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My mother has been Baker Acted twice in two months. She was in the hospital psyche ward for a week to 17 days each time. Between hospital stays (March 3rd-10th and April 17th to May 5th), she was in an assisted living facility with dementia care. She was bounced out of the ALF on April 17th, because she became paranoid of and combative with her roommate, and tried hitting the roommate and her visiting daughter, with a cane.
The hospital psychiatrist, social worker, and nursing staff all said that mom was not combative while with them, BUT she was talking in a paranoid manner about other patients in the ward, and beginning to show signs of misbehaving herself again. We conferenced, and felt the only way to have her eligible to go back into dementia care was to medicate her. She is 87.5 years old, and ambulatory. My concern has been the side effects of the anti-psychotic medication she is on-Risperidone. She has been on it for almost 3 weeks, and it is helping her.
Is there anyone out there with a similar experience, who would be willing to share their experience and any info?

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I agree with Pam - My memory care home told me it was time for a higher level of drugs or mthr would have to move. She was bypassing the alarm system, stealing anything she could when the office door was open, even with the manager in the adjoining office, and jimmying the locks. But the physical abuse, which I had warned the manager had been used on me as a kid and I was expecting to arise, was what had her on the verge of expulsion. One seroquel in the eve was not enough, so she's now on a larger one am & pm.

I much prefer this new calmed person with the potential for sudden death to that horrible abusive alternative. Sudden death would mean she would not suffer the indignity of having her diapers changed and not knowing who her family is.
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katiec, sudden death is a daily possibility when you are 87 and losing your faculties. I keep thinking of the elderly man recently shot and killed by police as he came at them with a large butcher knife. I think sudden death would have been easier than a shooting.
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Confused! I have a parent with advanced dementia, sundowning, restless leg syndrome, etc. ALL the new guidelines say don't give elderly with dementia any of these medications because they can create confusion, cause falls or result in sudden death. See Choosing Wisely website and even the Alzheimer's Association has this information. How are others deciding on this when the newest guidelines say not to?
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Confused! I have a parent with advanced dementia, sundowning, restless leg syndrome, etc. ALL the new guidelines say don't give elderly with dementia any of these medications because they can create confusion, cause falls or result in sudden death. See Choosing Wisely website and even the Alzheimer's Association has this information. How are others deciding on this when the newest guidelines say not to?
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Risperdol has worked wonders for my mom, but did not work as well with the Exelon patch, so the patch was dropped. Namenda is still being given.
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Thanks so much, you guys, for the practical suggestions above. I'm a bit more comfortable knowing there are others out there who have some knowledge about the Depakote (and maybe we should get the name brand sprinkles; we're on the generic versions for both the Depakote and Risperdal). And I do think we'll check out a gerontologist. I did finally get with an elder care lawyer today and feel a bit better about that aspect of things (I have DPOA, etc., was just hoping to have some kind of asset protection thing in place, even though I know there's not that much in the way of assets). I'm so grateful for this forum, thank you all again.
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goingbonkers60, I can only share that our hospice neurologist uses small doses of Risperdal for patients with dementia who are combative. The benefit is that it allows them to remain in the least restrictive facility or at home, and minimizes the risk of behaviors which could result in injuries to themselves or others, e.g. caregivers, family members, other patients. I don't know about long term side effects. I do know that in the past when I was doing mental health work, Risperdal......for a very few patients.....would have the reverse effect for which it was intended and cause an increase in agitation.
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P.S. It might be worth consulting a gerontologist,cindyoh, as you had mentioned. They are much more aware and understanding of your concerns about your mother's behaviors, and have greater knowledge of the impact of medications on the elderly that others in the medical field lack. They're often more comfortable in prescribing medications in ways, e.g. dosages, usage, that others might not be, and are much more aware of possible negative impact due to the difference in the way people who are elderly metabolize medication. .
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I used to work in inpatient and outpatient mental health. Whenever Depakote was used as a mood stabilizer, it was notorious for causing HUGE amounts of weight gain, e.g. 100 pounds in 4 -6 months for one patient...even for people who had NEVER had a problem with their weight prior to taking Depakote. I don't have an easy answer unfortunately. There are many anti-seizure medications, many of which can help stabilize mood or agitation in those who don't have seizures. Depakote is only one. Could they try something different in this same line of medications? (Although it may be that the effects of the medication in calming the brain are also affecting the appetite center in the brain....and...so far...can't be avoided with what medications have been developed??) It could be that Depakote is the CHEAPEST medication and that's why they're using it..not necessarily the BEST!! As mentioned.... with ANY medication the benefits vs. the side effects has to be weighed in each situation.
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The ketogenic diet is sometimes used to treat schizophrenia, obsessive-compulsive disorder, and other psychological disorders. The ketogenic diet is based on a low-carbohydrate, high-fat diet. (The fats are "good" fats, meaning nontrans or hydrogenated fats. Surprisingly, they include natural animal fats, such as fatty pork and butter.) Unfortunately, only cutting edge physicians and health practitioners are familiar with it. If you think your mom would be willing to alter her diet (give up starches and sugars and replace them with fats), you might want to research the ketogenic diet. A lot is available on YouTube. As a minimum, you might want to add coconut oil to your mom's diet (you can cook with it, put it in her tea or coffee, or use it like you would butter). Coconut oil does great things for the brain.
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cindyoh, my mom also went on depakote sprinkles and it was a life saver!! I highly recommend it. She slept too much at first but then became adjusted to it. After the agressive and wandering stages were over, I weaned her down on it and even off it but after several months she stopped sleeping at night so now she has a half a capsule most, but not every, night. I would highly recommend asking her neurologist for this. I even had (hyper active) students on this medication when I was working, its only an antiseizure medication which calms the brain. (no, my mom never had a seizure to go on this, it is used for dementia aggitation also)
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I've noticed one side-effect to at least one of mom's psych meds - weight gain. On the mirtazapine, she wants to eat and has put on at least 20 pounds since living with me. Yeah, I do make sure she eats at least one meal a day but find she's crazy for sweets and I have to hide those. I figure the Depakote isn't helping that. The family doc doesn't like it. The neuro doc is not much help with the meds here lately. I keep wondering if taking her to a gerontologist might help. Nobody will let me have a bit of Ativan. The neuro doc says no to Seroquel or Effexor yet since they're apparently stronger. Truly, I don't want her in a stupor but need something better for the 3 to about 7 p.m. period of time. I figure this will be an ongoing problem. Nobody has seen what she's like during this period of time daily but me.
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For 10 years caregiving for Mom, I held off accepting the doctor's advice to give her something to calm her down. Last year I relented because of behavior issues such as rarely sleeping, constantly agitated, aggressive, paranoid, trying relentlessly to get out of the house, etc. Mom, 95, is diagnosed with Alzheimer's and now takes Seroquel.

So, yes, I know what you're going through. But the IMPORTANT POINT I'd like to make is to hang in there on finding a medication that works for your mother. No two people are the same and don't react to drugs alike. Please keep trying until a substance and dosage are found to give everyone concerned a better quality of life.

Blessings for this challenging project.
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I agree with Pam and Ohmoon - my mother has passed on, but she was on meds at the NH that truly helped her. She was combative as well and threatening to others. I forget which meds she was on now; but it was amazing how it helped her. There were times she was hospitalized and the doctors there would "take her off" these meds only to have her revert back to her out of control behavior. This anti-psychotic medication she was on gave her a life and when she would return to the NH and was put back on the meds - she was a different person. So, just something to keep in mind if she is ever sent to the hospital. The doctors at the hospital had no right removing meds from a patient they knew nothing about and my mother suffered the consequences. I also would not worry about side effects at this age, especially if a dramatic difference in quality of life is given to the person by the meds. Take care.
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Ask a physician....it sounds as if she needs to be on meds & there are so many out there. Pam gave you some good advice.
As an R.N. , dealing with the same problem, I have used Risperdal with my husband who suffers from Solvent Dementia, among other things & it keeps him home & hanging in there. Blessing are YOU.
I also would not be inclined to be concerned with long tern effects of the meds.
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There are trade-offs with any medication. If the Risperidone helps her to be functional and non-assaultive, she may be able to function in an ALF. Without it, she will be posey'd in a padded room. Pardon me for being blunt, but for the last 30 years I have seen where no meds end up. It's not pretty. At 87, I would not be worried about long term side effects.
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