Dangerous and Demented: What Usually Happens?

  1. 3 when a dementia patient becomes abusive, what are the options? i'm just hearing now that my mother, who has alzheimer's and is in a memory care unit, has had four violent episodes in the last week, where she has attacked both staff and other patients. she's seen a psychiatrist who is tuning up her meds, but psych meds can often take weeks to achieve a therapuetic level. so what usually happens? i can't believe she'd be allowed to stay where she is a danger to staff and other patients. what happens? this is mostly an academic question on my part -- my sister has poa. in the icu, we can sedate them or restrain them. but what happens in ltc?
  2. Visit  Ruby Vee profile page

    About Ruby Vee

    Ruby Vee has '38' year(s) of experience and specializes in 'ICU/CCU'. From 'the Midwest'; Joined Jun '02; Posts: 9,226; Likes: 34,643.

    27 Comments so far...

  3. Visit  IamBSN profile page
    3
    Sometimes, we send them to an area psych unit, but normally the MD gives Ativan prn or something else they will respond to within 45 mins to an hour until the long acting meds have a chance to start working. If nothing else helps, we ask the family to find other placement in a facility better able to handle the resident's needs. Hang in there, it will get better.
  4. Visit  JZ_RN profile page
    4
    Where I worked they just let the abuse continue on inspite of the poor staff getting beat to a pulp. I left but eventually the worst abuser died. She was severely demented and very violent. I'm sad that she died because I know that that was not the person she once was, but glad that she got to leave this Earth where she was suffering and making everyone else suffer. In moments of lucidity, she'd ask, why does everyone hate me? It was so sad. But in a good nursing home they will try distraction techniques, meds, or move the patient to a special unit where they get less staff/patient ratios (like maybe a little less ridiculous) and get more attention.
    Anne36, gonzo1, anotherone, and 1 other like this.
  5. Visit  CapeCodMermaid profile page
    5
    We try to find a spot in a geri-psych unit where the staff to resident ratio is better and the staff is specially trained to deal with these behaviors. First, though, we'd get a urine and some labs to make sure that wasn't the problem.
    Antipsychotics aren't that useful in someone with dementia except for their sedative properties.
    Good luck. It's never easy.
  6. Visit  Zen123 profile page
    0
    Let the CNA's know especially the main staff who takes care of her= how much you appreciate what they have to deal with. It goes a long way.

    I have a resident who made a fast right hand hook 3 inches away from my face. I still get flashbacks. During hands on care he has to be held down to prevent from kicking and striking. The Ativan calms him down but sometimes doesn't work. We do not use restraints on him. The family comes regularly to visit and they know of his behaviors.
  7. Visit  SuzieeQ profile page
    0
    Here is my experience from an assisted living (retirement) facility... Depends on the facility, keeping in mind that every situation is different. Usually the Nurses call the MD for directives/increase meds, if that fails, they may Form 1 the resident if they are very aggressive and are harming other residents/staff, transfer to another facility is also an option, or send to emerg. As I said, every situation is different and it depends if the onset of the behaviours was sudden or if there is a Hx.
    Last edit by SuzieeQ on Aug 9, '12 : Reason: Forgot to write retirement experience
  8. Visit  OnlybyHisgraceRN profile page
    0
    First let me say that I'm sorry your MIL is suffering from Alhezimers. They don't know what they are doing, and often are referred to as trouble makers by the staff and other residents. As you know, this is part of the disease process. I used to work with individuals with Alzheimers so they always have a special place in my heart.
    From my experience, when a resident is physically abusing other residents then they are usually discharged from the facility. At this point we are no longer able to keep the resident or other residents safe.

    I pray all works out for her. This is fustrating not only for your MIL but you and your family as well. Hang in there.
  9. Visit  DSkelton711 profile page
    1
    I am DON of an ALF and SCALF. When someone becomes agitated or combative we first do a work-up to try and find a reason. Is she constipated? May need exam to know for sure. A UTI, pneumonia, infection, a toothache; There are many things that can bring on these behaviors that need to be ruled out before just sedating. Perhaps sending her to a geri-psych for medical and psychiatric work up can be done. Tweaking of meds may be needed. I wish you and your mom the best, this is a very difficult disease for patients and families alike. Regulations state that a resident must be removed from ALF or SCALF for persistent behaviors that put the resident or others at risk of injury.
    mandomania likes this.
  10. Visit  pinkfish333 profile page
    1
    Is she new to the unit? If so, there is an adjustment period that can take weeks. Are there new staff on the unit? I find continuity of staff helps, even when the resident does not "know" the staff or remember them from day to day. At my facility, the psychogeriatric nurse visits and makes recommendations. Also finding out what the precipitating factors to the violence are is critical. I would also want to rule out any infection, and ensure they are eating and drinking enough. Perhaps she is in pain? I have found residents who have pain may act out as they have no way to express that they are in pain. Maybe a full physical exam if possible is needed. ?? We also sometimes transfer out the resident to a geriatric mental health unit at a rehab facility if there is no other cause for the behaviour besides dementia. If she is going to stay on this unit, then the care plan needs to be altered, and we have all the staff - PSWs and nurse present to help provide care. Good luck and hope she is ok.
    Ruby Vee likes this.
  11. Visit  Ruby Vee profile page
    0
    Quote from suzieeq
    here is my experience from an assisted living (retirement) facility... depends on the facility, keeping in mind that every situation is different. usually the nurses call the md for directives/increase meds, if that fails, they may form 1 the resident if they are very aggressive and are harming other residents/staff, transfer to another facility is also an option, or send to emerg. as i said, every situation is different and it depends if the onset of the behaviours was sudden or if there is a hx.
    ​what does "form 1 the resident" mean? is that something like an involuntary psych hold?
  12. Visit  Nascar nurse profile page
    1
    Sorry to hear you are going thru this with your Mom. As others have said, it's most important to determine if there is a medical reason for the sudden change in behavior. Sometimes it can be a UTI, constipation, high blood sugars, pain, etc. I have a cute little guy right now that tends to refuse his insulin if certain nurses aren't around to give it to him. When his blood sugars get above 400, he becomes meaner than a tiger and then we all have problems with him.

    If I remember right, your Mom lives a distance away from you so you might not be close enough to witness her behavior changes. I wonder if there is something new in her environment. New roommate? New caregivers? Maybe something to ask about.

    Last resort, it may take having her evaluated at an inpatient geropsych unit.

    Good luck and let us know how things work out.
    Ruby Vee likes this.
  13. Visit  Ruby Vee profile page
    2
    Quote from dskelton711
    i am don of an alf and scalf. when someone becomes agitated or combative we first do a work-up to try and find a reason. is she constipated? may need exam to know for sure. a uti, pneumonia, infection, a toothache; there are many things that can bring on these behaviors that need to be ruled out before just sedating. perhaps sending her to a geri-psych for medical and psychiatric work up can be done. tweaking of meds may be needed. i wish you and your mom the best, this is a very difficult disease for patients and families alike. regulations state that a resident must be removed from alf or scalf for persistent behaviors that put the resident or others at risk of injury.
    ok. this all makes sense to me. thank you for the information. i'm not sure what has been done and what hasn't been done. my sister is poa and left the country on vacation leaving me an "oh, by the way mom has this issue and the only way i can be reached is possibly by marine radio on a clear day with 99% visibility and if the seas aren't too high" email today. i did get an email from her physician saying that they're titrating her meds. i really don't want her to hurt anyone (except maybe my sister, and i'll probably get over that).
    Esme12 and wooh like this.
  14. Visit  Ruby Vee profile page
    1
    Quote from nascar nurse
    sorry to hear you are going thru this with your mom. as others have said, it's most important to determine if there is a medical reason for the sudden change in behavior. sometimes it can be a uti, constipation, high blood sugars, pain, etc. i have a cute little guy right now that tends to refuse his insulin if certain nurses aren't around to give it to him. when his blood sugars get above 400, he becomes meaner than a tiger and then we all have problems with him.

    if i remember right, your mom lives a distance away from you so you might not be close enough to witness her behavior changes. i wonder if there is something new in her environment. new roommate? new caregivers? maybe something to ask about.

    last resort, it may take having her evaluated at an inpatient geropsych unit.

    good luck and let us know how things work out.
    you're right, mom lives halfway across the country. i haven't seen her since february, before my cancer diagnosis. i feel pretty helpless right now. i can't even go see her -- i can't travel. i'll ask about new roommates or caregivers. how common are inpatient geropsych units? i've never heard of them before.
    Nascar nurse likes this.


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