Triggers in behaviour?

[Linbrusco]

Mum 77 with moderate/end stage Alzheimers has been in her care home 20 mnths.

Although Dad has always pretty much been a trigger for her anxiety/agitation we are convinced her birthday is also.

March last year Mum had been in care 8 mnths. Had settled in well, doing great.
Celebrated her birthday at the care home, all of us there.
Within the week, agitated, not eating. UTI diagnosis.
Behaviour & confusion increased.
Another UTI, possible delirium and then Mums dementia was on a downward spiral.
Eventually Mum was trialled on Quetiapine that worked and she had been stable after a few dosage tweaks from about November last.

Now March again, celebrate her birthday.
Within the week back to agitation, not eating. Suspected UTI, Mum wouldnt cooperate for a sample. They started anti bs.
It quickly spiralled into massive agitation & aggression, hitting staff & residents.
Bizzare coincedence???

We have just had a horrendous 5 days with Mum in hospital.
Nothing medical found, even urine sample came back clear ( few doses of anti bs may have cleared it?)

Mum is back at her care home, but they are having a hard time, with Mum often needing 2 carers, and we feel she may be readmitted to hospital.
Last night she fell out of bed.
Her bed is low to the floor.
She was not hurt but she was still so aggressive despite meds, that she wouldnt let them move her back to bed. It took several attempts and half an hour of trying.

Despite everything I have learnt about Alzheimers nothing has prepared me for this.

 

[Georgina63]

Hi @Linbrusco, sorry I have no pearls of wisdom either, other than to send hugs and wishes. This whole journey can be so unpredictable can't it? I hope things settle for your Mum and for you. Gx

 

[Ludlow]

Just a thought - could it be something she eats or drinks at her birthday? Is she given boxes of chocolates or biscuits to herself that could be disagreeing with her if eaten in greater amounts than usual?

 

[70smand]

Dad has been in a care home for a year and although we used to be aware of some triggers, other times his agitation just appeared out of the blue.
His aggression is controlled with olanzapine but the side effects are the trade off. Every time they try to reduce the dose he gets fidgety and agitated again, and becomes aggressive. Sometimes I can pin point his aggression to certain staff or residents where there is loud noise or shouting around him, as he would often kick off at meal times, but other times there is no rhyme or reason. Some times it would simply be that he needed the toilet but would not be able to ask or take himself and staff would not think to take him often enough.
One thing I would say is that in the year he has been there we have never seen him become aggressive or agitated but only walked in to find him agitated and distressed after an ‘incident ‘ and my mum and I are always able to calm him now without any extra medication, unlike at home.
Sometimes he goes through episodes of agitation which last a few days and mum and I refer to them as ‘brainstorms’. The staff will always check for a uti, which was only ever the case once, but usually we find no rhyme or reason. Whilst going through these ‘phases’ I feel we( mum and I) can see his agitation building and watch him closely and can divert him , but when we are not there the care staff do not pick up on this soon enough.
Even when we thought he was going through a calm period we found out that he ‘played up ‘ staff during his care in the mornings and they used to go into him in twos, although my mum or I could manage him fine on our own.
I think the aggression is one of the hardest things to deal with and the most difficult to treat. Mum worries the staff will think bad of dad because he is usually so lovely, but I like to think most of them have the knowledge to understand that it is the dementia and not the person.
I hope it is ‘ just a passing phase’ for your mum, or if not can be tweeked with medication. Just a thought but Constipation can cause all sorts of problems also, but I’m sure that’s been considered. Just when you think things are settling down dementia has a way of throwing a curve ball.
I do hope you get some resolve but I can’t blame birthdays unless maybe the extra attention triggers something.
Sorry, I have a habit of rambling, best of luck xx

 

[70smand]

I forgot to add pain as a trigger. Could your mum be in pain at all but not be able to verbalise it? I’m sure my dad is worse in the mornings where he is no longer able to mobilise or move himself in bed and becomes very stiff, the same with sitting in a chair for long periods.

 

[Linbrusco]

Thank you all once again for replying. My head & thoughts are in a spin.
@70smand so much of what you wrote I can identify with.

You find yourself clutching at straws to come up with reasons for the change in behaviour.
Although they still think delirium they are only guessing it was due to a UTI, as with just a few doses of anti bs it may have cleared.
As far as pain Mums face and body language dont convey pain.
She is already on Nortriptylinr at night for bladder spasms which shes been on for 5 yrs.
We were well used to her body language when they were bothersome prior to going into Care Home. She mentioned it just once within going into the care home and never again.
Thats not to say they dont bother her but we just dont see the same symptoms.
Mum is not constipated.

So today we had a meeting.
Care Home Manager, Care Home RN, GP, Mental Health Nurse & Geritrician Nurse.
Upshot was they are going to increase Mums Quetiapine and now that Mum is in inco pants, remove her bladder medication, and probably cholesterol meds.
Mum is resisting meds most of ghe time if not in a good mood, and trying to hide it in food is hit & miss.
The less tablets & only the ones that count at this stage the better.
She will be reviewed by Geritrician next week, as they are questioning her Donepezil also. Mum has been on 5mg for 5 yrs and at late stage Alz.

I can definitely see her agitation is somewhat less. At least she hasnt hit me or my sister in the past 5 days but has with the carers with showering, dressing & personal cares.
Her mood changes at the drop of a hat.

If you have read this far many thanks.
I am due to go overseas for a week shortly to see my husbands family.
A long overdue holiday

 

[70smand]

Dad spits his tablets out now too so we have to crush them and hide them in biscuits or give liquid meds when it was never a problem about 8 months ago.
I guessed you would have ruled out all those things knowing how involved you are with your mums care.
Dad stopped donepezil over a year ago but is still on memantine, which originally helped with his aggression but I’m not so sure of it’s usefulness now. Still on cholesterol meds too for what it’s worth.
I hope the Quetiapine increase helps without side effects. We are desperate to get dad off the tiny dose of olanzapine as he declined the minute he went on it but unfortunately he becomes too agitated and aggressive.
Why is everything so hard? I do hope you have a a lovely holiday, sounds like you need/ deserve it. I am also going away for a few days over Easter abroad to see hubbys family but don’t like leaving my mum as her whole life revolves around dad and it can become quite all encompassing that I let her vent to me and try and support her as best I can.
My Mum and dad are only 72 and Dads had this Alzheimer’s for about 14 years so they’ve never been able to enjoy retirement but we’re forced into it- not fair is it? Take care of yourself x