Aggression in Alzheimer’s

[Kat loves milk tray]

Hello, I’m new to the forum. I just wanted any advice as to what medication can be helpful to reduce aggression. My Dad has recently gone into a care home as my mum was struggling to cope with him due to his aggression and agitation amongst other things such as the pacing about.
Dad has been taking Trazadone and Lorezapam however we felt these did not really reduce his outbursts and behaviour. The Psychiatrist would not change his medication as it would have to be something stronger which could increase side effects such as risk of falling. He did not want to do this whilst my Dad was still living at home.
So fast forward a few weeks my Dad is in a home and continues to have aggressive outbursts with the staff and ourselves when we visit. I have been in contact with his GP and we are having a review soon so I just thought I would enquire about medication and what other sufferers take.
I hate to see my Dad in turmoil and angry. Before this illness he never raised his hands to anyone.
Thank you.

 

[karaokePete]

Hello @Kat loves milk tray, you are welcome here.

I don't have experience of this yet but know it has been discussed previously so I'm sure you will get replies to your question

It's good that the doctor is on the case.

 

[Cat27]

Welcome to TP @Kat loves milk tray
You may find these links useful.

https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/aggression-and-dementia


https://www.alzheimers.org.uk/about...elieve-behavioural-and-psychological-symptoms

 

[Linbrusco]

Hi Kat, my Mum 77 was diagnosed with Alz in 2013, but symptoms 2 yrs previous.
Mum has been in care 2.5 yrs. Aggression & agitation set in from March 2017 after a UTI and it never resolved from there.
Mainly aggression with carers first thing in morning and with personal cares, but later on was at various times of the day.
A low dose of Lorazepam was trialled on waking.
This made Mum awfully sedated, unsteady on her feet, and speech jumbled.
We were asked to consider low dose Quetiapine ( Seroquel) which is an anti psychotic.
We had reservations but after a few dose adjustments has been on 25mg morn, noon, night.
It worked really well for Mum and gave her some quality of life back, as well as reducing hallucinations & delusions.
Even now after being on it 18mnths any attempts to lower her dose, or on the odd occasion when Mum has refused medications the aggression kicks in.
My Mum is now at end stage of this disease, is not eating, refusing meds, some fluids.
Even with crushing her meds into pureed food, or ones that can be added to liquids, its been extremely difficult to administer.
The agitation can be there, but as she now has little mobility the agression is less in comparison.

 

[Kat loves milk tray]

Hi Kat, my Mum 77 was diagnosed with Alz in 2013, but symptoms 2 yrs previous.
Mum has been in care 2.5 yrs. Aggression & agitation set in from March 2017 after a UTI and it never resolved from there.
Mainly aggression with carers first thing in morning and with personal cares, but later on was at various times of the day.
A low dose of Lorazepam was trialled on waking.
This made Mum awfully sedated, unsteady on her feet, and speech jumbled.
We were asked to consider low dose Quetiapine ( Seroquel) which is an anti psychotic.
We had reservations but after a few dose adjustments has been on 25mg morn, noon, night.
It worked really well for Mum and gave her some quality of life back, as well as reducing hallucinations & delusions.
Even now after being on it 18mnths any attempts to lower her dose, or on the odd occasion when Mum has refused medications the aggression kicks in.
My Mum is now at end stage of this disease, is not eating, refusing meds, some fluids.
Even with crushing her meds into pureed food, or ones that can be added to liquids, its been extremely difficult to administer.
The agitation can be there, but as she now has little mobility the agression is less in comparison.

Thank you Linbrusco I am hoping when the GP visits we can review medication as the current medication does not help and it is horrible to see my Dad so aggressive and agitated. He was presenting with challenging behaviour when he lived at home with my mum which is one of the reasons he went into the home.
I just want him to feel calmer, settled and not continually pacing as this is impacting on his physical wellbeing.
Thank you for sharing your experience. Sorry to hear your mum is at end stage care, do hope she is settled and comfortable..

 

[70smand]

Hello, I just wanted to let you know that we had a similar problem with agression and aggitation with my dad. He was given anti psychotic medication but had quite severe side effects from them. His antipsychotic was changed and I felt he was treated with too high a dose as his mobility became awful but his mood was much better. Dr’s are quite rightly very cautious ( except my dad’s consultant) about prescribing antipsychotic meds due to the side effects but sometimes there has to be a trade off in order for someone to be safe and looked after. Everyone seems to react differently to meds and sometimes it is just a case of trial and error to see what works for each individual.
My dads Alzheimer’s definitely progressed more rapidly on the anti psychotic medication, and he did still have the odd outburst but it was difficult to reduce them as they definitely helped his mood and enabled him to be looked after in a care home.
Not sure if this helps you or not but I wish you luck xx

 

[MaNaAk]

When dad had his last memory test the dementia nurse said that the next stage is that dad could get aggressive so she is going to have a chat with the care home staff and ask them to contact her if this becomes a problem. She will then come and prescribe memantine however I am always concerned about how dad will react to this because he is already on a lot of other medication.

MaNaAk

 

[Kat loves milk tray]

Hello, I just wanted to let you know that we had a similar problem with agression and aggitation with my dad. He was given anti psychotic medication but had quite severe side effects from them. His antipsychotic was changed and I felt he was treated with too high a dose as his mobility became awful but his mood was much better. Dr’s are quite rightly very cautious ( except my dad’s consultant) about prescribing antipsychotic meds due to the side effects but sometimes there has to be a trade off in order for someone to be safe and looked after. Everyone seems to react differently to meds and sometimes it is just a case of trial and error to see what works for each individual.
My dads Alzheimer’s definitely progressed more rapidly on the anti psychotic medication, and he did still have the odd outburst but it was difficult to reduce them as they definitely helped his mood and enabled him to be looked after in a care home.
Not sure if this helps you or not but I wish you luck xx

Thank you for sharing your experiences with your father. I’m hoping the GP will advise if my Dad should try something stronger to calm him and enable the staff to assist him with personal care tasks. Psychiatrist from the older adults mental health team discharged by Dad from caseload in November. he would not prescribe anything stronger as my Dad was still living at home with mum caring for him. That’s changed now as he is in Residential care. Unfortunately like you say stronger medication can increase different side effects, such as mobility..

 

[Kat loves milk tray]

When dad had his last memory test the dementia nurse said that the next stage is that dad could get aggressive so she is going to have a chat with the care home staff and ask them to contact her if this becomes a problem. She will then come and prescribe memantine however I am always concerned about how dad will react to this because he is already on a lot of other medication.

MaNaAk

My Dad is unable to take memantine due to low kidney function so Psychiatrist prescribed trazadone and lorezapan. So difficult to manage them when they become aggressive and irritable. I was always so worried for my mums safety . My Dad hit me last week when I visited him, it’s just so heartbreaking..

 

[70smand]

I remember when my dad became quite paranoid and aggressive it was mostly directed at my mum and I used to have to ‘fly’ round and try and calm the situation or take my dad out and turn his mood around before retuning him home but my mum used to try to manage and did get hurt because he used to insist he had to go home, when he was home so she would lock the door or try to stop him leaving and often got pushed out of the way. It was the worst time ever. To start with lorazepam as and when needed worked well but as it was needed more and more it became less effective. Dad ended up in a psychiatric unit and memantine actually worked well for him for a while - that and my mum accepting my help more. It wasn’t easy as dad would not accept carers or sitters, only my help, as he did not accept there was anything wrong with him. Gradually dad’s unpredictable mood got harder to manage but we couldn’t get him in a home- he simply wouldn’t stay as he was so aware and I think he was petrified. When even I could no longer calm him we were at our wits end. Numerous calls to social services were not much help as dad was self funding, until one lovely social worker went out of her way for us and he ended up back in a psychiatric hospital where the consultant there was very heavy handed, We felt, with medication and dad was like a pussycat, but needed a lot more help with everything and finally got accepted by a nursing home. It was his memory clinic consultant who had diagnosed him years before who continued to visit him at his home and always listened to our concerns and tried to reduce his meds. He has now been in a home almost 2 years and is off most meds except memantine and a low dose of sodium valproate for seizures. We tried trazadone when weening him off antipsychotic meds but even a low dose made him very ill - he seems to have become extremely sensitive to all meds as his poor brain has gotten worse. His condition has progressed so quickly in the last two years, whereas he has had a slow decline up until then over a fifteen year period.
It’s been such a rollercoaster and I really do feel for you. It’s such a shame that your dad was discharged by his psychiatrist as I have a lot more faith in dad’s psychiatrist from the memory clinic than the Gp at the home he is in and I used to regularly email her with updates on dad’s condition. The gp would change medication without talking to us first and then we would have to wait a week until he was back to get it changed back again and we were never consulted even though we visit every single day and know how he reacts to all the meds he has tried. His consultant would visit him at the home and discuss everything with us first before making changes. I also did a lot of searching on line about medication and it was just unfortunate that my dad seemed to be so sensitive to everything he took.
I totally agree with you on how heartbreaking this whole thing can be and I do hope you find something that agrees with your dad x

 

[Grannie G]

I discussed this with my husband`s consultant when he was at the stage of presenting such challenging behaviour. The consultant said the same, more medication would affect mobility and increase the risk of falls.

I argued my husband was tormented, deeply unhappy, and had no quality of life. Without quality of life, what use was mobility? I know falls could involve broken bones and could not ignore that but it really was about trying to find a balance.

Mood swings and challenging behaviour don`t only give carers a hard time. The person who experiences these mood swings and challenging behaviour does not choose to be this way. It is an indication of deep distress .

 

[MaNaAk]

My Dad is unable to take memantine due to low kidney function so Psychiatrist prescribed trazadone and lorezapan. So difficult to manage them when they become aggressive and irritable. I was always so worried for my mums safety . My Dad hit me last week when I visited him, it’s just so heartbreaking..

My heart goes out to you! I was worried about dad attacking the carers before I
put him in a home. I am having one or two problems of my own at the moment and if you want to know what I'm talking about read 'Staying In Dad's House'.

I am sending my hugs to you and your mum because you need to know how special you are and your dad is very lucky.

MaNaAk

 

[Kat loves milk tray]

I discussed this with my husband`s consultant when he was at the stage of presenting such challenging behaviour. The consultant said the same, more medication would affect mobility and increase the risk of falls.

I argued my husband was tormented, deeply unhappy, and had no quality of life. Without quality of life, what use was mobility? I know falls could involve broken bones and could not ignore that but it really was about trying to find a balance.

Mood swings and challenging behaviour don`t only give carers a hard time. The person who experiences these mood swings and challenging behaviour does not choose to be this way. It is an indication of deep distress .

Thank you Grannie G, well said, I will be quoting this to the GP when I attend the review.

 

[Kat loves milk tray]

My heart goes out to you! I was worried about dad attacking the carers before I
put him in a home. I am having one or two problems of my own at the moment and if you want to know what I'm talking about read 'Staying In Dad's House'.

I am sending my hugs to you and your mum because you need to know how special you are and your dad is very lucky.

MaNaAk

Thank you for your kind words. It comes after yet another difficult day as my Dad attended A&E early hours this morning which again was another traumatic visit, with Dad being aggressive and security being called then my Dad being sedated. I will have a look at your post, staying in Dads house