What options do I have if my mother's Alzheimer's related anger is getting her kicked out of her nursing home?

Lrdarrah asked...

My Mother has middle to late stages of Alzheimer's. She has lived in an Alzheimer's unit nursing home for over two years now. She has never been easy to get along with but her aggressive and violent behavior has escalated recently and the home has asked me to move her. I can't seem to get doctors to medicate her and no one else has any ideas. She currently lives in one of the best homes around here. I fear I am going to have trouble placing her elsewhere and if I do, they are not going to like her behavior either. HELP!!!

Expert Answer

Jytte Lokvig, PhD, coaches families and professional caregivers and designs life-enrichment programs and activities for patients with Alzheimer's disease and related dementia. Her workshops and seminars help caregivers and families create a healthy environment based on dignity and humor. She is the author of Alzheimer's A to Z: A Quick-Reference Guide.

Dear L.R. Your mother's behavior is not that uncommon. In the later stages of Alzheimer's disease, people lose the ability to express themselves verbally, often resorting to aggression and violence as their only means of communicating their problems, i.e. hunger, thirst, anxiety, boredom, fear or pain. At this point, people have also lost the ability to manipulate or lie, leaving it safe for us to assume that these episodes are cries for help and have a valid basis. It's not always easy to identify these sources.

Here a few possibilities:

  • UTI (Urinary Tract Infection) is the most common cause for outbursts, acute depression, loss of appetite, and a sharp decline in cognition
  • Infections, aches and pains
  • Interactions or reactions to medications
  • Lack of mental or emotional stimulation
  • Boredom or a feeling of futility
  • Anxiety brought on by the environment. Some people fear of getting lost in a facility that's too large and confusing
  • Or it could be just the opposite. The facility is too small and lacks socialization
  • The staff is not trained to handle a variety of behavior problems

Hopefully your mother's nursing home will be willing to work with you on finding solutions. Ask them to give you a couple of months, either to develop different approaches to her current situation - or, all else failing, an appropriate placement for her.

I recommend that you start with a thorough review of her medications with a specialist in geriatrics and pharmaceuticals. The reluctance on behalf of your mother's doctors is probably because of the high risk that many mood-regulating drugs represent to elders, especially those with dementia. (Many psychotropics and anti-depressants have dramatic side-effects in the elderly, i.e. nausea, headaches, constipation, - or in a few cases, premature death.)

Your mother should have urine tests, blood panels and a physical exam to eliminate everything from ingrown toenails, toothaches or sore gums, to a slipped disk - and of course, a urinary tract infection.

If you have not yet done so, spend a day, or at least an afternoon, at her facility as a "fly on the wall." Your objective is to get a true impression of your mother's daily life and her interactions with other residents and the staff. It's important that you only observe (and take notes.) Refrain from "visiting" with your mother during this time and be especially careful not to intervene if you witness a confrontation involving your mother.

The purpose of this exercise is to gauge the stimuli, good or bad. Even the best staff in the world does not have the luxury of spending the time necessary to really learn the needs of each resident in each situation. They do the best they can, but may not be aware of subtle triggers of adverse behaviors. With any luck you'll see what sets off these situations with your mother, so they can be prevented in the future.

Hopefully you'll witness both positive and negative encounters. Here are some specifics to look for and note:

  • Does your mother connect with other residents?
  • Does she engage in conversations, interactions, decision-making or tasks?
  • Does the staff encourage residents to get involved in organized activities as well as impromptu projects, big or small (e.g. sorting things, setting tables, or helping with other chores?)
  • Does your mother react positively or negatively to specific individuals? "“ and under what circumstances?
  • How do these individuals "push your mother's buttons"
  • Does staff help initiate socialization with groups and help individuals engage with each other?
  • This time spent observing should give you a good foundation to work with the facility in developing a new care plan for your mother.
  • You may also solicit advice from a social worker, talk to the Ombudsman's volunteer and your local Agency on Aging.

"Behavioral Care Units" are homes that specialize in behavior problems like your mother's. They show remarkable results in most cases. Unfortunately not every community offers this kind of service, but it may be so beneficial to your mother in the long run that it's worth traveling to another state.

Resources for you:

ADEAR (Alzheimer's Disease Education and Referral Center) 1-800-438-4380 (They're easy to talk to and very helpful.)

National Institutes on Health: http://www.nia.nih.gov/Alzheimers/

Medications: http://www.nlm.nih.gov/medlineplus/druginformation.html

Selecting a Home: http://www.nia.nih.gov/Alzheimers/Publications/services.htm http://www.alz.org Search "Behavioral Care Units"

I invite you to go to my website: www.alzatoz.com - And, if you haven't already, join a support group. Go to alz.org to locate one in your area.

Best of luck.