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We started getting in-home care December 21st. Since then, 4 aids have quit because of Mom's aggressive behavior. I was skeptical at first but have seen/heard enough of the episodes to know that Mom really is ramping up the screaming and physical attacks. It catches them off guard because she's very sweet otherwise and only 100 lbs - but it's all sinew.

Anyway, we have to find a way to manage these, or better understand the journey with vascular dementia. We have tried ativan, haldole, klonopin, and seroquel. I don't think any of them helped. You can wipe Mom out with seroquel but that is NOT what I want - though I may not get what I want.

Mom is mostly aware and enjoys engaging with staff, dancing and going to Church. Wiping her out with drugs will remove all the enjoyment she still has. I have read and gone to courses on general alzheimer's aggression/behaviors. We are trying to implement all those tips. Any other ideas?

My husband and I are very anxious about losing our new found help. And I don't see a very bright future for my Mom if we can't make this work. She won't last long in a facility and she won't be happy.

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I'm curious as to what papers say that medication is a last resort. I thought that depression and anxiety were best treated with medication. Keeping in mind that it's not so much unwanted behavior you might be dealing with, but the mental pain, anguish and torment the patient is feeling that causes them to act out.

And since the dementia patient has limited or no memory, behavior modification would be futile since the patient forgets whatever the lesson is from minute to minute. I would think that helping their mind be more at peace would result in a more content and less aggressive person.
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rojo, sounds like a good outcome. I hope it continues to work like it is now. All paws crossed for you here.
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We eventually found out she had a UTI and was constipated. We dropped the clonazepam and are using risperdol. She is doing better. She still gets agitated around toileting, especially for bowel movements. Without a doubt the aids who are more compassionate and attentive - and have had dementia in their family - do better with Mom. The company has so far refused to provide dementia specific training.

Mom was in rehab (a nursing home) for 2 months this summer. The facility forced me to take Mom out 'Against Medical Advice' - but rest assured, they forced me to take her out. They were not prepared to care for someone with dementia behaviors. Mom was solid bruises from her elbows and knees down and had a large skin tear when she left there. She also had 4 staples in her head. She has none of those things now and laughs everyday.

I've read a lot of papers. They all say drugs are the last resort and behavioral modifications (of the staff/family) are the first line. No agency or medical personal follow that advice though. It is disappointing.

Anyway, I appreciate your feedback. Apologies for the lack of response. We continue to struggle with the agency. We do have better coverage now and may have a full set of staff for Mom - no back up but at least a full front line for Mom.
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If trialing medications at home isn't working, she may need to be admitted to an inpatient psych unit or senior behavioral clinic to get the correct meds and dosages.
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rojo, I had the same questions as SouthPecan did, so I won't ask them again. One thing that might help your mother is to have her visit a geriatric psychiatrist who can work with her medications to get a good balance. I agree you don't want to drug her so much that she isn't really living anymore. But she does have to be around people who can help while you are working.

BTW, you may find that she does better in a facility than you think she might. Many people have been surprised when their loved one adapted after a few weeks. You don't want to hem yourself in to home care if it becomes too difficult. Sometimes we have to consider other options. Good luck!!
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1. Ask for helpers that are experienced not just with elderly but with people living in dementia. 2. When does she act out? When told to do something, to stop doing something, or that she is wrong about something she says? Maybe it is not as random as it seems. Does she respond to putting on favorite music, not just to sedative drugs? Is there something like that the helper can do to diffuse the behavior?
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We give mom 10 mg of Buspirone 3x a day. It is not a strong drug according to my mom's geriatric dementia psychiatrist, but it seems to work for my mom who is like 120 lbs.
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Ask the doctor about BUSPIRONE. It helps my mother, who is a lot like yours. Also now we are getting Depakote sprinkles for her food, as well as Zoloft. But everybody is different. What will work for you might not work for me. The only ones I have experience with is the Seroquel (maybe cut her pill in half? My mom was taking Seroquel 1 whole pill and it was making her sleep like a zombie too until we halfed the pill. Now it calms her but doesn't knock her out. And I have experience with the Buspirone and my mom is much less apt to yell or fight on that. It takes about 1/2 hour up to 1 hour to hit her system though after she takes the pill so I have her on a schedule with it, and it really is helping.
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