of problems. Both COPD and heart problems will contribute to her Dementia. COPD because she is not getting enough oxygen and heart because if weak, not pumping blood thru her system.

Taking care of someone with Dementia is very hard because they are so unpredictable. I hope someone has POA. Because now is the time to enforce it. Grandma should no longer be driving. The POA can't take over financially.
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ellbee May 3, 2020
Thank you so much for this kind response. I’m wondering why the Aricept increase if it can lead to more agitation. I guess we will see how these next few weeks go and if the same or worse I may ask to stop the Aricept.

You are right. She has a significant amount of health issues. Coupled with the fact that she refuses to quit
smoking (she is at 2 packs a day) I sadly think she hasn’t got much time left.

My mom does have POA for grandma. Thankfully she doesn’t drive and never has. Luckily she still trusts us to handle the “big things” like finances and medical needs. She has no interest in managing these on her own. Really hope that lasts a while.
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I think it is getting to the point where your Grandma can not live alone and needs more than a HHA or other caregiver a few hours a day.
It also sounds like she should no longer handle financial matters either. Giving her a card with a limited amount is a good approach to this. When the caregiver takes her shopping can they possibly stick to a list? If so the caregiver can make out the list before they leave the house and that may limit unnecessary items.
You should also talk to her doctor about medication that will reduce her anxiety.
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ellbee May 3, 2020
I agree. I can’t see this going on much longer. Especially considering how rapidly her cognitive abilities are declining. Sadly we don’t have the funds to move her into an AL facility and she’s not progressed so far as to be a candidate for a MC unit.

I do handle all of her finances now, surprisingly she is OK with us handling this because she knows she can’t keep the thread on her bills. She was nearly evicted in January because she owed back 4 months of rent and I think that scared her.

Her HHA did try to intervene and make a list and only get those items. My grandmother was not having it and still bought $300 worth of food. When she wanted to go back to the store the next day, her HHA said no, and she waited until she left and went out on her own and bought another $200 worth of groceries.
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Did your grandmother begin to scream and yell after the Aricept was started or was the Aricept prescribed specifically for the screaming and yelling behaviors?
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ellbee May 3, 2020
That’s a good question. I’ve noticed the screaming/anger issues have increased since the Aricept was prescribed. But admittedly, she was very sick with the flu and then pneumonia in the weeks prior to her beginning the Aricept, so was just generally more subdued and less energy because of being sick. She had a visit with her neurologist this week who suggested we up the dose of Aricept from 5 mg to 10 mg to help combat the mood issues. We will follow up in 4 weeks to see how she does.
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You posted under Alzheimer’s and dementia, so I’m assuming that your grandmother has been formally evaluated and diagnosed by a neurologist. She should also visit her doctor for a urinalysis for a urinary tract infection. These can be chronic. My mother’s were and they’d test her once a month. When my mom had one, she became combative, violent and mean. I still have a scar on my arm from when she clawed me. In addition, if she has been diagnosed with Alzheimer’s/ dementia, she should or can be on medications that will help her (and you) deal with her behaviors. If she has not been diagnosed and you are assuming that’s what she’s suffering from because of these behaviors, she still needs to see her doctor.

Your grandmother may be having issues giving up her independence. All of us “of a certain age” deal with this. She may still be capable of realizing that life as she once knew it is now over for her. She’s losing her independence and although her HHA is obviously a saint, she is still more or less “a stranger”, not family, who is charged with taking care of this independent lady. Things like removing the shower chair are just her way of saying she’s not giving up her independence gracefully.

Having said that, you don’t need to take abuse and stand there letting her scream at you. If she still has cognitive abilities and is able to understand, kindly but firmly explain to her that if she doesn’t start cooperating, she will not be able to stay in her home. Leave the choice up to her. If she remains uncooperative, you will begin researching assisted living facilities for her.
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ellbee May 3, 2020
Yes, she has been formally diagnosed with dementia by a neurologist and is on Aricept. She hasn’t complained of any UTI-like symptoms and luckily no issues with incontinence yet. Would dementia halt her ability to feel the usual UTI symptoms? She does have urgency issues now that I think about it, but her neurologist mentioned that could be an issue.

Thank you for your thoughtful response. We have explained to her that the shower chair and HHA are there to keep her in her home as long as possible and if she is uncooperative, sadly we will have no choice but to move her into a LTC facility. To that she just says “you will NOT, you can’t do that, I won’t go” and we explain that it’s no longer up to us, she’s on an MLTC program and if the state deems it necessary we will have no choice. Just such a difficult time.
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Surprised HHA has not walked out and not return
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ellbee May 3, 2020
This is what we’re most afraid of! She’s a lovely woman and very good at what she does. The worst part is my grandmother actually likes her. I just think she is frustrated with the fact that she needs help with daily tasks and this is her way of rebelling.
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You can't "argue" or reason with a person with dementia. So, that line of "defense" is gone with the wind. Hopefull the aide knows this too.

Watch Teepa Snow videos on YouTube for ways to handle her combativeness. Get her to a geriatric psychiatrist for an assessment of her mental health and the advisability of meds for agitation. They can be a real game changer for some folks.

Please try these two things and let us know how it's going!

((((((hugs)))))))
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ellbee May 3, 2020
I completely agree with you. There’s no point in arguing with her. I am trying to convey that to my mom, but it’s difficult for her to not react (my grandmother has a way of pushing my mom’s buttons just so).

Thank you for the recommendation! I will check out the videos and ask her PCP for a referral to a geriatric psychiatrist.
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