Dangerous and Demented: What Usually Happens?

Specialties Geriatric

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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?

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.

Specializes in OB/GYN/Neonatal/Office/Geriatric.

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).

you have been baptised by fire! sorry you are having to learn all this in rapid fashion. i would make sure that if she is still agitated or combative to ask the doc if she needs to go to a geri-psych unit in a hospital. they would not only work on meds, but can also rule out any physical reasons like i and other posters mentioned. dehydration is another biggy. i would just want to make sure that those avenues are run down before getting her on too many meds. meds definitely help, but you just want to make sure that reasons for behavior are not because of something that can be taken care of. tight shoes can even make them agitated. we had a gentleman that once got on regular laxative ritual really calmed down a good bit. good luck. maybe you and your sister can be involved together so in the future you will know more about how to deal with these things as they arise. be strong and be knowledgable.

Specializes in Psychiatric nursing.

Ruby, I work acute adult inpatient psych. Geripsych units are pretty common around my area (southeastern massachusetts). There are two that I know of within a 30 minute car ride.

Specializes in LTC, Hospice, Case Management.

I'm in the midwest - geropsych units are pretty common here too. I've sent some residents out and they appear to come back no different but other residents have had great sucess that greatly improves their quality of life and their ability to participate and even enjoy facility activities.

Hugs to you Ruby. It really really sucks that you have your own major health issues, you can't even go check things out for yourself and your sister...well I won't even go there! I've heard you brag what an awesome facility (with great staff) your Mom was in. Trust them - 90%, or more, of us really care what happens to our people. We also want the best for them. Find that one person on the staff that you can relate to best and keep in close contact with them so you have a built in advocate for your Mom.

They get sent from LTC to my hospital where there is a work up done to check for UTIs amoung other things. etc. Psych sees the pt and usually changes meds. Most of the time that helps. It is a world of difference.

At the LTC where I used to work the DON did not like to send out residents who were violent. there was one who had alzheimers who would punch you if he got mad. there was a parkinson's resident who would go into other rooms and throw things, disregard cna and nurse help (she ended up falling and I caught her because she would not listen when i told her that it was not safe to try to sit in the chair with the leg rest out). this patient received ativan to no use and when she would become unbearable they would send her to the er. i left that job but last i heard they were encouraging family to find a psych placement for her since hers was mostly behaviors and she knew what she was doing (she would talk about the incidents later).the LTC facility just was not equipped to handle her. it was unsafe for her and other residents. all the alzheimers violence i have seen the LTC liked to control with ativan and haldol.

Specializes in Alzheimer's, Geriatrics, Chem. Dep..
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?

it is a tough call. in the past we could restrain residents - posey vest, mittens (if they scratch) etc. then, even for fall risk, we stopped being allowed to restrain them. it was considered abuse.

then we had to turn to chemical restraints (keeping them sedated enough so they aren't a danger to others). then chemical restraint was considered abusive. so they had to have more staff attention (1:1) distraction, affection, food (lol), etc. would help somewhat. but still, sometimes there's nothing that will help except for physical or chemical restraint.

it is tough, esp. since it is your mom, and esp w/ your sister having poa (does she have medical background?) it would make me so sad :( and i'd be angry if my sister would not let me have input in decisions. i am so sorry ruby ... xo

Make sure her clothes and shoes fit! People gain weight in facilities when they lose mobility and staff push to get them to eat their whole dinner. Far too many residents don't have comfortable clothes. Also, ask how she's sleeping. If she's up all night because of fall alarms going off or uncoordinated meds/VS/whatever waking her up, she might be extra feisty. Also, are they toiletting her enough? We had a miserable resident who cried and screamed but when we figured out that meant--I need to pee, life for everyone improved. All the best to you, her, and all the caregivers. It's a hard road.

Specializes in Care Coordination, MDS, med-surg, Peds.

I agree with many PP.. I was wondering if the 4 x in one week abusive episodes were sudden onset? If so, then I would definately rule out UTI and draw some labs. New Roommate/room move/ favorite staff member retired, etc., should all be considered.

LTC LOOOVVEESS to move residents like checkers pieces to get in new residents and with Alzheimers residents that is a mess! Alzheimers res do not deal well with changes and room moves can really shake them up. I have seen many change behaviors drasctically after a room move.

I know this is hard for you. I know you are annoyed at your sis, but if the episodes are sudden onset and she already had plans/tickets/reservation, then she had little choice in the matter. She can't be expected to cancel everything unless it is life and death. I hope the LTC is already checking out all the medical possiblities. Check with them.

If all checks out fine, then an in-patient stay for med eval/medical eval might be just the thing!

Above all else------she is in good hands, you've said so yourself previously! Try to not over stress yourself as you HAVE to take cae of you!!!! Keep communication open with the staff, and REFUSE to allow her to moved to another room unless it is a dire situation.

Hang in there---- ruby-vee........

In reply to JZ_RN, what kind of terrible place did you work that lets their staff get beat to a pulp? Incredulous!

Most of info has already been said. Been in this business 30 yrs and seen alot. I just wanted to express my empathy and sympathy and prayers for the situation and let you know that at my facility we have a person who regularly just wants to wap on us, and guess what, he is our most loved resident. We do understand not his fault, and not who he really was/is, and hopefully you will have similar staff there, though they will have to protect themselves and darn sure protect other patients.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

Thank you all for the information, good wishes and sympathy. I've profited by all. Hopefully I can ensure my mother profits from your collected wisdom. Thank you.

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