What next? Violent talk, physically aggressive, changes words w/o notice, won't eat much, incontinent, miserable, multi-personalities. Any advice?

What caused your aunt to be placed in a nursing home. Was some of this behaviour becoming apparent before she went to the NH? I totally agree with checking on the medications. A major change like moving to a NH can bring on dramatic changes. She is like a ship at sea with no engine, there is nowhere to go so it's round and round in circles or wherever the wind takes her. She is angry but so would anyone be locked up with a group of other crazy old ladies. it is a strange environment nothing belongs to her. It is not her own bed. lots of times she dressed in clothes she does not recognize. she doen't know wher the bathroom is anymore and if she is taken there it is different and she may be handled roughly or male aides may be performing very personal tasks for her Does not like the food and is not hungry and it is served on stained melamine plates. The hot drinks are luke warm and taste of plastic. If you are permitted take in a plate of her favorite food and see if you can tempt her. Her behavious dictates that she has to stay in that environment because she would be too disruptive anywhere else. if she was not mentally ill before she entered the facility reasons have to be found for the change in her behaviour. if it is the drugs they can be changed stopped or increased. You will have to really advocate for her. If you have a friend or relative with medical training try and have them go with you to any meetings. you are too emotionally involved to be objective right now. Blessings.

She definitely can not be left in her current torment. So tell them to do what ever is necessary after the Dr has answered your questions.blessings and hope for a peaceful end.

Personally? I'd start by stopping all of her psychotropic medication. Some will need weaning. Is she taking Namenda, by any chance? I'd suspect THAT one in a heartbeat.

Has her medication changed since she was moved to the nursing home? If so, I'd be DOUBLY suspicious.

Be her advocate. She's miserable.

Totally agree with Maggie. talk to the Social worker at the NH about your observations of the drastic change in your Aunt. Talk to the psychiatrist or doc or NP who is overseeing her meds. This kind of stuff can be CAUSED by meds. Also, has she been checked for a UTI?

Check in with her primary doctor and ALZ care team at the facility. Be prepared to go over your observations and concerns. The change in diet and routine could also be the start of a UTI which could exacerbate the behaviors, paranoia and hallucinations.
Do these seem to dissipate when you are visiting for a length of time? Does she get better when you are with her or accompanying her to an activity at the facility?

If this move is still new to her, she may be having an adjustment anxiety and is working herself up so that she can't get ahold of herself. She may need something prescribed in the short term to help her anxiety provided there are no underlying physical ailments.

Meet with her care team or social worker, director there and get their perspective. Ask if they have a support group you might join to share experiences and help you understand what could be happening.

This must be very hard and you are doing the right thing coming here to bounce it off others.

She's had a much lesser degree of a lot of this behavior at home up until about 3 months ago. It was a case of refocusing her up until July/August, but then everything shifted and it became harder and harder to get her to calm down and stop. She began talking non-stop (I swear she talked in her sleep all night long) and she had an imaginary friend she'd talk to. She'd tell her friend that she needed to use the bathroom sometimes so you'd have to listen carefully to her chatter. She has been on Namenda for some time now and the doc gave her an antianxiety med to help with some of her issues (didn't like to be alone for even 5 seconds and would get worked up if someone walked out of the room; that sort of thing). At the home they began a psych drug and a PRN anxiety med. I told them that she's shown changes in behavior before when she had a UTI so they tested her - they said no infection. I know change is extremely tough for her, but the violent thoughts and behavior are very disturbing.

I'll call the home and ask some of the questions you all suggested. THANK YOU!

You did the right thing in providing 24-hour care, in shifts so the caregivers are fresh and no one is trying to do this alone for 23 hours! Placing her in a care center was wise and kind.

Dementia gets worse over time. Sometimes it is a slow gradual decline, sometimes it happens in fits and starts, sometimes it happens quickly. But it does get worse. Always.

Your dear Aunt has gotten worse. That particular decline started while she was still with you, and accelerated in the care center. It might have accelerated BECAUSE of the change in environment, or it might have happened even faster if you'd tried to keep her home. There is no way to know. Please don't blame the "if only" game! You did what was smart and necessary.

I agree that her medications should be discussed. Maybe getting off some or on others would help the symptoms. Keep checking out any indications of infection or illness. (For my husband, ANY physical distress, from a slight cold to constipation to being over tired or over heated, made his dementia symptoms worse.) Advocate for her, and do everything you can to work toward a more peaceful time for her.

BUT I don't know why anyone should be surprised that a person with dementia has gotten worse. That is what dementia does. This is not to say "give up" but what you are attempting is to ameliorate the worst of the symptoms, not to cure her or get her well. Stopping or changing meds MAY help, but I doubt very much it is caused by drugs. Learning to interact with her in soothing ways MAY help, but he behavior is not caused by inappropriate interactions. This dear woman has dementia. Dementia gets worse. Always.

I sincerely hope that with your advocacy and participation ways can be found to counteract what is going on, and you can once again have pleasant visits with her.

I don't think I said I was, or eluded to, thinking she wouldn't get worse. She is dealing with a number of changes all piled on top of each other. Like I explained to the nurse and coordinator at the home today, it is really hard to draw any sort of conclusions at this point. If things were introduced slowly (or removed slowly) we might have a better idea of what is happening . . . is it just the Alz progressing, is it the change in environment, or routine, or any number of other factors.

Now they want to meet with us to discuss "mental health" issues. I don't understand why we have to meet with the doctor to discuss - to me it would be appropriate to evaluate and then discuss options. Isn't that why she is there - to get the medical care she needs? Why delay it? The coordinator had the nerve to talk to me about her quality of life, which is something I brought up and spoke to her about weeks ago. Are we going to tip toe around everything now?

I found out today that they haven't even bothered to test for a UTI! I had a bit of a moment with them. I spoke with two different people about it over a week ago and no one collected a sample or spoke to the doctor about getting preventative antibiotics. Seriously? Got a call back this afternoon that they were going to start the antibiotic tonight.

Not real happy about things right now, but don't want to fly off the handle. They do have to care for someone who requires a lot of people. Counting to 10, and waiting for them to set up this meeting.

My only question is has the UTI been treated properly. Have they retested her urine? other than that, it is possible the drugs could be making her worse. This does happen but in a behavioural unit they should be aware of that. Ask which drugs they are giving her and look up the side effects. Ask them to write the names for you. There are other drugs they can try but the way she is npw is not any kind of life to continue with. This may just be she has entered the predying phase and is on the very of actively dying. The question is should she be more sedated and allowed to remain in bed and have a more peaceful end. It really is something the family needs to decides depending on the staff input. no easy answers here but at least be sure the UTI is treated before making any other decisions. It is not an easy time but the thing to concentrate on is your Aunt's comfort and peace

Thanks Veronica. I called this morning to speak with the doctor and the UTI question was one of the top ones on my list. I asked the nurse if she felt that we were in the end stages of the disease and she didn't want to answer me, and said that the doctor liked to answer questions of that nature. This is no way for her to be, surely, and anything we can do to help end the torment is what we need to do whether it is just letting things run their course or medicating more heavily.