I guess I don't know how to look for topics because I'm sure this has been discussed many times. Dh has been so agitated the past few days and nights. He gets angry over the least thing and hits the table, wall, door whatever. I may have not said what he wanted the other night and he shook me and then put his hand around my throat. I just quietly said his name and told him that he wasn't doing the right thing. He then hugged me and said how much he loved me. Well, I know this can't go on because next time he might not back off. We went to our pcp today and he gave me the number of a local geriatric psych hospital and suggested I call. I am going to go visit and talk with them but I know that is why I can't sleep tonight (it is 1:34 a.m.) This is such a serious step. I've talked with my dil and one son - not her husband he is out of town and they don't want to encourage or discourage me on this one. They agree I must do something. So my question is what experience have you had with this? Dh is not on namenda anymore that seemed to just cause more anxiety and rage he started on risperidone 1 mg today. I gave him 1/2 tab this a.m. and it didn't seem to have any affect but tonight at supper I gave him a whole tab and he was like a drunk. He couldn't walk straight and he kept going from door to door seeing they were locked. He wanted to go "home" insisting we didn't live here. He was insisting we go home when one son called. Son called back and told him he had called the housing authority and we could stay where we are tonight. This helped some but I never convinced him we live in this house. But the pill put him to sleep so far tonight. I've been taking tylenol p.m. to sleep but then I'm groggy until noon the next day so I thought I could fall asleep tonight but this psych hospital thing keeps going through my head. I sure don't want to put him in some Snake Pit thing. Our daughter was in a psych ward once and it was awful. Give me some thoughts or some experience with this I'm at my wits end. I may be at my end too!!!
flo39, I don't have any advice other than you have to keep yourself safe. I think I would check with the psych hospital and ask whatever questions I have before making a decision maybe they will get his pills adjusted so he can return home. I am sorry you are going through this and I hope everything turns out for the better.
flo i am so sorry to hear you must make these difficult decisions, but once they become physical with us, there isnt much else but to refer them to medications adjustments. you are very correct in that the next time he may not back off. they can become quite scary and unaware that they can hurt us even if non intentional. please check into the geri psyche units near you and ask questions you need answered but i think you already know he needs to get his meds adjusted before you will be able to keep him at home and compliant. its not an easy decision to make but as many here have seen it has beneficial results in the long run once the meds are ironed out. good luck. divvi
flo-as you already know psych admits can be terrible. Often all patients are thrown into the mix. I hope you can find a unit that at least has a geri care unit. Your husband will have to consent to be admitted. If he won't you will need a court order. Here in Florida we have the Baker Act. It is not a difficult process if your doctor is willing.
flo, I know how upsetting this is for you-both the physical violence and the decision to put him in the geri-psych hospital. As divvi said, he needs to have his meds adjusted in a controlled environment like the psych hospital and it is better to get him treated now before he does something to really hurt you and then the police will make the decision for you. I know-that's what happened to me-DH's physical violence towards me began escalating until finally I had to call the police because I feared for my life. Once the police got involved, I wasn't allowed to see him for 72 hours, they had him admitted to a psych hospital and brought domestic violence charges against him on my behalf (I told them I wouldn't press charges but they filed on my behalf). So my advice is do this now on your own terms and for your safety.
Although I too was fearful of him being in a psych hospital, it was the best thing for both of us because they got the right combination of meds to control his behaviors and agitation without making him a zombie and allowed him to come back home. The process does take at least 2 weeks and in his case it took 3 months to get the right med combo that worked to control him without side effects. If that didn't work, the only viable alternative was permanent placement in a psych hospital or a psych nursing home, neither of which I wanted for him because as you know, those institutions have clients with a wide range of severe psychiatric problems, not just behaviors associated with dementia.
Please call the hospital today and ask your questions. The sooner you act, the sooner he will get effective treatment. If you're concerned about the hospital, call the state ombudsman and ask questions and look up the hospitals rating on your states website. Good luck-I know how upsetting this situation is.
Flo...I know exactly what you are going through. It happened here in April and I had no one to turn to, only I called my Kansas son to distract while I called our pcp. Pcp ordered Paxil, low dose, to be increased (doubled) if necessary. Took almost two weeks to take effect but dh quieted down and has been very mellow. I just try to keep him from getting too tired.
All the advice here being given is the best. Don't wait until things are seriously bad before you act. Not worth it and could be very damaging to you.
It is so difficult to deal with mental as well as physical problems. This crazy disease has no respect for age, health or mind.
Flo, I have problems with Lloyd being aggressive from time to time. Usually I am able to tell him that if he wants to be mean, we can both be mean. He knows that am not afraid of him. He only weighs 120 anymore so I outweigh him by 30 lbs. If he outweighs you at all, this won't work. I just seem to be able to make him comprehend that violence is unacceptable. Or maybe he remembers how my first husband was...mean SOB and he just doesn't want to do it. I wonder if their frustration doesn't make them lash out sometimes. Of course the right combination of meds may be the key. It's taken years, but I have gotten Lloyd's right...for now. I try to avoid sedatives and sleeping pills because I don't want him to be more impaired and I start new stuff at very low dosages and work my way up to the right level. Get the help you need, but you will be the one who knows what works. Lloyd's doctor was always starting with 500mg of stuff so I would go to the PCP and he would order the same in liquid form and we would start with half a tsp (100mg) and go from there. The PCP gave me syringes so I just take the needles off and use those to squirt the meds in his mouth...no battles with a spoon.
My heart goes out to all the spouses who face the horrors and genuine sheer terror of being physically attacked while providing care for an intimidating mate. Adding this burden of fear and anxiety for one's own safety to all the other tasks of care-giving is just one more overwhelmingly incomprehensible horror of this disease.
Maybe I'm a little off topic here but, I have a question to the other male caregivers and for anyone else who can reply:
I did a search here and didn't find any instance or comment from any of the men, (admittedly a tiny minority and a small sample) who post here on the site about experiencing similar symptoms, aggressive behavior, with their DW's. I don't know if we've (DW &I ) just been lucky, not at that stage yet or is aggressive behavior far more the norm for male victims of AD vs the female patient. I wonder if it's testosterone driven? Although, most AD males, other than early onset, are not of the age where they're producing excess amounts of the hormone. Could it be, just the male aggressive genes we're all born with rearing their ugly heads in the fog of AD ? OR maybe the problem is equally distributed and I'm just not aware of it. Any thoughts, sharing of experiences will be welcomed. I'm just trying to learn what to expect Ha, Ha the unexpected!
DW, was Dxed in 07 now late 5 early 6 and I've yet to witness any aggressive behavior. We cared for her mother who also had AD for her final two years (in the late 1980's) I have no recollection of her becoming physically aggressive). We placed her in a NH due to her uncontrolled incontinence which she insisted on sharing with every wall in our house. She died, catatonic, within months of placement of electivly non-treatment of pneumonia.
As others have said, I'd want to make sure it was a geriatric psych unit where the other patients would be, in general, less physically dangerous, and where dealing with the pysch issues specific to dementia is the norm.
Thanks to everyone for your comments and I welcome anyone else's opinion. Marty - A male friend of ours told me during the time his dw was in early stage she would fight him. Now that is lots different because of the size difference he could overpower her and control the issue. My dh is not a big man but he is of course stronger than I. In all our 60 years his gentleness was one of his virtues I admired. His father was a big guy and this same gentleness was evident about him. This is a geri-psych hospital that our pcp has referred me to and a two week stay is recommended. Dh is more mello this a.m. we both were awakened at 8:10 a.m. by the phone so I guess his meds will allow him to sleep. I gave up and took the tylenol at 2 a.m. DIL called to say she was in her office and to bring him by about 11 if I had errands to do. She is a gift in more ways than I can count. Our son who lives in our town but works out of town will help anytime he can. Bluedaze - I wonder if he needs to consent since I have medical POA? Hadn't thought of that one. I can tell you he will never consent - maybe our pcp who we've gone to for 30 years would be able to convince him. Just another thing to think about.
My dh was admitted to a geri-psych unit in May 2012. Before he was admitted he was angry, yelling and crying for hours. The PCP had to increase his meds to control him so that he became over medicated and a bit like a zombie. I signed all paperwork and did not have to have a court order. The geri-psych unit had a wonderful staff and a great doctor. My DH went from 4 people having to subdue him, to model behavior. The staff at the geri-psych unit went from fear of my dh, to enjoying his playfulness and sense of humor. For me, it is more enjoyable to be around my dh than it has been for 5 years. I too, didn't want to have to have my dh admitted to a psych unit, but it certainly has been the most helpful thing to happen to us for several years. Good luck.
My grandmother was very aggressive and violent in the later stages of Alzheimers. Even when she was mostly bedridden she would pinch the nurses, trying to hurt them. I think it gets downplayed unless the violent person is larger and perhaps even stronger than the caregivers.
flo-in my state POA won't do it unless you also have guardianship. Once DH was admitted I was automatically granted guardianship for his stay. Since he was declared legally incompetent during his stay they required my permission for any medication change. Loved those 4am calls when he was out of control
marty, usually not an issue when there's a female spouse with AD because husband can usually overpower them. However see paulc's comments about his wife and the call his son made to 911. Paul's situation was similar to mine except the courts insisted that charges be pressed (w/o his consent) and his wife was put on 3 years probation for spousal battery. This situation, no matter the gender of the spouse is very serious once the police are involved. I feel lucky that the prosecutor was willing to drop the charges...but the days before were hell and I have no doubt the days after would have been too if DH was given probation or worse yet incarcerated.
Around 3 years ago L would could become quite angry. Had at least 2 caregivers quit when they saw what she was like when angry. She didn't threaten them but her face, stance and voice were quite scary.
At this time our son called 911 twice. One time he was alone with her and she was pacing back and forth and cursing me (we were on the phone, I was doing a favor from her, I got tired of the verbal abuse and hung up on her. The second time there was an arguement over what to do with some of my son's books that were too young for her. I was making a pile of books to donate and those to store away. She didn't understand and I handled it poorly. She ended up attacking me an son called 911 and hung up but police came. Long story short she was arrested for misdemeanor spousal assault and felony assault on a police office (he was in the way between her and her iced tea). I think this was traumatic more for our son than anyone else.
A few months later, after court appearances we were ready to go get our new wills signed. Before doing so L talked with her father, who didn't believe we needed lawyer's wills (felt that hand written wills were fine since we were married and leaving our money to each other) and she absorbed his anger and almost bit off my ear. Nothing like having teeth holding your ear and keeping extremely calm and talking her down. She was on probation and if she did bit it off (she did draw blood) it would have meant a hospital visit and major legal problems.
Oh yeah, there was the occasional violent outburst over the past 25 years and the time she hit me on the head with a pan, I guess 4 or 5 years ago, and her not understanding why I struck back. And my son reported a period that she would pull a cat's tail if it misbehaved.
Today her record has been cleared and we don't see the violence. But that is partly due to the medications and the change in my behavior. Never argue. Change the subject. Agree. Avoid conflict. Keep calm. Don't let her feel confused.
So I'm lucky, the violence has been situational and not constant. While I don't worry about violence the feeling is always in the air and I am alert to stressors and her behavior.
It sucks.
If the violence returns and cannot be controlled she will have to move into LTC. I cannot have that happen around my son.
What, unfortunately, can be the case in situations where AD people become aggressive/potentially violent is that even a LTC facility cannot manage the behavior without significant medication.
Jeff is living in an ALF dementia unit. A level of medication sufficient to keep him content and non-aggressive also reduces his functionality in almost every capacity. Sadly, this is just what is necessary right now.
My point is that I often hear aggressive/violent behavior named as one of the things that would cause a spouse to decide in favor of placement, but the thing to keep in mind is that in these cases, whether or not placement is chosen, the behavior will still have to me modulated, most likely pharmaceutically. The result being a possible decrease in functionality which, in and of itself, might make placement a more likely option.
I know that some of us have spouses who've done pretty well on these meds without too much diminishment in ADLs (such as self-feeding, toileting, etc) but it's not always possible to avoid reducing function.
dh has been on resperidone for a couple of days and his aggression seems so far to have lessened but he is also groggy and I'm now concerned that he will fall. We have steps down to a sunroom before going outside and also into the garage so that is a concern for me. We are 79 and I sure don't want him to fall even if he didn't break anything I could never get him up. He woke up every two hours last night and was certain they called and wanted him to catch a plane out of Huntsville. Many years ago he did do that very thing so I guess that is going through his mind now. I had a hard time convincing him that "they" called to say the meeting was canceled. So I'll stay with this Rx for the two weeks the doctor prescribed and see if we can manage some kind of normal existence. fat chance
Thank you all for your input! Much appreciated. Even though this is my second go round in the role of a caregiver there remains much to learn. Hopefully this knowledge will provide me with the tools to best cope with the situations as they arise.
Thus far Ativan for Sundowning hyperactivey+ the "generic form of Marinol" + Namanda and generic Aricept have kept DW's moods anything but agressive. On the rare evening she's having problems sleeping I've used Melotonin 1/2 of 3mg tab. After expirmentation I found that it works far better than the Ambien and no AM residual issues I'll just count my blessings for that Thanks again
flo39--I understand your hesitation about having your husband admitted to a psych unit. I felt the same way--it was an unknown quantity and I had many fears of what the experience would be like. Although my husband was never aggressive with me or the aides, he became uncooperative with care and it reached the point where a medication adjustment was too complex to do at home. He was in a geripsych unit twice in 2011 (for a total of 7 weeks) and it was a good experience. The second time his medication "cocktail" was developed (7 prescriptions--all to address AD issues) and I can honestly say that it calmed him down without lowering his ability to function. Soon it will be one year since his discharge and things are status quo. Having a good neuro and a unit devoted specifically to dementia is crucial, I believe--I'm sure glad I took the plunge.
Marty--I've heard of women with dementia that became quite aggressive, but as others have said, usually their physical size and strength limits the damage they can do. It does seem to be more of a male issue, especially males at the younger end of the spectrum. However, at my husband's ALF, it is the female residents who get into verbal arguments, much more than males. They can be quite childish and nasty, and are good at using words as weapons. Yet I've never heard any of the male residents calling each other names, etc.