Help please

[Lisa74]

Granny is having a very bad day so is everyone else.

She was up most of the night and early in the morning and had accidents resulting in a lot of poo trampled around everywhere and smeared on surfaces. Accidents happen so my parents and I were ok about cleaning it all up and putting her back to bed several times in the night but she has been being absolutely vile today, which really is rubbing salt in the wound/s!

She normally has a rest in the afternoon (I have her to look after by myself some week days) but got up a minute ago and is still being very aggressive but my Mum gave her 1mg diazepam. My uncle is a doctor and said that we should give her diazepam rather than her prescribed lorazepam because lorazepam is much stronger. (Previously I have given her 1/4 tablet of lorazepam on 2 occasions when she was trying to knock the front door down to escape at night).

Does anyone know if diazepam is ok for VaD? I read on one medical site that it's best avoided and lorazepam is better and faster acting. 1mg is a very low dose of diazepam so I'm not sure how well it will work!

 

[Beate]

To be honest, both appear in the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults: http://www.americangeriatrics.org/files/documents/beers/2012AGSBeersCriteriaCitations.pdf
Recommendation: avoid for treatment of insomnia, agitation or delirium.

 

[Pottingshed50]

Oh dear poor you. I should imagine that Granny would be horrified if she really knew what was occurring. There comes a time when you have to consider 24/7 care in a care home. Mum used to be very aggressive and like your Gran often at the Care Home she would try and kick the front door in. She even lobbed one of the poles from the Gazebo in the garden through the lounge window and could have caused all manner of injuries to those inside, luck was in that day and someone was not in the chair beside the window. She was given a very strong drug which at the moment does not come to mind but I will look through my paperwork and try and find it. It did calm her down but I am not in favour of any of these drugs long term.

On Monday have a word with her doctor and dont be fobbed off by the receptionist. You must get the correct advice for your Gran, her doctor will have her medical history in front of her/him and be able to make a correct decision. Dont worry things will be sorted out.

Bless you for caring. It will get better - I promise.

additional Edit


I have just been through Mum's papers and can now tell you she was on Risperidone when she first went into the Care Home. She was also placed under what they term a DOLS ORDER which is Deprivation of Liberty Safeguards Order. She was under this for about 6 month when it was removed together with the drug.

I always felt this was a sledge hammer to crack a nut but then I am on Mum's side, but and a big but, I did not have to live with Mum as she was in a residential care home and they were afraid that she would escape (tried several times) and get knocked over on the main road outside.

 

[Tin]

I have the same question ready for mum's gp on Monday. When mum came to live with me a year ago she was prescribed 2mg Diazapam to ease anxiety, also helped her sleep with very little side effects the next day, it worked. Then change of gp who prescribed half mg Lorazapam, sometimes works sometimes not and the side effects the next day were very odd, mood swings, total confusion and some very odd behaviour. I never asked why the change, because as far as I understood neither were recommended for Dementia suffers. So will report back after Monday.

 

[chrisdee]

I guess its a case of trial and error. Extreme agitation has to be managed somehow, and I was grateful that lorazepam in extremis helped Mum. the mental health team had no hesitation in recommending it for occasional use, the 0.5 dose that is. For many its either peace at last or breaking the house down. No contest I'm afraid.

 

[Lisa74]

Thanks Chrisdee, Tin, Pottingshed and Beate for the advice and support.

Chrisdee, definitely sometimes things just get to breaking point.

Pottingshed, yes maybe- unfortunately she was always a difficult person so even though this is clearly dementia at work, it is sometimes difficult to see it as just that! I'm sorry to hear about your Mum too.

Beate, thanks I'll have a look at the guide although maybe if it does work with minimal side effects it might be worth going against advice.

The 1mg of Diazepam seemed to work amazingly well today- she went back to sleep and woke up quite sedate but perfectly content! When I've given her Lorazepam in the past it has disrupted her sleep at night (several hours afterwards) so we will have to see if she gets the same side effect tonight and whether her mood/behaviour is worse tomorrow.

I wish there was something like Diazepam that could be used constantly without her developing tolerance/dependency!

 

[meme]

I think dependency is not an issue at this stage...if the drug is helpful then use it...that is what it is for after all, if more is eventually needed then again at this stage I would use what keeps Granny comfortable and makes life bearable...