Is there a better medication for my Alzheimer's mother to help control her abusive behavior?

15 answers | Last updated: Oct 15, 2016
A fellow caregiver asked...

My mother has been in a nursing home for about 3 months. She has severe dementia and was originally placed in the nursing home after a stay in the hospital for blood clots. My dad cannot care for her at home but the nursing home acts like they cannot care for her either. They say she is too abusive and arguementative and are trying to find her a bed in another facility. They have her on seraquil but it does not seem to help. The biggest problem with her care is that she cannot keep herself clean and won't let others help her.We feel like there must be other medications that could help manage her behavior. Right now she is on private pay but will eventually get medicaid. If we move her to a private facility we are afraid we will never be able to get her back into a nursing home when their money runs out and she needs medicaid coverage. Any ideas. I am lost!

Expert Answers

Ladislav Volicer, M.D., Ph.D., is recognized as an international expert on advanced dementia care. He is a courtesy full professor at the School of Aging Studies, University of South Florida, Tampa, and visiting professor at the Third Medical Faculty, Charles University, Prague, Czech Republic. Twenty-five years ago, he established one of the first dementia special care units.

Rejection of care is quite common in individuals with advanced dementia. Your mother does not understand why the caregivers try to provide care for her and resist their care. In addition to the lack of understanding, rejection of care is often caused by depression. The best would be, if you could find a place that specializes in care for Alzheimer patients because the staff is more skillful in decreasing resistiveness to care. You might also suggest that an antidepressant treatment could be useful in improving your mother's behavior.

Community Answers

Oreards answered...

I put my Mom on Celexa at bedtime and it has made a world of difference.

Bethkent5 answered...

Everyone hates the drug because of long term side effects but Haldol helped my mother with anxiety and agitation. The problem is that facilities see it as a chemical straight jacket. I had to call in Hospice in order to get a Nurse Practioner to order it. Very small doses cleared up alot of her resistance to help. Good luck. I know the problem from both sides since I'm a caregiver in an assisted living facility too.

Amet answered...

We watched my mil go through that too. She is 81. Experiencing her unwillingness to cooperate and abusive behaviour was heartbreaking and maddening at the same time. She was initially hospitalized for an erratic heartbeat, but was transferred to a mental facility to diagnose her dementia, where she broke her hip, basically her life and ours was a nightmare for about a year...dealing with her health issues and legal ones(she never made a will or health care directive) We even transferred her from one nursing home across country to one that is close by. Haldol has helped her too as well as the understanding staff. Don't give up. Sometimes it can seem that no one understands or wants to help. In our case, the other siblings did not want to become involved and even suggested that we just leave her in care of the state. I'm so glad we didn't. She has her moments, but, for the most part seems happy to be in the care of educated,benevolent staff.

Lrdarrah answered...

An issue here that is not being addressed is the fact that there is a tremendous lack of options for care for those "problem" patients. I have had similar issues with my mother.

First, after a great deal of searching, I found the right doctor. You need a geriatric doctor who specializes in dementia care. Regular MD's are NOT the answer.

My mother was "asked to leave" a Memory Care Unit, because they could not handle her behavior. I asked them, "If an Alzheimer's Unit is not the place for my mother with Alzheimer's - Where is the right place?" They could not answer.

At this point - they want your mother OUT. They are not too concerned with whether or not she is in a nice place or a good place or even the proper place - they just want her OUT of their place. They cannot (by law) just dump her. Do not let them bully you. I allowed them to bully me with my mother and now she is in a very bad place (state scores prove this) and I am going to have a terrible time getting her out of there. I will get her out - but she suffers because of improper care while I try to get that accomplished.

Currently, my mother is in a nursing home - they have a "special" unit in the back. They led me to believe it was for people with Alzheimer's - but it is not. It is for people that have behavioral issues and that nobody else wants. Don't let your loved one get into a place like that - it is very difficult to get them out and that is not the proper place for them.

People like my mother and your mother need extremely specialized care. The absolute right doctor is crucial. Next, a unit that specializes in care for dementia patients is critical as well, because the set up fits their needs much better. They need thier own space, they need quiet surroundings and caregivers trained to care for the special needs of dementia patients. Between the right surroundings and the right doctor who will keep trying different medications and dosages of those medications is exactly what has to be done. Our Mother's will always have issues, it is my understanding that the actual location of the brain damage is what causes most of the issues with behavior. That will never stop - but it can be somewhat controlled with the proper medications and surroundings and care. Those are the main issues here.

It is very difficult - my mother has been in nursing homes for over 2 years now. She is in late stages of her disease, but is also still aware of many things. It is a horrible place for these victims of dementia to be. They are absolutely paralized with fear every minute of every day. They do not know where they are, or why they are there. They do not know the people caring for them and maybe worst of all, they don't realize they have the disease - so they think they are fine and don't know why they can't just go home. That would make you angry too - wouldn't it? The only defense they feel they have is to "strike out". Try to imagine if you thought you were just fine and somebody came in, who you did not know and wanted to wash you or clean your private areas. You would fight them too. Understanding their position and fear is a big part of caring for them.

I have found that in the 2 years my mother has been dealing with this horror - that very (VERY) few caretakers understand what is happening to her - they just see her as a "problem" and want her to stop. They treat her like she is trouble. With my mom - she feels that attitude from those caregivers and thinks, "I will show you trouble" and she does!

The care they receive and the doctor providing medical care are the key issues here. It is difficult - but do not give up. Keep fighting for your mother's rights as a human being to be treated with respect and try and help her caregivers understand what she must be feeling and tell them what you want them to do to care for her.

I had to travel quite a distance to find that "right" doctor. However, they only require one or two actual office visits - the rest can be done by phone with the nursing home and the doctor's office. Monitor it - demand to know everything that happens. Knowledge is power in these situations.

Good luck my friend. I completely understand the frustration and sorrow you feel and the helplessness you feel, as well as the anger you feel. It is a difficult journey and if it is this hard for you - imagine how your mother feels. So the fight is worth it.

Good luck - and God Bless.

Caffy answered...

I have a question for LRDarrah...what did you mean by this statement in your article "Don't let your loved one get into a place like that - it is very difficult to get them out and that is not the proper place for them." Does this mean that you can't remove your mother from this nursing home or that there isn't any other place at the moment that you'd consider moving her to?

Lrdarrah answered...

Caffy: I am saying that this causes numerous issues:

  1. It is just a very inappropriate place and that makes it horrible for my mother.

  2. It is difficult to get them placed elsewhere because they act out more in a place like this (because the care is poor) and when a new potential place is looking at the records all they see is "TROUBLE" for their facility. When actually, she could potentially act out less if the care was approriate for the disease and the caregivers were trained to give proper care.

  3. You find yourself (as the guardian) raising a stink, because of the lovedone's poor care - and then you become unpopular at the facility and they make it hard to find new placement unfortunately just out of spite. Yes, that does happen.

  4. I want my mother placed elsewhere more than anything - however, when her care is so poor, it effects the chances of new placement. She was walking when she entered this home (3 months ago) and she can't walk now. As a large woman, she is moving quickly toward bedridden and having to use lifts. This is proportionately because of her disease, but more so because of the lack of care. She is "trouble" - so they put her in a chair and leave her all day. She gets no assistance to walk or to stay mobile.

My meaning with that statement is drill the potential new facility you will be placing your loved one in about everything. Ask them for proof of statements. Look the facility over more than once before you decide. Check the state records (online) for the facility to see about complaints or non-compliance on the part of the facilty. It is so important to be absolutely certain about where you place your loved ones.

I hope this clarifies the statement I made - ask me further if not :)

Goldmobile answered...

Thanks to everyone for all the helpful information.

LRDarrah - It sounds like we had very similar issues. Thank you for all the information. We are learning as we go. You are so right that no one wants to deal with these patients and they don't know how. I know there are tons of others in this situation and it will only get worse with the growing elderly population. I truly believe the care for dementia patients will be an epidemic in the coming years.

Opiegirl answered...

Check with your social services to see if they have mental health services available from outside. At our facility we have Navos available to many of our residents, also Oasis. They have ARNPS who specialize in geriatric dementia of all kinds. They will do an assessment and recommend what meds. to try. They do followup as needed and monthly. Good luck, I know this challenging, I have been a Long Term Care nurse for over 20 years.

Opiegirl answered...

Check with your social services to see if they have mental health services available from outside. At our facility we have Navos available to many of our residents, also Oasis. They have ARNPS who specialize in geriatric dementia of all kinds. They will do an assessment and recommend what meds. to try. They do followup as needed and monthly. Good luck, I know this challenging, I have been a Long Term Care nurse for over 20 years.

Caffy answered...

Thanks for the clarification LRDarrah! I haven't had any experience with nursing homes yet. It's good information to have.

Kim griffith answered...

We have just put my MIL in a nursing home. She went there from a geriatric phychiatric unit. They began her on Zyprexa. I had so many doubts about the drug at first. She seemed so different. They asked me to be patient for 2 weeks while she adjusted to the drug. I am glad I did. She had begun to hit, bite, paraoid and hallucinate. She still does, but at least now she has times that she is more like her self even though I know the quality days are gone. Her hallucinations are so-o-o real to her. I sit for hours and listen to her talk to what seems like a room full of people. She is so happy acting. It breaks my heart for this to have happened to her. Her grandchildren and great-grandchildren have been her life. Now, even though they can not be with her in real life, they are there with every day in her memories. So, even though you may not think you are making any kind of impact on the life of someone, never stop being a part of it. You can never tell when you will be what gets them through.

Santeek answered...


Lrdarrah answered...

goldmoble: Let me clarify one other thing. My mother is currently NOT in a Alzheimer's Unit - she was in an Alzheimer' unit in the facility that asked her to leave. I am not saying Alzheimer's Units are bad or not appropriate. Actually, I would say it is the contrary. Those units are specialized for the needs of Alzheimer's patients. They are generally smaller, much more quite and have a higher staff to resident ratio. My mother is NOT in that type of place, she is in a "special unit" where people with behavioral problems live. It is not approriate for her. There are problems with all places that care for the elderly - you need to look it over really well - know all the people and ask lots of questions. Find out exactly how this facility handles people with behavioral problems. You don't want to move her any more than you have to. Ask them if there is a point in which she will have to move.

Thank you for the prayer - You have mine right back at you. Good luck.

Donoharm answered...

It is very important that you do a check on any medication given. This is the no. 1 priority.