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combative violent behavior
daves
Posted: Saturday, January 18, 2020 5:50 PM
Joined: 1/18/2020
Posts: 13


hi, my name is dave and new to forum, my father has alz. disease and he is very agitated and gets violent and combative , he has been discharged from 3 facilities and i am so worried , none of the medications are calming him down , this has been going on for 4 months and keeps getting worse ,i am in florida and the facilities can not handle him. any info would help or past experiences
Streetfacts
Posted: Saturday, January 18, 2020 10:24 PM
Joined: 1/18/2020
Posts: 1


Hi Dave. Sorry to hear what is going on with your Dad, I hope others with similar experiences can shed a light on alternatives and options. 

Rob


ruthmendez
Posted: Saturday, January 18, 2020 10:49 PM
Joined: 9/8/2017
Posts: 2205


Hi Dave. Has your father been to ER recently? All medications need to be looked at too. My father tried attacking the caregiver and he did hit me a few times  ( it didn’t hurt though...he didn’t really use much strength). The psychiatrist told me to stop the mirtazapine and increase dosage on another antipsychotic until we saw her the following week for his regular appointment with her. The mirtazapine was not good for him.

 Another time he had hyponatremia as a result of too much diuretic in his medication.

  It really bothers me that facilities just keep kicking people out like that. 

If your father is getting too much stimuli, that is not good for him either. He needs to be in a calm environment and not approached by different people too often when he is not feeling well. It’s hard for him as it is and more confusion is not helpful.

I recommend you post in the caregivers forum for more helpful responses. There are very good members here with very good info  to assist you. 

 


ruthmendez
Posted: Saturday, January 18, 2020 11:00 PM
Joined: 9/8/2017
Posts: 2205


Also, for a period of 6 months, my father walked around the house a lot and I would let him roam outside too (locked in yard) and allow him some freedom while watching over him like you would a toddler.

 If the staff keep trying to put rules or restrictions on your father, that is not good for him.  It’s a lot of work caring for someone like this (and frustrating), but it’s worse trying to stop him from everything.


daves
Posted: Sunday, January 19, 2020 8:13 AM
Joined: 1/18/2020
Posts: 13


thank u for your kind responses, my father does get more angry and violent when facilities control him with rules , usually it is because he is going in other peoples rooms or doing things to disrupt the facility, when they try to redirect him he will punch or fight and het violent
jfkoc
Posted: Sunday, January 19, 2020 12:52 PM
Joined: 12/4/2011
Posts: 17815


I replied to your other post. What meds is your father currently taking???
daves
Posted: Sunday, January 19, 2020 8:02 PM
Joined: 1/18/2020
Posts: 13


he was on depakote then seraquel and then haldol injection - none worked and now they hgv have him on the haldol once a month injection and seraquel 50mg at night and might raise the seraquel, also they tried menantine
ruthmendez
Posted: Monday, January 20, 2020 8:50 PM
Joined: 9/8/2017
Posts: 2205


Dave, I myself stopped the namenda (I think it’s the same as mementine) myself. At the stage your father is at, I felt like it made my father have more anxiety. At that time, dad was up to 200 mg/day seroquel. The 150 was bed time along with Ativan. As my father progressed with his disease, I began to reduce both seroquel and Ativan with guidance from his psychiatrist. Now he only needs seroquel (150 mg) and Ativan (0.5 mg) bedtime and no drugs during the day. His anger bouts have reduced or he forgets what he’s angry about more quickly now. Actually, most of the day he’s happy, except diaper changes or bed bathes. But it’s not that bad. 

My father is probably ~138 lbs and doesn’t have any other serious health concerns. So at this time, his dosage is probably still okay.  At this time, at least.


CTEdaughter
Posted: Wednesday, February 5, 2020 3:55 PM
Joined: 2/5/2020
Posts: 7


  • I would look at what environmental manipulations you (facility) can make/ add that are associated with the antecedent to the aggression. 
    • If he is going in other peoples rooms- is he looking for something/someone? Is he looking for his own room? Does he want to leave?
     
  • It may just look like wandering, but if you 'wander' with him, you may be able to see some trends. As hard as it is, try to see it from his eyes. Observe.
    • My father is constantly looking for papers and books (he always had lots of papers/books), and is trying to gather the other residents for activities (he was was a teacher/coach). 
    • Some individuals are looking for their room or to go home/to work.
      • Images of high familiarity items on their door, and a familiar symbol on a floor mat can be helpful. Also, playing music or a familiar show on the tv or radio (throughout the day, so he is drawn to it) can appeal to auditory processing.
      • Can the MCU curate an area for him with his familiar stimuli, e.g. paperwork, newspapers, books, his favorite music playing, a safe approximation of a previously preferred activity (e.g. golf tees and a hammer for someone who was a wood worker). Can he have a 'job' similar to one that he performed often, e.g. a night watchman checks the doors.
      • Can the MCU alter their daily activities schedule to include things that he MAY have some interest in. e.g. my dad (surprisingly) flocks to the activity room when earth, wind, & fire plays.
       
     
  • If you can't do this, you could hire a caregiver/private CNA with some experience in this area to help you temporarily. You can also look for behavioral gerontology specialist. 
  • In my experience, the drugs are a slippery slope from lessening symptoms to sedation.  
    • I read a wonderful explanation somewhere that some individuals are not anxious by clinical description but rather their confusion over their misplaced memories just looks like the same topography. I think about how I look when I miss place an important doc I need or don't understand a crucial item. This is what they are experiencing all day. This could be why some indivdiduals do not respond to anxiety meds.