Guest guest Posted April 6, 2008 Report Share Posted April 6, 2008 - I'm sorry that your dad is experiencing so much aggression & agitation... I looked back and read that he's on Namenda & Aricept. That at one point he was given Haldol - but you know that he's not been given it any more. Make sure of that. And that he was given depakote and zyprexa. I question those heavy duty meds. Can he first be weaned off those two and then can he be tried w/ Seroquel instead? Many LOs here have had success with Seroquel. But should start low, go slow by using Dr. Boeve's titrating schedule listed here: http://www.lewybodydementia.org/docs/DLB-BoeveContinuum04.pdf (page 16 - listed as Quetiapine) > > My dad has been in a geriatric psych ward for a week now. His mood > fluctuations are great. We saw him for the first time yesterday. I > am > unsure if he knows who we are. He would sometimes stare at us with a > obsessed angry look. At times he would laugh and smile. The > agitation > is very evident still. I was concerned he would give them problems > after we left. At lunch earlier he had been spitting. They told me > when I called at 10:00p.m. that he had a really good night and was > sitting in the chair smiling, talking. Prior to that though he was > combative during shower. This morning when I talked to staff he had > been awake a lot during night (previous night he only slept for 5 min > at a time probably 20 min max for night), they said he was scary and > combative. I don't know what to do he is suppose to go to a assisted > living dementia unit. I know he won't last their a day due to his > behaviors. Where do you place people who have such uncontrolled > behavior issues? Do nursing homes take them, or are they sent to > some > psych facility?? We don't know what to do. My older sister is > having > trouble excepting his quick chaige in behavior and always seems to > blame > it on whereever he is at. She seems unexcepting that the changes > could > happen so quickly. I know she beats herself up thinking if she would > not have sent him to respite none of this would have happened. I > worked in psych for 6 years as a nurse and I can tell you I have seen > the hallucinations and craziness in his eyes for well over a year. I > keep trying to tell her it was probably only a matter of time till he > exploded. Probably the new environment just pushed it sooner. He > has > never been agitated with us like now. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2008 Report Share Posted April 6, 2008 , My Mother had a lot of agitation. It's hard for a nursing home to deal with strong behaviors, but we were fortunate that one of the nurses asked my Mother's doctor to refer Mother to a geriatric psychiatrist and he knew about LBD. My Mother had declined very fast, so she wasn't on much medication. It took a while, but we finally got the right cocktail of meds that allowed my Mother to be manageable and she improved her communication. The doctor added one medication at a time, so that we could see if it was working or not. Most of the medications take about 3-4 weeks to see an improvement. We had tried Aricept, but it made my Mother very agitated. We ended up with her on Exelon (which was like a miracle drug for my Mother), Namenda, Seroquel (200 mg at night to make her sleep through the night, 75 mg AM, 75 mg noon), and Zoloft. The doctor started the Seroquel slowly and kept increasing it until it was working. At first even a small amount made her sleepy, but her body adjusted and then it took the 200 mg at night to make her sleep through the night. As LBD advanced we started lowering and then removing the daytime Seroquel since she was sleeping too much. A good doctor that knows LBD can make a lot of difference. We had tried a neurologist, but the psychiatrist was much better. My Mother went from fully functional with just some slight memory problems to totally nonfunctional and in a nursing home within 2 months. She wasn't sleeping at night and even with aides helping she was just too much for my Dad and I to handle. Putting her in a nursing home turned out to be a very good thing in that she improved and we were able to bring her home on weekend afternoon until the weekend before she died. Good luck, in Dallas > > My dad has been in a geriatric psych ward for a week now. His mood > fluctuations are great. We saw him for the first time yesterday. I > am > unsure if he knows who we are. He would sometimes stare at us with a > obsessed angry look. At times he would laugh and smile. The > agitation > is very evident still. I was concerned he would give them problems > after we left. At lunch earlier he had been spitting. They told me > when I called at 10:00p.m. that he had a really good night and was > sitting in the chair smiling, talking. Prior to that though he was > combative during shower. This morning when I talked to staff he had > been awake a lot during night (previous night he only slept for 5 min > at a time probably 20 min max for night), they said he was scary and > combative. I don't know what to do he is suppose to go to a assisted > living dementia unit. I know he won't last their a day due to his > behaviors. Where do you place people who have such uncontrolled > behavior issues? Do nursing homes take them, or are they sent to > some > psych facility?? We don't know what to do. My older sister is > having > trouble excepting his quick chaige in behavior and always seems to > blame > it on whereever he is at. She seems unexcepting that the changes > could > happen so quickly. I know she beats herself up thinking if she would > not have sent him to respite none of this would have happened. I > worked in psych for 6 years as a nurse and I can tell you I have seen > the hallucinations and craziness in his eyes for well over a year. I > keep trying to tell her it was probably only a matter of time till he > exploded. Probably the new environment just pushed it sooner. He > has > never been agitated with us like now. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2008 Report Share Posted April 6, 2008 Ahh . So sorry about your dad's off the wall behavior. I guess we are in similar situations. My dad has been at the Geri pscyh unit for two weeks and is set to go to a LTC dementia home upon discharge. His behavior has spanned every possible scenario during this stay. We have seen it all. Some, such as threatening/angry behavior he didn't exhibit toward mom at home. It is so alarming! He still isn't really lined out. That is our question as well. What the hell does a home do with somone who isn't even stable to begin with? Do they just sedate them to control the behavior? How can they handle someone who wanders, etc? I wish I had an answer for you, but I guess I will sooner than I want. Dad's doc wants to discharge tomorrow. We aren't too happy about that, but probably have to face the fact that dad's doc probably thinks there isn't too many other options at this point. My mom also beats herself up for admitting dad this time. She thinks he was better off at home. This disease just tears families apart. No easy answers. > > My dad has been in a geriatric psych ward for a week now. His mood > fluctuations are great. We saw him for the first time yesterday. I > am > unsure if he knows who we are. He would sometimes stare at us with a > obsessed angry look. At times he would laugh and smile. The > agitation > is very evident still. I was concerned he would give them problems > after we left. At lunch earlier he had been spitting. They told me > when I called at 10:00p.m. that he had a really good night and was > sitting in the chair smiling, talking. Prior to that though he was > combative during shower. This morning when I talked to staff he had > been awake a lot during night (previous night he only slept for 5 min > at a time probably 20 min max for night), they said he was scary and > combative. I don't know what to do he is suppose to go to a assisted > living dementia unit. I know he won't last their a day due to his > behaviors. Where do you place people who have such uncontrolled > behavior issues? Do nursing homes take them, or are they sent to > some > psych facility?? We don't know what to do. My older sister is > having > trouble excepting his quick chaige in behavior and always seems to > blame > it on whereever he is at. She seems unexcepting that the changes > could > happen so quickly. I know she beats herself up thinking if she would > not have sent him to respite none of this would have happened. I > worked in psych for 6 years as a nurse and I can tell you I have seen > the hallucinations and craziness in his eyes for well over a year. I > keep trying to tell her it was probably only a matter of time till he > exploded. Probably the new environment just pushed it sooner. He > has > never been agitated with us like now. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 7, 2008 Report Share Posted April 7, 2008 -- I looked at your profile and it reads Columbus - if that means Columbus, OH here are a couple of LBD-savvy doctors: The Ohio State University W. Scharre, MD Memory Disorders Clinic, Clinic Building, West 10th Avenue Columbus, OH 43210 Fax: neurology @medctr.osu.edu (no spaces) http://tinyurl.com/6o4o7v Article: http://www.neurology.org/cgi/content/abstract/47/6/1403 The Ohio State University Q. Beversdorf, M.D. Memory Disorders Clinic, Clinic Building, West 10th Avenue Columbus, OH 43210 Fax: .Beversdorf @osumc.edu (no spaces) http://tinyurl.com/6o4o7v Article: ajgponline.org/cgi/content/full/12/5/542 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 7, 2008 Report Share Posted April 7, 2008 > > My dad has been in a geriatric psych ward for a week now. <snip> I don't know what to do he is suppose to go to a assisted > living dementia unit. I know he won't last their a day due to his > behaviors. Where do you place people who have such uncontrolled > behavior issues? Do nursing homes take them, or are they sent to > some psych facility?? <snip> , My husband is in a geriatric psych unit at our university hospital for a little over 1 week as well. He was " bounced " back to the hospital from a skilled nursing facility, and the geriatric unit in our case seems to be doing well for him so far. They reduced his Seroquel to increase his awake time, and now they are starting an anti-cholenergic. This class of drugs usually helps with LBDD. The staff psychiatrist seemed well versed in the correct and incorrect medications for patients with LBD when we had our conference. If this is not the case where you are, please see 's database files regarding medications and provide information to your father's team. I am also happy to see that another Parkinsonian in the unit, who was very combative at first, but less physically ill than my husband who is also suffering from fractured vertebrae, has mellowed considerably without being over medicated. I take this as a hopeful sign for my husband's case. The nursing home could not put my husband in a dementia unit because he was not yet recovered enough to walk (must be ambulatory), so they left him unsupervised. He was there 2 days and three nights, and was sent to the ER every night -- the third night they wouldn't have him back. See the thread of postings under the " bounced back " subject line. If you send your father to a nursing home, they also need to be LBD saavy, and provide enough oversight. I wish you and your sister all the best. Things are looking up for and me, I hope they will soon for you. Kathy 60 year old caregiving spouse for 83 year old (Parkinsonian since 1991 w/ later onset LBDD, currently recovering from fractured C1 & C2 vertebrae. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 7, 2008 Report Share Posted April 7, 2008 Dear , I think has sent you information on links that will be helpful. I would like to share with you, too, from my personal experience with a mom who had supposedly " uncontrollable " behavior - and from my experience as an admin with a senior care organization that includes a geriatric hospital, retirement communities, ALU and nursing home. , it is pretty unusual not to be able to " control " LBD-related behavior. Kathy's advice is very wise: your dad must have a doctor who really understands LBD. That is because LBD requires different kinds of medication and behavioral treatment than other kinds of dementia or psychiatric illness. Hallucinations, delusions, aggressive behavior, screaming, etc. are very upsetting to everybody, including our loved ones. My mom was a total mess before we got her a good doctor who started the correct meds for a person with LBD. She was totally out of control with behavior - screaming, hitting, cursing, hallucinating all kinds of terrifying creatures. The doctor was a " good " MD, but wasn't trained about LBD. He gave her what I now know were the worst possible meds - when she didn't improve, he ordered even more, thus making her behavior worse. I had to insist on an MD who knew LBD. He weaned Mom from the bad meds and slowly started the correct meds. I did not see 's reply, but she likely referred you to the treatment articles by Dr. Brad Boeve at the Lewy Body Dementia Association web site. Read there which meds are considered safe and helpful for LBD. We have links here also to the meds that LBD experts sayare dangerous for our loved ones. What meds is your dad on? And did this behavior come on suddenly? If they haven't, the MDs should be checking for infection and possible drug interactions. My mom is maintained comfortably now on the proper meds, but her behavior worsens quickly and dramatically whenever she has an infection. You're right, no good facility will be able to accept your dad if his behavior isn't at least basically controlled. And truly, he doesn't have to suffer in this way. You have every right to insist on a second opinion of your dad's diagnosis and medication schedule. If the MD won't call in a more experienced colleague, call the MD who heads the unit, or the medical director of the whole hospital, or the administrator - and insist on a care plan meeting. Some hospitals call them " staffings " or " case management consults. " That means everyone involved in your dad's care - doctors, social worker, discharge planner, dietary, pharmacy, etc. and you gets together to review the case. It sounds as if you must be the one to push for help for your dad. He's fortunate you are there with him and are ready to advocate on his behalf. Not all persons with dementia and other diseases are so blessed. Please do keep us posted. Everybody here cares! Lin p108nky wrote: > > My dad has been in a geriatric psych ward for a week now. I don't know what to do he is suppose to go to a assisted > living dementia unit. I know he won't last their a day due to his > behaviors. Where do you place people who have such uncontrolled > behavior issues? Do nursing homes take them, or are they sent to > some psych facility?? , My husband is in a geriatric psych unit at our university hospital for a little over 1 week as well. He was " bounced " back to the hospital from a skilled nursing facility, and the geriatric unit in our case seems to be doing well for him so far. They reduced his Seroquel to increase his awake time, and now they are starting an anti-cholenergic. This class of drugs usually helps with LBDD. The staff psychiatrist seemed well versed in the correct and incorrect medications for patients with LBD when we had our conference. If this is not the case where you are, please see 's database files regarding medications and provide information to your father's team. I am also happy to see that another Parkinsonian in the unit, who was very combative at first, but less physically ill than my husband who is also suffering from fractured vertebrae, has mellowed considerably without being over medicated. I take this as a hopeful sign for my husband's case. The nursing home could not put my husband in a dementia unit because he was not yet recovered enough to walk (must be ambulatory), so they left him unsupervised. He was there 2 days and three nights, and was sent to the ER every night -- the third night they wouldn't have him back. See the thread of postings under the " bounced back " subject line. If you send your father to a nursing home, they also need to be LBD saavy, and provide enough oversight. I wish you and your sister all the best. Things are looking up for and me, I hope they will soon for you. Kathy 60 year old caregiving spouse for 83 year old (Parkinsonian since 1991 w/ later onset LBDD, currently recovering from fractured C1 & C2 vertebrae. ------------------------------------ Welcome to LBDcaregivers. Quote Link to comment Share on other sites More sharing options...
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