Help

[purchase]

Hello everyone

I need your help and advice again please.

Firstly has anyone got any information on Mirtizapine. This is apparently the drug that mom is going on and I was wondering about the side effects and the possibility of this maybe causing mom to be a little sedated.

Secondly my sister visited mom yesterday. The residents have been moved into a new lounge which will be a much better place for them but they were all a little confused. Anyhow my sister was greeted by a member of staff who said that mom was upset. My sister found mom in the new lounge really distraught. She was with another resident who she gets on very well with and my sister was told by mom and her friend that another resident, who mom hates, had upset her. My sister couldn't get much infor except that mom said that this lady was always following her and that she has known her for a long time, not true, and that mom wanted to split her in half and watch her blood run out. Nasty. Eventually mom calmed down a little but continued to say really horrible things about this other lady and she growled at her whenever she went past. I rang the home this morning and was told that mom isn't being followed and that this other lady is quite quiet and that nine out of ten times mom is the instigator and they have to take mom away and calm her down. Mom insists that she used to know this lady and won't be swayed from this. I asked how mom was today and was told that another incident had occurred and that mom had started to shout at this lady and had to be taken out of the lounge again to be calmed down. This has been happening fo a while but seems to be getting worse and we just don't know how to handle it. Should we tell mom that her behaviour is not right, will she remember this. We are worried that if this become too bad that the home may ask us to move mom. Mom has always had a tendandcy to nastiness but this is quite bad. Could it be part of the AD Please advise if you can. Visits have been so stressful lately with mom crying almost continuously that my husband is now saying that my sister and I should only visit together but this would mean that mom only gets one visit a week and this seems a little sad. Also I don't want the carers at the home to see mom like this and I don't want her to talk about killing people and calling them a bitch.

I have even started to wish that mom would go downhill. How cruel is that.

What a life.

Sorry but I am so sad at the moment. Jacky

 

[blue sea]

So sorry about your mum. My dad has been very aggressive lately but the new medication is helping a lot. He is really gentle by nature so this is yet another dreadful side effect of dementia. Getting CPN involved has helped considerably. I'm sure the home has dealt with similar situations before. Your mum cannot help her behaviour and they will understand that. i know exactly how you are feeling though. This illness is a living hell at times, for them and us.

Blue sea

 

[Kriss]

Is the home an EMI home? The reason I ask is that my Aunt moved recently mainly due to a deterioration in her condition part of which was showing as aggression to other residents. We were horrified at the thought of an EMI unit but she settled immediately and there have been no problems at all. My concerns that she would be put on stronger medication were unfounded. The staff ratio is higher than in her residential home and there always appear to be at least one carer who can give her some attention and she seems to be revelling at least for now.

Kriss

 

[purchase]

Hello Kriss

No mom is not in an EMI home because her previous consultant felt that she would be more stimulated if she were in resindential care there some of the residents were just frail. The problem is that mom thinks she is there for convalescence because we lost our lovely dad just over a year ago. The new psychiatrist thinks we should tell her that this is a permanent thing but my sister and I can't face the prospect of this at the moment. Mom has cried almost constantly every time we have seen her for the past fourteen months. The consultant says it is because seeing us reminds her of our sad loss and because of her short term memory her grief is very raw.

Thanks also Blue Sea. Mom unfortunately has always had an aggressive streak and I am worried that this will become worse. Sorry about your dad.

Thanks for your kind thoughts.

Jacky

 

[Kriss]

I guess it will vary from home to home and in different areas and maybe we are extremely lucky with the EMI home that Aunt has moved to. She is definiteley more stimulated proablbly due to getting more attention.

Good luck
Kriss

 

[KarenC]

Hi Jacky,

To try to answer some of your questions from my experience with my mom:

Yes, this could definitely be part of AD. "Agitation" (sometimes a polite word for really nasty behavior) and aggression are among the symptoms.

Yes, it might be helped by medication. Seroquel has been pretty effective with my mom.

My mom was previously in an "assisted living" home. They could handle memory loss per se, but not the "agitation" -- e.g., throwing plates at the nurse, grabbing the waiter by the tie and trying to choke him, screaming fits in the middle of the night. When things got too bad she was moved to a dementia home per se, which has turned out really to be the right place for her.

It is not necessarily cruel to wish her to go "downhill" in the sense of the dementia progressing. Although she might have less mental ability, she may get to a stage at which she is less upset and angry, more content, and that may be easier for everyone.

As to talking to her about her behavior, that's hard to say. In the early stages, we kind of encouraged Mom to express her feelings and feel as in control as possible. And we took lightly things that previously would have been meant as a joke. But there came a time when if she said "I'm going to hit her!" we realized she might do it, and responded as to a toddler: "No! Don't hit people." Not yelling or making a big deal of it, but trying to be firm about what is acceptable.

Good luck in a tough situation!

Karen

 

[Sandy]

Hi Jacky,

First of all, here are a few links on mirtazapine:

http://www.nmhct.nhs.uk/pharmacy/mirtazap.htm

http://www.netdoctor.co.uk/medicines/100005044.html

Both sites say that drowsiness can be a side effect. The first site says that side effects can wear off in a week or so. It also says that it can take upto 4 weeks to lift depression in the older patient. The second site also mentions another side effect can be restlessness.

Regarding the frequency of your visits, it might be a good idea to not to reduce the frequency over the next few weeks so as to better monitor her reaction to this medication.

"This has been happening fo a while but seems to be getting worse and we just don't know how to handle it. Should we tell mom that her behaviour is not right, will she remember this. We are worried that if this become too bad that the home may ask us to move mom. Mom has always had a tendandcy to nastiness but this is quite bad. Could it be part of the AD ."

The main thing is that you don't have to handle it alone - you should have the support and expertise of the staff at the home and your mother's medical team. Personally, I doubt if telling your mom that her behaviour is not right would be terribly productive. She would probably not remember it and she quite possibly does not have the insight into her own circumstances to see your advice as valid.

If you are worried about her place in the home, the best thing is to sit down and talk about this with the home's manager. As much as this is a personal situation for you and your family, the home will probably have dealt with this type of progression many times before. What you want to avoid at all costs is having to find a place in an EMI home at very short notice.

Some residential homes can get a special license to care for a named resident with dementia, that's down to the individual home and their ability to prove that they can care for the person adequately. Personally, I would start to consider the possibility of an EMI home at some time in the future. If you find a good one, and they are out there, you will see that having staff and facilities that are geared up for the specific needs of people with dementia can actually provide a more supportive environment for your mother (and for you and your sister as well).

Your mother's behaviour could be part of the AD, or it could be due to something else like the medication. One aspect of dementia is the "social controls" that operate at so many levels in adults start to come undone. Also the lack of perspective and loss of skills can make things seem more provocative and more frustrating/threatening. This makes behaviour like swearing and even physical aggression much more likely.

Sorry - so much to think about.

Take care,

Sandy

 

[purchase]

Dear Karen and Sandy

Thank you so much for your help and advice. A lot of things ring so true. I will look onto the website about Mirtizapine. It came to me and my sister yesterday during one of our long telephone calls that because we were told that mom would totally forget us by spring this year that we haven't looked for the other side effects of this awful disease. I think that slowly we are growing wiser. I will continue to visit maybe for a shorter period 1) because I want to see my mom and 2)because I want to monitor her progress. The home is good but at the moment the manager, who is a trained elderly care nurse and is very good, is away and I think things have gone a little haywire.

Yes it would be nice if she were to become more content because then for a while at least we could see her smile. We honestly haven't had one happy time with mom in fourteen months. I know this is nothing compared to what some other carers go through but at the moment it is so upsetting.

Anyway today is a new day and I am determined to be positive and to remember all the good things that I have going for me and there are a lot of them.

Thanks to all of you.

Jacky

 

[Sheila]

Dear Jacky, it does sound as if your Mum's condition is causing concern and perhaps her medications etc need reviewing. I agree with what Sandy says. It is better to find a suitable EMI home at your own pace rather than under pressure, so start looking now and get her name on the waiting list of your favourites. Sadly an ordinary home will not usually have the security often needed to stop a dementia sufferer wandering off into harm. This is one of the most common reasons for a move to EMI. Pleas let us know how things are going, love She. XX

 

[blue sea]

Jacky

Researching possible EMI homes might be a good idea. Dad is in a nursing EMI unit (there are residential ones). The advantage of nursing EMI is that a qualified RMN is on duty 24 hours a day so can administer medicaton on a need basis (within the doctor's overall guidance for dosage). In dad's case this is now essential to help manage his agitation / aggression. Obviously there are down sides in that many of the other residents also have difficult behaviour problems and that can cause problems for dad. In his case I know there is no better alternative as a residential home would definitley not cope with him. In your mum's case it doesn't sound as clear cut. An appointment with consultant to review all the options might be worthwhile. Don't feel pressurised into telling your mum she's in a home permanently - how could that help her state of mind? I kept telling dad he was there because the doctor wanted to try out some new medication to make him feel better. I have never said it would make him better - only feel better. I've long passed the stage of believing I should tell dad the full truth about his condition and situation (not that he would understand now). Would you tell a 2 year old they had a terminal illness that was taking away their mind? I don't think so.

I feel so sorry for you that your mum continues to be upset when you visit. I really can't see how you can change that for her but some changes of medication might improve her mood. A lot of it seems to be trial and error unfortunately. Incidentally my dad's home has a daily activities organizer who is very good at working with the residents to stimulate them, though as the disease gets worse of course this is more difficult.

You are doing your best - it is like being in a living hell at times I know as there is no way of knowing what are the best decisions to take. It's even worse when there are no obvious decisions available to you. Take care of yourself - sometimes it's better to let it flow over you for a while until you feel strong enough to get involved again.

Thank God for TP - at least we know we're all in this together.
Blue sea