How can I help the nurses to not be offended?
My 79 year old husband had a massive stroke 10 years ago. It left him with complete left side paralysis and he is left-handed. I took care of him at home for five years. He has now been in Nursing home for nearly 3 years. Since being in the nursing home, he has started calling people bad names. He usually remembers that he did it and is remorseful. It usually happens when some one accidentally hurts him. Sometimes it happens when there is no apparent reason for him to be angry. When this happens, I have learned to see it coming because he will repeat a request over and over and seems unaware of anything that is said to him. Before stroke, he never used bad language and did not even want to be around people who did. I have tried to explain to the workers that they should not take offense because he has no control over what he says at times. They will not believe me and some even refuse to take care of him. Is there any thing I can give to these workers that will explain this to them? Most of the literature I have found on IEED seem to refer only to involuntary laughter and crying at inappropriate times. The crying and laughing were there at one time but then have not reapeared for over a year. At first, he would apologize when he realized what he had said but they said they refused his apology so now he doesn't apologize.
Please helpe me inform the Nursing Staff in a way they will understand.
Expert Answer
This, unfortunately, can be a very tricky issue.
The mainstay for helping with this problem is taking some basic steps to curb any arguing. First, avoid ANY confrontation with the patient, and please let the nurses know that they should do the same. Second, remind the nurses that he was not like this before the stroke, and that it is a symptom of the stroke - not his normal personality.
Sometimes this type of problem gets better with time. Unfortunately, it seems that he had his stroke several years ago, so the recovery may be completed. If that is the case, there are four different medication options that I use to help abate these outbursts. Selecting the right choice amongst these four is somewhat of a trial and error process. The first two options are anti-depressants: Tricyclic anti-depressants and SSRIs. The third option is a relaxation-type medicine class called the benzodiazepines. The final option are the "heavy-duty" medicines including anti-psychotics. I have had variable degrees of success with all these types. Please ask his doctor if they have ever tried these medicines or would like to try one. You may find one of them to be very effective.
I hope this helps.