Nightly attempt to escape house

[whoknows]

Hi, does anyone have any advice on my Father who, almost nightly tries to leave his house. He has got a Full Time carer and me, his son, who lives with him, but on occasion, he will wake up in night and attempt to exit the front door. He's unable to open it and then he gets extremely agitated and whacks the door with his stick. Whilst they are thick double glazed glass, he's managed to break both top pane and bottom pane, they are now replaced with toughened glass, so I hope he don't break again.

Coupled with this door kicking and whacking, there is verbal abuse. I try best not to open the door as then going into the street it can cause disturbance out there, as he can whack his stick around the wall, or the hand rail, which is rather loud, esp like 3am.

I have heard you can put a mirror on the door to deter this, however, it's not a wood door, its 2 pane glass, so I doubt it can be safely mounted. It would be possible to hang something from the top, like a picture of bookcase, but my dad is very clever, I have my doubts.

Coupled with this, is other acts of aggression, which includes banging his head against a wall when he don't get his way, for example not being able to exit the house. We can try to give him Diazepam, which the Doctor recommended, but a. Have to try to get him to drink it via cup tea & b. It don't have much effect, when he's so agitated.

He has been to a Respite care home and he did all of the above, to the extent that they won't have him again, and another care home, who confirmed his similar behaviour at their partner day care, so that's now been cancelled, which is a real nuisance as the Full Time carer don't get his relief.

In fact at the Respite care home he escaped, apparently through a window, so they had to send 4 people out to hunt for him, I think this is reason they won't have him again. Also he got out of the Day Care, although they have got a pin code system, he walked about quarter mile and got onto Underground track, lucky enough a Good Samaritan got him off and he got back to Day Centre, somehow, I don't have all details how.

He's quite a handful, and he surely will have to go into a Home at some point, but trying to give him a few last moments in a loving house what he recognises, before that day comes to pass. Coupled with all the above is my frustration, under a separate post, that I can't safely unlock some of his assets so a. Boiler replacement. b. Downstairs loo. c. Additional carers all of which go some way to benefit him.

[Izzy]

My goodness - that is hard going. My mum used to get up during the night and announce her intention to go home. She wasn't very mobile though and wouldn't attempt to go down the stairs. Occasionally my husband has got up and said he's going home. He hasn't ever been aggressive with it though.

I'm not sure what to suggest. Am I right in understanding that you have an overnight carer? I wondered if he had a pressure mat beside his bed the carer would hear him get up and perhaps be able to divert him before he got the distance of the door.

Sorry - a pretty lame suggestion but it's all I can think of at the moment. I hope others will be along with better suggestions soon. x

[Grannie G]

I hate to suggest medication because it is frowned upon so much but I see it as the only solution at times like these.

You are not happy but neither is your father and if he could have a peaceful night`s sleep without such disturbance I feel medication would be justified.

[beech mount]

Hi, mirrors can now be glued to any surface but perhaps you could try hanging a dark coloured sheet or courtain over the door? dark colours seem to restrict the movements of people with dementia, worth a try.
Good luck,
John.

[whoknows]

will definitely try the dark curtain, as that can be taken on & off night & day.

The mirror would have to be permanent which takes out the light from the hallway.....

Agree the drugs is last option, he does have Diazepam, but that has less & less effect, if it can be got into him......

In fact, I am probably the last connection my Dad has to the world, so am trying my best to keep that going, he is far more prone to get agitated when i am not here, which has become less and less I can go out for an evening for instance.....so just don't know how he would fare in Care Home, I know they have ways, but the previous ones have given up hope.

[jaymor]

Hi.
My husband is a head banger, wall puncher and kicker and can go 4 days without sleep , not even 40 winks in a chair. I was given night medication for him to take but would be lucky if it worked. The assessment centre have managed to reduce his aggression but not remove it. The not sleeping they cannot correct. They give him extra medication but still he wont sleep. He is also a pacer and spends hours walking. I think they quite admire him for no sleep and being able to walk a marathon every night.

Jay

[NeverGiveUp]

I sympathise, mum is Sundowning the same as it sounds like your dad is, at least you do have an overnight carer, here it is just dad & me.

Bed sensor sounds like a good idea, can be set to a specific time absent, basically a pressure sensor you put under the matress, allow say 5 mins for the loo or whatever time, then an alarm goes off remotely and wirelessly, aprt from wire coming out from under matress to socket it is noticeable. The alarm base station vibraates as well as making a sound so carer can put it under his pillow. Speak to OT about Telecare, we get in on free loan - smoke detector, exit sensors (useless, they fall off the doors have to fit them more permanently), gas shut off valve, carbon monoxide detector etc all linked wirelessly.

I agree with Grannie G totally about medication, our medicine of last resort is .25 halloperidole in liquid form in dropper into mouth. Consultant tells us this is best limited to less than twice a month, often its less than that, we just have to put up with the shouting. With mum, the criteria we use is the level of agitation and distress for mum.

Can't you hide the stick, he could start to injure people as well as property, you get into a totally different ballgame then.

We get all the shouting and insults, mum is horrified about it in the morning, she seems to have some vague memory of it. When things are bad I have to sleep on the hall floor to be near her. So far tonight I have just put her back into bed for the 7th time. Last night I got less than an hour's sleep, looks like tonight might be fun, not.

I think you need some serious advice from dad's consultant, this situation could get seriously dangerous, you need to verbalise this to someone.

Can't you get the door changed? What i thought was maybe get something solid off Ebay or Freecycle until this phase is dealt with. The mirror would worry me in case it was like a budgie wher eit attacks the image, if dad is regressing he might not recognise his older self.

Got to go, mum shouting for help, she wants the loo for the third time in 10 minutes, out of bed for occasion number 8. I understand about the shouting at 3.00, I'll be thinking of you at 3.00 - just give us a thought as well!

Good luck!!!

[WordDoc]

Hi - this sounds awful for all of you. I've heard that putting an official-looking No Entry sign on the inside of the front door can deter someone with dementia from trying to go through that door. But of course you'd need to remove it for those occasions when you do need them to go out.

The only other thing I can suggest is trying to get to the bottom of your dad's frustration. The locked door could have some powerful meaning from his past. If you could find out what it is, you might be able to reassure him. For instance, an old lady in a care home may get anxious in the afternoons because she thinks she needs to go and pick up her children from school. Telling her the children are staying with their grandma can put her mind at rest. Perhaps your dad is feeling he's going to be late for something important that he used to do (work?) and the locked door is stopping him. If so, you could tell him it's okay, he's got the day off today and he can have a lie in. Good luck anyway

[sistermillicent]

If it's any consolation my mum did this sort of thing for a while but doesn't any more.
Apart from that she goes to a really good home for respite which has the main door cunningly disguised to look exactly like part of the wall with picture rail and painted the same colours as the rest of the wall, which is opened using a key pad. Residents are able to get out into the secure garden if they want to though.

[JaneAnn]

Hi - I'm sorry you're going through this as I had the same problem with my mother. The respite home also refused to have her back after 4 attempts in a week. You mentioned being unable to access money for repairs, etc. and I wondered whether you could get yourself named as a second person on your father's bank account, which would give you on-line access and a cheque book. I did this with my mother some years ago and don't know what I would have done without this facility. If you explain to your bank manager why you need to do this he will probably be sympathetic. Although I hold a power of attorney for my mother I didn't need to use this when applying to be second signatory on her account.

Hope this helps.
JaneAnn

[Derek61]

I had a very tough time since March, as mum's sundowning just seemed to get worse and worse, as did the confusion where she would call me at all hours of the night wanting to be picked up and taken "Home" When asked where home was she would give the address of her current home. Often called out at 3am, as she'd been found wandering, and taken to hospital. She had a urine infection, not enough to cause discomfort, but enough to get across the blood/brain barrier. Once treated with antibiotics she calmed down a lot, but was then diagnosed with a slight chest infection, more antibiotics. Now does not wander, but also has more social interaction with twice daily carers, once a week daycare, and me visiting twice a day too. It might be a good idea to have your dad checked out for infections? I and our GP just thought it was the progression of the disease, but the hospital doctor knew otherwise. When I was going through hell via sleep deprivation, I did, with my GP's approval give my mum Melatonin tablets (10mg) bought from the USA. This really put mum to sleep, as we thought that her own sleep deprivation was feeding a vicious cycle of exhaustion and confusion. I know every case is different, but when you exhaust all the alternatives, you have to consider "other factors" as to why your dad does not sleep well at nights. I have also found that a small Philips SAD light that mum is exposed to for 30 minutes in the morning help to reset the circadian rhythm. Hope this helps.

[wonder]

Hello,

My mother has Alzheimer's and I am also a professional dementia carer.

Firstly let me say i know how difficult your situation is: respite care or a home may be a helpful. my mother is now in a home and is much happier being there.

Regarding wandering and trying to 'escape': I realize it may seem counter-intuitive but your fathers feeling of well being is actually more important than his 'causing disturbance' - so let him go out, keep with him or have a stay carer with him, put a gps tracking device on him and allow him to stay safe and happy in the world he is now living in.

He is getting upset because he is suddenly being imprisoned and he doesn't understand why. It is actually quite a reasonable response.

Are you locking the door? Do you a have deprivation of liberty order given to you by the court of protection regarding your father? I ask because there is now a legal president which states you cannot deprive a person of liberty (i.e. leaving a room/ house) without special court permission.

My mother has started wandering, which was extremely dangerous, so we simply got her a GPS tracking necklace and GPS shoe. Expensive, but now she cant get lost and we, and her home, always know exactly where she is.

I really recommend a book called 'contented dementia'. This book is a revolutionary way of dealing with Alzheimers which will change you and your fathers life. using it you follow some basic rules which always help: never disagree, ask no questions and give no bad news.

When a loved one gets dementia we generally try to reason with them and protect them by trying to keep them within the confines of normal behavior. Both these strategies tend to fail. The loved one gets more and more aggressive and we become exhausted and exasperated.

The trick is to enter their world and gently move things or change things around them so that wherever they are going, or whatever they are doing, in that world they remain safe.

This might seem impossible at first but it is actually quite simple. If you father goes for a night time wander with a carer in tow he will be perfectly safe and also not get so angry or upset, this will make the world feel safer for him: he is living in a confusing world which often feel scary. You can make it safe by helping him live moment to moment in a world where nothing upsetting happens for him (he has no coping skills for upsetting things happening any more, he cannot adapt, so you have to adapt instead).

This kind of strategy can change you from having an angry, destructive, violent parent to having a happy, calm engaged parent.


Which ever route you take i really wish you all the best

[BobDemarco]

Let me start by saying clearly, I am not a doctor.

My mother would get up every night around 1:30 AM and 4:30 AM. She would open the door and look around for a bit and then come back in. I had to get up every time for 2 years.

We stumbled on to a solution by accident. Her blood pressure spiked up every night and was very high in the morning. After trying several solutions that didn't work our doctor prescribed the lowest dose of Clonidine. It stopped the spike in her blood pressure, and it she started sleeping through the night. Perhaps you can relate this story to your doctor.

You father is trying to go somewhere. Probably "home".

One of the readers on the Alzheimer's Reading Room did the following and it solved the problem. When her father "wanted to go home", she would put him in the car and drive him around and then bring him back home (to where he now lived). When they would arrive back she would smile and say "here we are" and then gently lead him back in to the house. Once inside she would give him some positive reinforcement, in this case ice cream. He loved ice cream.

One of the most difficult problems faced by caregivers is breaking a "bad pattern". This is more or less like breaking a bad habit.

The key to success is trying to change a pattern and hopefully replace it with a new, different, and better pattern. In this case you want your dad to sleep through the night.

I would next suggest that you keep him up during the day, and make sure he gets plenty of bright light. If it is not sunny outside, taking him to a well lighted store and walking him around.

I can not emphasize enough the importance of "bright light" in dementia care.

Please ask him when he "takes off" day or night, where are you going. Then take him somewhere and bring him back. Try to satisfy the need.

If you can change the pattern you will reap the benefit.

I can't put in links yet. However, we have lots of information on wandering and bright light on the Alzheimer's Reading Room. You can find that information in our knowledge base by using the search box on the right hand side of every webpage.

I want to say that Talking Point is an excellent resource and better than any message board than we have in the U.S.

Good luck to you and your family. Keep trying. Change the pattern.

Bob DeMarco, Founder
Alzheimer's Reading Room.

[patsycat]

Hi am concerned that wonder says it is illegal to lock people in. My mother is 90 and lives with me. If I go out without her I always lock the door- not only can she go walk about (using a zimmer frame and liable to fall) she is also likely to invite anyone in e.g. burgulars, people selling things etc.On one occasion people collecting furniture came to the wrong house and totaly confused her- fortunately a neighbour interfered, but if the door had not been locked I would have come home to no mother and no furniture!

[jenniferpa]

I'm afraid wonder is wrong about Dols. Dols only applies to people in care homes or hospitals - not private homes.

As this factsheet (http://www.alzheimers.org.uk/site/sc...ocumentID=1327) makes clear

The Deprivation of Liberty Safeguards (DoLS), referred to as 'safeguards' in this factsheet, are part of the Mental Capacity Act (2005). They aim to protect people in care homes and hospitals from being inappropriately deprived of their liberty. The safeguards have been put in place to make sure that a care home or hospital only restricts someone's liberty safely and correctly, and that this is done when there is no other way to take care of that person safely. (See Factsheet 460, Mental Capacity Act 2005 for more information about the act.)

Further while the COP is where you would challenge such an order, they are not responsible for issuing them in the first place.

The application for a standard authorisation must be made in writing to a supervisory body. In England and Wales, this would be the local authority in the case of care homes. For hospitals this would be the relevant primary care trust (PCT) in England or local health board if in Wales.

So patsycat don't worry about it from a Dols stand point. The only thing that would worry me would be what would happen in the event of, say, a fire. From that point of view there may be a safeguarding issue. Having said this, there are an awful lot of elderly people in a similar situation where due to a lack of mobility they couldn't leave the property if the door was wide-open.