What do we do about mom and her outbursts/anger at night?

Glasses and hearing aids:

Mom had cataract surgery years ago, releasing her from lifelong glasses, except for mild readers. She is also being treated for Mac Deg, many years now and my plan is to continue this until she loses sight or regresses too much. She also wears a hearing aid, so losing her sight would be disastrous!

Funny that our mother ALWAYS wears the glasses, even though they are only for reading. That is likely because she wore glasses for so long, much longer than not (and long term memories stick around longer!) She constantly "cleans" them too, insisting they are dirty, or she needs a new Rx for them! They aren't intended for long distance, but I let it go. They are only about 1.5 (tried stronger, hated them!) Depending on your mom's eyesight, I wouldn't stress over the glasses too much - if they are for distance, it isn't like she needs to read those upcoming road signs!

The hearing aid(s) are another issue. When mom moved in, she had one that she would wear and another we kept for spare (she lost one and we got another when she was living alone, then YB found the other when we started clearing out her place.) When she moved in, we noted the hearing aid, but didn't request any help - she was okay doing it herself. Too often when I would get there, it would be dead battery, not working. So I gave them batteries and suggested what the provider told me - change it every two weeks. Didn't happen, as best I can tell. I would find her wearing it with a dead battery, or would have to search her room to find it, sometimes battery ok, sometimes not.

Earlier this year I get notified that it went through the laundry with her sheets. I really expected it to happen much sooner. Took me some time to find another provider (previous did not respond to messages.) The new ones are chargeable, so I gave the charger to the nurse as mom would lose it or throw it away. I left it to them to take it at night, charge it and give it back in the morning. Maybe 2 months go by and new email telling me it is MIA. They have no idea what happened to it. GRRRREAT! We did order a pair, just molded for the one side (other side is NFG), so I had to get provider over to set the second one up. Hopefully they keep better watch over it now (the first 2 years she was better about wearing it, but later would question it, say she doesn't wear one, etc.) They will NOT reimburse - the new ones come with loss protection, we'd only have to cough up $400, but they refuse. I didn't complain about the first loss, but seriously, I left THEM in charge of the new one!

Two suggestions - esp for the hearing aids:

When needing to put the aid in, she needs to be aware. You probably interact with her out of habit, but some people don't understand. When the provider came to fit the new one, he started to put it in and she recoiled and batted him away! They really need to approach her from the front (she might not hear or be aware of them from behind or the side), make sure she understands what they are doing and go from there. They have been taking mom's away when she keeps taking it out, to help prevent loss (she will wrap it in napkin or tissue.)

For the glasses, might she accept either an eyeglass cord, those ones that allow the glasses to hang on your chest, or some kind of clip or jewelry to hang them on so she will have them but doesn't need to wear them all the time? They do make nice ones (eyeglass jewelry and/or brooch.) I hang my readers over a necklace I am wearing most of the time, sometimes over the edge of a shirt or sweater, but they can fall!

Some confusion from your posts:

"I don't want her to leave and I know that my brother doesn't either."
 VS
"My brother wants to move her after 6 months due to finances."

Although you are not POA for finances, you two have to work in conjunction. Have you been able to discuss the financial concerns with him? If she truly doesn't have enough funding to stay beyond 6 months, this needs to be dealt with NOW!

Would her income be low enough to qualify for Medicaid?
Does the facility she is in accept Medicaid?
If she is over the income for Medicaid, what are the alternatives?

Moving her might not even be an option - while costs can vary, if she is in dire financial need, there isn't likely to be another place she can afford. AL & MC certainly are not cheap, and are usually in the same dollar bracket per regional area. Hiring in-home care is usually MUCH MORE expensive and finding good aides is difficult at best ($25/hr x 24hrs x 365 = $219,000! Mom's MC is less than half that - we're in a more expensive but not the most exp region.)

Focusing on the behavior first:

Having read through most of the comments (focused more on your posting/replies, the previous comment if context needed) I agree with 2 things others have said:

Test for UTI
Sun-downing

These *MIGHT* be related. Our mother, when living alone, didn't have traditional sun-downing symptoms, but rather ever longer OCD behaviors later at night, just before bed (we had camera that caught all this!) She is in MC now (3 years in January.) Around mid-year last year, she developed some serious sun-down symptoms (posted more in response to another/your question if it only happens at night.) It WAS UTI related AND behavior was only later day/early evening. She was always begging to go home regardless (less now) but in general was mild-mannered, well behaved, so this was out of the ordinary for her.

You indicate mom has been there about 3 months - is this a recent behavior change? It could be one or the other or even both UTI/sun-downing. The UTI test is simple, cheap and can rule out that as the cause. She may not need any other medication changed, but in our case mom got Lorazepam (anti-anxiety) to take the "edge" off. It was the smallest dose, only one later in the day if needed for the sun-down behavior, and once UTI was treated, we haven't needed it again. It works quickly (10-15 min, even the first time), doesn't "dope" her up and took care of the behavior.

There is also discussion about moving her to AL - she IS where she needs to be, in our opinion. She has already wandered from her previous place, and there are NO restrictions to coming/going in AL, so there won't be anyone around to prevent her wandering off, which she WILL do. Additionally, every move is hard on those with cognitive decline. She is where she will need to be, I would not move her. She is also only recently moved - it can take a long time to adjust fully. Mom sometimes either doesn't realize this is "home" or forgets where her room is (first one around the corner from the LR/TV area and mere steps away from the hallway bathroom, who she is on intimate terms with!!! :-D

When I joined this forum, I didn't believe the UTI posts, but now having experienced it, I am a believer! Additionally, she recently had night-time bed wetting, which is also not her norm, and sure enough, UTI. Clearly it was, because now that it is treated, the bed wetting has stopped.

Also, no matter how clean they (or she) might think she is, UTIs are so easy for elderly to get. Merely wiping "the wrong way" can introduce bacteria and the older we are, the less able our bodies are to ward off the infections.

This may indeed be sundowners. A neurological exam may be in order.

I had pain for osteo arthritis and my doc perscribed CBD oil, just 2 drops at bedtime. Didn't do much for the pain but made me very very relaxed and sleepy. Maybe CBD oil could help your mom against outbursts.

Hi Judy
Doubt that your mom with dementia will ever be able to live in a regular assisted living unit. Memory Care Unit within an an AL could work until dementia becomes worse. The drugs Namenda and Aricept, have been used for years to help slow progress of Alzheimer's disease. Having worked with patients who took these meds, I would say results are mixed. Nothing works for everyone! At a point in the progress of the dementia, the above meds are most definitely not going to help! But there are other medications that can help with combative behaviors and also drugs to help sleep patterns.
Also remember that sundowning behaviors can partly be caused by waning of light, increased shadows, and fear. (Many other reasons too)

Be involved with her care. Talk to supervisors and/or MD staff.
Perhaps she needs medications changed to manage her brain chemistry.
It is certainly possible that line staff do not know how to deal with your mom in an appropriate manner - with the stress they are under. I would encourage you to not 'just' let the staff deal with her as some here are advising. If I were you, I'd ask to speak to the MD/medical professional in charge.

You have some great advice here. Wishing you the best.

Have you taken your Mom to a neurologist? The anger & lashing out is very problematic & is VERY possibly there! Sundowners.
my mom was giving Quetiapine (seroquel) for her fits of rage & sleeplessness. My Mom has taken swings at me multiple times.
The staff knows of sundowning but probably can’t do anything about it. You’ll have to make that step to help her in helping them, medication.
A friends Mom used to get violent but because they had never researched, they didn’t know what to do & would instead take her to ER. That’s how bad this mood swing can get...the hospital would end up sedating.
It sounds like you need to take this info, from caregivers, to heart & research! They need your help if you are your Moms POA.

Most employees are trained to deal with these issues so stop worrying about that - your mom isn't the first one to be like this & unfortunately she won't be the last either - she probably finds the glasses & hearing aids as intrusions in her personal space [which they are] so when someone else tries to make her wear them then it is extra intrusion ... think about from this perspective as you may see what she is on about [sometimes]

My mom became a little more agitated when her night time medication was stopped, so her doctor put her back on it. See if that is what is needed. I've watched new and old residents move in and out of my mom's assisted living place. Most who had to leave when their care got too difficult were the wanderers and the hitters, then they went to memory care, but your mom is already there, so I would think that is where, between her doctors and staff, her needs should be dealt with. Did you see the posts on sundowners? Lavendar filled cotton balls in a cup calms people.

I was caregiver for my Mom in her condo before I needed to place her in a Memory Wing of a care home. Yes, what you are saying is Sundowning. Each person exhibits it some what differently, but yet the same. I can not begin to tell you about all the things my Mother said and did. The Memory section of the home was the very best for Mom. She would have needed 24 constant care/supervision etc by a skilled person if remained at home, of which there was no way humanly possible I could do. Dementia/Alzheimers is a journey of changes, many happen fast. The main thing through it all is let her know you love her with your kind words, hugs and kisses. It is not easy for you, I know, but as the child of a parent that is going through this, we are now the parent giving the comfort and love as they once did to us when we were little children. However they could correct us when we did something wrong or unsafe, where with this disease....we can't correct them, they can't learn and it would make it worse. There were times my Mother would say or do things that would make me laugh about it when I got home and those times I still remember along with all the many good times through the years. I know it is not easy, but try to focus on those times.. My Mom passed away over 10 years ago at age 94. Now my husband is in the mid stage of Alzheimers. I know from my experience with Mom, things can change in an instant, so live in the now. I wish you and your Mom a very sunny day, filled with love. I hope I was able to be of help to you.

This happened to my mom. It was Quite unsettling. Yep urinary infection.

First of all, please understand that dementia is not just a "forgetting" disease. Many aspects of the person is impacted. Their entire behavior might change in addition to memory loss. Some people become withdrawn and others become violent. There is no predicting nor preventing or controlling the behavior. Sundowning is very common. They frequently become more agitated then, and might be more prone to act out. Striking out physically is more likely to be then than first thing in the AM, although as you have learned, they might try to hit someone at any time. I'm sorry there isn't more I can say to help. If you don't feel her caregivers are up to the task, it might be time to move her to a specialized facility where people are specifically trained to deal with patients in that stage of disease. At this point, moving her into your home is the last thing I would recommend, especially if you have children. You certainly do not want to put them at risk.

Oh Boy, having her live with you is the very last thing I would do. The people who are taking care of her are clinically trained, let them handle her. She is just in another stage of her disease, there is no getting better at this point.

Consistent routines and calm demeanor of all caring for her are the best for dementia patients. She probably is more confused and tired in the evenings so things seem more threatening to her - Sundowner's Syndrome indeed. They may have to get her ready for bed earlier than usual. If her behavior is threatening staff, tolk to her doctor about mild antianxiety agents to help her relax in the evenings.

Honestly, I would try to figure out, if there is anything at night that causes anger. It could be health issues or fear. Did she really hit someone or is it profiling. Take one step at a time. Try to put the puzzle pieces together. Certain health problems can cause anger, have that checked out. Did something, in her life, ever happened to her at night. Is someone abusing her. One never knows. The things I know, you don't want to know what they are doing to older people. The things they have done to me to cover up deliberate mistakes. Attacks, profiling & darn right lies. A police officer did stick up for me & told me the little bit of proof I showed him was more than enough. All proof of anything, did not put on line, because of fraud & theft, but get a good filing system too heavy to pick up or nail it to the floor!!!

The same thing happened with my father, pleasant in the morning, angry at night...sometimes we would feed him in the bedroom and put medicine in his food or drink as if he came out to the kitchen table he would not go willingly back into the bedroom and would refuse to walk. Also the deal with his hearing aids, brushing his teeth, drinking, or holding drinks in his mouth. My husband used to put on some Italian music for him and it would calm his nerves..he would tap his feet and hold his hand...it kept him more calmer at night, so perhaps her favorite music?

Teepa Snow on YouTube has been a tremendous help. She has wisdom on how to approach Alzheimer’s and Dementia. Perhaps you could recommend her to staff.

You are looking for trouble if you take her home. I made that mistake & she hits, punches curses , scratches, bites me & the private pay caregiver. She also curses her. Hard to hold onto caregivers but one stays. One caregiver quit because of the physical & verbal abuse. The SNF warned me this dementia gets worse. I have to give her medicine to control agitation, but lots of times she refuses..so I have to find other ways to give it...like in ice cream or a little piece of chocolate. That she never refuses. Please don’t ruin your life by taking her home. She don’t walk or stand so we use stand assist lift. She also now don’t know when she has to do number 2. She is incontinent. You have to change her diapers. I also have had to do wound care. So this is a full time job that pays nothing & get abused to boot. Sept 24 will be 2.5 years I discharged her from SNF. I thought she was going to not live long since the bones by her neck was showing & she was picking up every germ in the SNF. But since she home, she eats better & bones don’t show anymore. I was at SNF every day when she was there. ....but there is no end in sight now with her being home. So Please don’t take her home...it will be a major mistake.
Hugs 🤗

It's the neurologist that wanted her kept on Aricept. He is going to up it to 10 mg.  Not sure why, or if she even needs to.  Going to start it on the 26th and see how she does.  Her doctor saw that he is moving the mg up to 10.  Thanks for all of your help and suggestions.  This is all so new for me.......

It definitely sounds like Sundowner's. Following your question there is a blueish green symbol with the word sundowner's syndrome. If you click it it goes to a page on this site with all of the information about the topic. I think if you read it, it will become clear that you should really take to heart your last sentence that you'd love for her to live with you but it could be more than you can handle. It seems very clear when reading more about sundowners that trying to handle this stage at home is often the proverbial straw that breaks the camel's back. If she is in a good facility you are doing the right thing by keeping her there and trying to add services/ meds there to get this resolved. Sundowning is commonly associated with Alz. If she's in memory care, employees should be equipped to deal with her and your Dr. should be able to treat based on what the care team is reporting.

Director of Nursing. I don't know much about Aricept, my mom never took it.

Judy, are you familiar with Alz.og? Even if your mom doesn't have Alzheimer's, they have loads of good articles.

https://www.alz.org/alzheimers-dementia/treatments/treatments-for-behavior

Thank you.  Just hope that her doctor can figure out what meds need to be adjusted.  Aricept wouldn't affect her behavior,would it?  I was told that is just to help with her memory.   Again, I'm learning here.  That is why I ask a lot of questions.

I would be speaking to the SW and DON about these issues right away if one of the caregivers said she would be asked to leave.

So, in MC units I've had experience with, patients will ne transferred, temporarily to a geripsych unit or "senior behavioral unit" to get meds adjusted.

Judy, your mom is in Memory Care? And you think she may be asked to leave if she has a behavioral issue?

That DOESN'T sound like Memeory Care.

My mother who had vascular dementia  in her last few months of life was quite well in the day time but at night time developed  these really angry outbursts against care givers, hallucinating,, was terrified, distrustful &  confused. and would loose hearing aids tablets, glasses, them be reasonably fine in the day time.  Our dr gave an oral medicine  - Buccal Midazalone which helped calm her to a certain level and it was easy for everyone  to give. He said it was the normal progression of dementia, people stay at a level for months /years and then deteriorate without explaination, Talk to the Dr/Geriatrcian regarding meds he is dependant on feedback as they don't  witnesswhat was going on and meds may help her. As someone said check for any signs of infection, chest urine as sepsis will cause a lot of confusion and distress Best wishes on getting good support

Judy, has your mother been evaluated by a Geriatric Psychiatrist?

In my mom's journey with Vascular Dementia, the GeriPsych folks and the advanced practise nurses who worked with them were the best source of information and treatment. They were able to get mom on a regimen of meds that kept her calm but not knocked out.

You may want to ask that Mom be tested for a urinary tract infection (UTI). My mom became angry, confused and combative when she had them. We had her tested monthly for them at her facility. They are common in the elderly.