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Medical Forum / Diseases and Disorders / Alzheimer's / January 2005combative
I have just returned from visiting with my mother at her Alzheimer's ALF. The staff tells me she has started being combative (hitting at them and pinching) when they are getting her dressed. I was there last Tuesday when she was having her hair done, she wailed the whole time they were rinsing the shampoo from her hair. These behaviors are relatively new. I have read of other LO's who have become combative. Is there anything that can be done to make this better? Does anyone have any suggestions? Camille > I have read of other LO's who have become combative. Is there anything that > can be done to make this better? Does anyone have any suggestions? medications can help reduce her anxiety. Thanks, Dennis, I will talk to her Dr. about this. Camille >> I have read of other LO's who have become combative. Is there anything >> that >> can be done to make this better? Does anyone have any suggestions? >> > medications can help reduce her anxiety. : I have just returned from visiting with my mother at her Alzheimer's ALF. : The staff tells me she has started being combative (hitting at them and : pinching) when they are getting her dressed. I was there last Tuesday when : she was having her hair done, she wailed the whole time they were rinsing : the shampoo from her hair. These behaviors are relatively new. : : I have read of other LO's who have become combative. Is there anything that : can be done to make this better? Does anyone have any suggestions? I'm neither a health pro nor a spokedude for anyone else here, but the first thing I'd if I were again in your situation is to try have all reasonable explanations for comabitiveness ruled out, obviously these would be medical and comfort issues not related to the dementing illnesse, and also try to check for signs of elder abuse. Absent any of those obvious causes - actually before even trying to deal with them on my own - I'd have a talk with my LO's psych. If and when he was ready to rule the other stuff out and thought a good time to try an antispychotic, you may, as we did, find it helpful for your LO's comfort. I disliked using one as it's essentially a chemical restraint. The good news for us was that it wasn't a permanent medicine for my LO, she didn't need to be on it after about 3 months before wen titrated her down and off the stuff and the combativeness was gone. > : I have just returned from visiting with my mother at her Alzheimer's > ALF. [quoted text clipped - 22 lines] > my LO, she didn't need to be on it after about 3 months before wen > titrated her down and off the stuff and the combativeness was gone. Thank you for your response. We visit quite often and are always watching for any sign of abuse. I will talk with her Dr. regarding this. She now takes the anti-depressant Celexa. Is this considered an anti-psychotic? What drugs are considered anti-psychotics? I like to educate myself prior to discussing things with the Dr. The conversation seems to go better when I have understanding and input and don't just have to sit and listen. Thanks again, Camille Antidepressants like Celexa don't help with aggression, paranoia, combativeness - for that you need an antipsychotic. A common one used for people with Alzheimers is Respiridol, particularly if the problem is ongoing (such as with your mother), as opposed to very sporatic - if it was only occasional, sometimes tranquilizers like Lorazepam are used. My mother in law's agitation was very occasional, so a little sedation every now and then did the trick - unlike many people who get more easily and frequently wound up. The staff need to be watching for what her "hot buttons" are. She likely gives out signs that she is getting stressed prior to flipping out, and they are either unable to read them, or unwilling to accomodate her. You can often head off a catastrophic reaction by backing off, toning down, making sure the person is not stressed before you start the activity in question (i.e. they are fed, rested, you are in a quiet environment etc.). Mary G. I will speak to the person who described this to me. Mother has been at this facility for going on 2.5 years and this person has been working days with her for all that time. Normally she does back off and comes back and tries again whenever Mother would resist. The facility has a very low staff turnover so I am acquainted with most all of the people who work directly with my mother. I will speak to the doctor regarding medication. In the past, he was reticent to use tranquilizers for fear of her falling. She now is in a wheelchair so that should no longer be an issue. Thanks for your help. Camille > Antidepressants like Celexa don't help with aggression, paranoia, > combativeness - for that you need an antipsychotic. [quoted text clipped - 15 lines] > > Mary G. Keep in mind that antipsychotics are NOT sedatives. Respiridal/done is more likely to settle her out without making her drowsy that something like lorazepamz. Just for a contrast here are the side effects of risperidone http://www.rxlist.com/cgi/generic/risperid_ad.htm vs. lorazepam/ativan http://www.healthyplace.com/medications/lorazepam.htm#adverse Neither type of drug is without its downside, but the antipscyhotic often works without the floppiness/sleepiness that is the downside of a tranquillizer. Mary G. > Keep in mind that antipsychotics are NOT sedatives. Respiridal/done is > more likely to settle her out without making her drowsy that something [quoted text clipped - 13 lines] > > Mary G. yes, mary is right. my mother in law got to a place where she began to get argumentative, feisty and "in my face" a couple of times. my husband was still working part time at that point and it was a little scary cause she was quite strong and i knew it wasn't something i could manage alone. we tried a tranqilizer at first and it affected her balance and that wasn't good at all. she was getting feisty because of delusions that were upsetting her. she kept imagining that she had to go out to feed "the cows" from her girlhood, who were hungry and needed to be fed and milked. there were other delusions too, and we could not dissuade her from any of them. needless to say we don't have any cows, nor had she for about 70 years at that point, but it was VERY real to her. it was at that point the doctor then gave her risperdol which mellowed her personality a bit and she was much more easily dissuaded from the more upsetting delusions and more relaxed in general. as time wore on, the risperdol was no longer necessary because her illness had advanced more. she doesn't take it anymore and shows no more of that kind of behavior either. i can honestly say it was a very helpful drug at the time for us, but having its own drawbacks, it is a decision best worked out with your doctor. it is something where the need for it must be factored out against its risks.  SignatureRegards, Evelyn (to reply to me personally, remove 'sox") Yes, I can vouch for the effectiveness of Risperdal (generic name: risperidone) for getting rid of delusions and paranoia. In addition to both my parents having Alzheimers, both my children have autism-spectrum disorder. Additionally, my older son began to have symptoms of mild schizophrenia when he was 12. He began to have paranoid delusions that we were 'out to get him' so were his teachers, his other relatives, etc. Any time he was disappointed, he would accuse us (his father and I) of deliberately causing it. Risperidone got rid of this sullen, suspicious person and gave out son back to us. This is especially a relief since he is now 19, stands 6' 3" and weighs 240 lbs. Definitely not someone I would want combatively angry with me!. Sarah Kanary >> Keep in mind that antipsychotics are NOT sedatives. Respiridal/done is >> more likely to settle her out without making her drowsy that something [quoted text clipped - 38 lines] > your doctor. it is something where the need for it must be factored out > against its risks. |
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