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Mom's caregiver at night says she is becoming more confused and anxious in the evening. Says she wants to go home (she already is) wants to be alone, wants to call 911 on everyone. Got up last week and wanted to make breakfast at 130am. It takes a while to calm her down . The caregiver says there are meds she could take. I can't see Mom taking a pill when she's all worked up like that but maybe there is some thing she could take daily. Something that won't zonk her. I made her an appt in a few weeks but would like some suggestions about what you have done to deal with this problem.

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ZWILLMAN, if it seems to work, that is hard to beat! Valium is a prescription drug. Was it prescribed for your dad? If not, I'd discuss it with his doctor.
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I WAS GIVING MY DAD , A DEMENTIA PATIENT, 95 IN AUGUST, 1/4 OF VALIUM AT 5:00PM FOR SUN DOWNING/AGITATION. IT SEEMED TO WORK. YOUR THOUGHTS? KAREN
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Good luck everyone. I had my lip split open by my MIL (hence my photo here), my back injured when she knocked me down and then proceeded to bash me several times with her walker--the abuse went on until she died. And now my own health is in the sewer. I feel cheated out of the 17 years of caregiving that went on until I am too ill to enjoy my own life now that she's gone. She lived to be 98 and the combative dementia, in spite of seraquel, didn't help. Nothing helped. Death helped. And someday death will help me.
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My mom has taken to crawling on the floor, under tables and especially loves to roll up the rugs! She has PPA with dementia. She already takes 1mg of ativan x3 a day and respirdone at .25mgs x2 a day. She doesn't hurt herself or anything else but what is normal under these conditions? Anyone else experience this?
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Dr's just put my mother on depakote to try and calm her. I'm hoping it will help with the anger also. She has demintia and is very agressive and combativeand verbally abusive. She just had surgery to remove an infected knee replacement joint and has since gotten much worse. They have tried the antivan, seroquel, Xanax and others. She cannot get out of bed and is currently in rehab for the knee but will not cooperate with the therapist so we will either have to put her in a nursing home or take her home with home health. I work a full time job and can not afford to quit. It is so mentally exhausting and frustrating, but you know they are not themselves and they don't mean it, but it still hurts. I am also dealing with a mother in law with stage 4 lung cancer and am having to help take care of her also, so I am frazzled! Praying for all caregivers that go thru this.
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My grandad started being mean to my wife who stays home with him. He has demintia and we have lived with him and taken care of him for four years now. Anyways his doctor put him on depakote and it seems to have helped with his anger
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Very true pamstegman! I think often it's easy for doctors & experts to under-estimate the stress on families and caregivers.
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While the FDA issues warnings that anti-psychotic meds may lead to death, factual evidence presents that a patient who is waving a twelve-inch butcher knife at others is at considerably greater risk of imminent demise.
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None of the antipsychotics are FDA approved for agitation in dementia patients. However doctors are allowed to prescribe "off-label." It's supposed to be done as last resort, after trying alternatives, and after warning patient and family of the risks. (Using antipsychotics in dementia has been linked to a higher risk of death, risk of falls, etc.)
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I thought FDA has banned Risperdal on eldery, especially dementia patients, quite a while.
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No med can do the better than your love. I hope you will find some better solution.
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It's very hard you want them comfortable but also would like them to have a conversation very hard to attain that happy medium. My mom says she going to kick my a** and then she passes out. She is one tough chick. The patch and antivan keeps her comfortable we can hear clearly all the dirty words lol but that's it she takes ice chips coke. And some ice cream teaspoons full not much but better than nothing I think you just have to see what works you. Day 3 pray for my mom and to be taken out of this agony.
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My father-in-law had Parkinson's Disease which was accompanied by dementia. He was anxious, fretted about his finances, and had trouble differentiating between reality and his very vivid dreams. His worry over the subject of his dreams stayed with him. His neurologist tried him on lorazepam and a couple of other drugs in the "pam" family. We found through research that this family of drugs was often not good for a PD patient. Eventually we got to hydroxide which was prescribed as a sleep aide. This helped with his sundowners, let him rest more comfortably at night and seemed to manage his anxiety as well. It is supposed to be non habit forming and had no side effects that we noticed. Take care and the best of luck.
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One thing I have found to work for me is that I made a bracelet out of turquoise & amethyst. I wear it on my wrist. As my husband, who I now live next to because I could no longer live with him, comes at me as the enemy(??), all I can do is to listen as if it makes sense to me, in his anger & all. He suffers from early onset solvent dementia & is only 64 but is on meds & I am a Psychiatric R.N. too. I use my prayer bracelet to pray on when I am being verbally attacked & it puts things into proper perspective for me. He is my teacher-as weird as that may sound. Not a day goes by that he teaches me not.

Having a strong spiritual take on it all help me so very much.
Blessing are....
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hi mrn4eva,
In general, the safer & less "zonking" medication options for angry/anxious dementia patients would be an SSRI antidepressant; in geriatrics we tend to use Celexa, Lexapro, & Zoloft. Namenda is another class of drug; seems to help some patients, and generally doesn't seem to make thinking/balance worse.

Ativan and Xanax are benzodiazepines and do make thinking & balance worse. They, along with the antipsychotics, are on the list of 5 things to be careful about when it comes to healthcare for aging adults:
http://www.healthinaging.org/aging-and-health-a-to-z/topic:choosing-wisely/

You may still find the benefits of trying these medications outweigh the risks...in the end it's often necessary to make difficult choices in order to maintain sanity.

Safest is to use non-drug approaches for anxiety/anger, like having a regular routine, treating pain/constipation (this does require meds sometimes), regular exercise & fresh air. Aromatherapy massage, pet therapy, music therapy and more have worked for some people.

Good luck!
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The past weeks she has been experiencing the sundowner thing, it's like we trade off one thing and have two more things come up, not eating or drinking now, but no pain or severe anxiety. I am very scared, I am unsure if this is the right thing. I am here next to her now, I want her to be comfortable
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Mover2: I do not want to sound insensitive so I want to see if I can ask this question gently. You said your Mom was in hospice and was on Morphine and Xanax and you are concerned about her not eating, drinking and sleeping too much. I just wanted to ask is she in the final stages of her illness? I only ask because when my father was very ill and hospitalized they put him on morphine to keep him comfortable until he passed. You said she has suffered a long time, perhaps her sleeping a lot is a good thing at this point. They tried morphine on my Mom as a way of stopping the sundowning in the hospital and allowing her to sleep, but it did not work she is able to override almost everything, this is very frightening to me, I would rather have my mom comfortable and sleeping.

God Bless You Both!
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Thanks for the advice everyone.
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I knew I liked assandache7 my mom is from Boston Sicilian hard to the core. Love her she is one of a kind. I have been in denial about her dementia but for two weeks now it has been awful, hospice gave her morphine n Xanax but as a result she is not awake or drinking or eating. If it works for one issue it brings on three more. She has suffered a longtime .
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I too have been losing my mind with trying to find medications that can work to resolve issues or behaviors that are bothersome (drive you nuts) and trying to find something that does not sedate them to the point they are sleeping.

My Mom is one of those unlucky people that many medications were tried on and they did not seem to work. We have heard how great Seroquel was so it was tired and it was like she was taking water, same with Haldol, Valium and several others. Remeron and Celexa worked until she began getting headaches and had to come off, although they did make her tired and sluggish.

Now she is on Ativan .25mg 3 times a day and Ambian 2.5 mg at night and she is wide awake, not sluggish, BUT I have to tell you that this JUST BARELY controls her and sometimes, does not control her. I think it needs to be increased or add some Xanax to it, because she can and does drive me nuts! It does not relieve any of the bad behaviors. She will ask me 50 times a day if the dog has been fed, she will get mad and decide SHE WILL FEED THE DOG WHEN SHE WANTS AND WHAT SHE WANTS...(THE DOG IS ILL AND ON A SPECIAL DIET). She gets angry with me and says very mean hurtful things...."I am tired of looking at your face, pack your s--t and get out, you can live on the streets, what have you EVER done for me" You name it and it rolls out of her mouth! I have cared for her for 8 years and her sister, my father and brother in law for a total of 17 years. I am her POA for Medical and Financial and I do about 99% of everything that has to be done for her, so when she spouts off this stuff and does it for so many years, you do not care if "it is just the disease talking" you get upset eventually and I am about ready for her to go into a facility. It isn't what I wanted and is the opposite of why I took her POA, but mentally, physically and emotionally, this disease is not just a "person killer" it is a "family killer!" I am ready for it to end.

When we look at these medications, we want them to have as much of themselves as possible for as long as possible, but when their actions and behaviors become such that we or our paid caregivers can no longer handle them or put up with their behaviors, I think we need to either increase meds or change them. My mother could go on living with these same exact medications, but I CANNOT GO ON LIVING WITH HER TAKING THESE MEDICATIONS, she is too difficult for ME TO HANDLE!

So if you are paying someone to care for your mother, you need to look at other medications that may make her a bit sleepier, but if your caregiver cannot take it any longer, chances are YOU WOULD NOT BE ABLE TO HANDLE IT EITHER AND YOU NEED TO MAKE CHANGES.

My two sibling have no idea what I go through daily, they come over to visit and Mom is fine all day on her best behavior. On Monday when everyone is gone, she is back, screaming and yelling at me.

Don't lose a good caregiver, make sure to tell her you will get on it immediately and see about some changes.

Good Luck and Best Wishes
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Love. One time, my husband was very upset. I approached him from his back, and gently hugged him. I said to him with very low and soothing voice as if I was talking with a sleepy baby, “don’t worry…you are all right…you are in safe…” whatever I could think of. He calmed down. After he went to the bed, I gently hold his hands until he fallen a sleep. Hope you will find something other than medication for her
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It seems I can't edit my post, so I want to correct something I said in my comment above -- the dosage my father gets of Seroquel (quetiapine fumarate) is actually 25mg, not 1mg. Apparently, 25mg is the smallest available dosage. The range that the doctor prescribed was 1/2 to 2 tablets per day, not 1/2 to 2mg. My mistake!
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When using Benadryl - it contains diphenhydramine which will cause a dementia-like symptom which will diminish when you stop using it. It is still good if you have an allergic reaction to something.
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I agree with Pamstegman about contacting the MD, otherwise your caregiver could quit. This a really tough one. It might be better to talk with a pharmacist, as they are more knowledgable about meds and its side effects. I have started to be more "open" to marijuana as I saw a utube video about women patients that tried it and NO side effects! Never tried it, but there are lotions! apparently. Look into all options.
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mm4vea This sounds like sundowners. Try distractions give her a laundry basket with a bunch of socks/towels/scarves and see if she will fold/sort them. Give her something to do that will make her feel useful and appreciated, praise her for her help. Have her caregiver help her create a memory book of family photos/pictures out of magazines, play music from when she was a teen, give her a box full of artificial flowers that she can arrange. Sort out a sewing box. A lot of caretakers meet the daily living needs not the mental needs, having her mental needs met will give her a better quality of life and not want to give up and lessen the attacks. We all need to feel our life matters. Call a memory care facilities and ask to speak to the activity coordinator ask what other stimuli you could use to help Mom decompress.
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Something new is arising-- Last year I had was living with Lynn, who had anxiety. Lucky for me there were two other caregivers and the neighbor across the street sat in when problems arose. I supported Lynn with her need for anxiety meds, as her intestinal issues were also helped. When she wanted to try heavier sleep med, I said OK. Her neighbor backed me up against the other two caregivers. This still did not stop Lynn totally, and one night --even though she could just call me and I would be there within a minute--she got up to come get me to help her. She fell and cut herself badly on the walker. I took her to the ER and after admitted they decided to keep her and run tests. They found her cancer had come back and diagnosed her death within 3 weeks. I hate to tell this, but be sure to have another person or two to back you up.
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Yes. There are definitely meds that can help calm dementia patients without zonking them.

But they all require trial-and-trial-again. This is true of "natural" remedies as well as prescriptions. If the first thing you try works, hallelujah! But it is more usual to adjust dosages, try different drugs, try some combinations, and finally arrive at the most effective with the least side effects.

Our neurologist's rules were to
1) try ONLY ONE new drug or remedy at a time. If you are taking multiple new drugs how will you know which one has the side effect?
2) start at a very small dose and titrate up until the dose is effective or you've reached the max without success
3) reevaluate the entire drug mix frequently

I don't know how we would have gotten through the 10-year dementia journey without a patient, knowledgeable doctor well versed in available drug therapy. We were very fortunate that my husband responded very well to medications. In the letter explaining his autopsy results the doctor remarked on that fact and said "we don't know why" drugs were especially useful for Coy. Wouldn't it be great if doctors had some clues, some biomarkers, that would reduce the experimentation and help them chose the best drugs right from the start, or to know that drugs would not be successful? My dear husband donated brain tissue for such research.

By the way, seroquel was one of the most useful drugs for Coy. It did turn him into a complete zombie for about 2 hours. I learned to give it to him only after he had his pajamas on and was in the bedroom. I wouldn't have given him any during the day. I know others who take a few doses throughout the day, and some who have tried it and it made matters worse for them.

Each brain is absolutely unique. There are no one-size-fits-all solutions. But there are solutions. Hang in there!
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Good ole Benadryl helped Mom. she was on Lorazepam 0.5mg but it quit working. I would give her 1/2 of a 25mg Benadryl and the other half 2 hours later it helped a lot it helps take the edge off when she would get anxiety attacks. I get it at Costco. I use it if I'm having trouble sleeping it doesn't leave me groggy in the morning.
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Try some Melatonin at night or an antihistamine. Give those in the lowest dosages and see if they work. Let the doctor know what you have tried when you do see him/her. Try a bath with Epsom salt as it has magnesium (mostly) and it will relax her too.
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PS: This is only one of the many injuries she inflicted on me--the split lip right through to my skin that had to be stitched up because she smashed me to the floor with her walker and kept pounding me with it until her son, my husband, dragged her off. I decided to post that picture because many people on here just don't get it. They don't realize what combative dementia can do to the caregiver.
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