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She is still carrying on with her delusions of a man + his girlfriend living in her house, stealing money + jewelry from her, watching her every move, etc. She's called the police twice already. I got a potential live-in caregiver + she adamantly refused stating she doesn't need anyone. She has been living alone for many years and functions independently. I have inquired about AL with my brother but how do you get her there if she is going to refuse?

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My mom, too, is on Seroquel. She started it two years ago for delusions and hallucinations associated with sundowning. Her starting dosage was one half of a 25 mg tablet (smallest dose available) or 12.5 mg. When the medication was started we were told that the dosage would need to increase periodically. Now, two years later mom is taking 75 mg a day in the evening, it helps with her sundowning tremendously.

Seroquel carries a black box warning of increased mortality in those with dementia. The doc said he has a number of dementia patients on 400 mg a day and will not prescribe more than that.
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Most patients with dementia reach a point (often early in the disease) where they are not able to safely live alone. Perhaps your mother has reached that point. Have you discussed her living situation with the doctor who prescribed the seroquel? What is his or her recommendation?

What is safest, of course, is no delusions, no dementia, and capabilities to live alone. You have no control over that. Seroquel is very effective for many dementia patients, but not for all. The only way you can tell is to try it. BUT you really cannot conclude anything about the drug unless it is being taken as directed. Follow the doctor's orders and monitor the results closely. Is the increased dose helping?

It is not "safe" for someone to have paranoid delusions. It is not "safe" for most dementia patients to live alone. Drugs like seroquel are not "safe" for elders. There are no perfect solutions here, but I'd go with the drug and hope for the best. Your mother will be more comfortable and you and your brother will have more options for her care if she is relieved of some of her fears and paranoia.
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A Dr. will always start someone off at a low dosage and increase it as needed.
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AL will not take a patient with hallucinations and delusions. Do not get a live in caregiver, there is too much risk she will attack this person. Pursue a full Guardianship, with a court-ordered psych evaluation. She cannot refuse the court order.
Seroquel starting dose is 50mg twice a day, then gradually increased, not to exceed 800 mg per day. She is nowhere near the maximum. I'm willing to bet she is not even taking it, given her independent attitude. Is this safe? There are reports of increased mortality, but age and co-morbidities are a factor in any medication that is given. On the other hand, not medicating her is unsafe for both her and the community around her. So at 87 you do your best to keep them comfortable first, because time is very short. At 87 every day is a gift, the prospect of death is imminent and should not be spent in a fearful state of mind.
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