Medication /Aggresion

[alanalan]

My mums in a nursing home, diagnosed with Vascular Dementia. due to very aggressive behaviour, being very vocal and abusive to everyone and long bouts of banging her head, she underwent a psychiatric assessment by the Community mental health team [CMHT ]. They prescribed Mirtazapine 30mgs which, taken at night was meant to calm her down and help her sleep. it didn't.
The CMHT were called again, they upped it to 45mgs, still had little effect, if anything her behaviour has worsened. She has now been prescribed Promethazine [ as and when required ]. She has been given it one a day for the last four days, as well as the Mirtazapine at night.
The staff have told us this has had no effect on her aggressive, abusive behaviour. She continues to bang her head, lash out at the nurse and carers, throw food and drinks at the staff and scream and shout foul and abusive language.
Any advise please.

 

[ASH74]

Perhaps she needs an admission to the local service for a more comprehensive assessment rather than CMHT.


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[katie1]

My mums in a nursing home, diagnosed with Vascular Dementia. due to very aggressive behaviour, being very vocal and abusive to everyone and long bouts of banging her head, she underwent a psychiatric assessment by the Community mental health team [CMHT ]. They prescribed Mirtazapine 30mgs which, taken at night was meant to calm her down and help her sleep. it didn't.
The CMHT were called again, they upped it to 45mgs, still had little effect, if anything her behaviour has worsened. She has now been prescribed Promethazine [ as and when required ]. She has been given it one a day for the last four days, as well as the Mirtazapine at night.
The staff have told us this has had no effect on her aggressive, abusive behaviour. She continues to bang her head, lash out at the nurse and carers, throw food and drinks at the staff and scream and shout foul and abusive language.
Any advise please.

Have they ruled out any other causes? an infection, pain elsewhere? has she been examined for any bruising injury etc?
Is she better if on her own, in subdued lighting, away from other noise? or with low level calming music?
I really wish I could help!

 

[alanalan]

Perhaps she needs an admission to the local service for a more comprehensive assessment rather than CMHT.


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Thanks for that, what do you mean by 'Local Service' rather than the Community Mental Heath Team.

 

[alanalan]

Have they ruled out any other causes? an infection, pain elsewhere? has she been examined for any bruising injury etc?
Is she better if on her own, in subdued lighting, away from other noise? or with low level calming music?
I really wish I could help!

Thanks katie1
She does have some pain from a hip op she had a while back, but is on pain relief for that, she has no infection, and only has the bruising she gets from banging her head.
Being on her own, etc. makes no difference, she is just constantly aggressive and abusive.

 

[Karjo]

It really sounds like she needs admitted to an NHS psychiatric assessment unit, though there may be some resistance to this as she is supposed to be in a place of safety.This happened to my Mum but she was served notice of eviction first as the home knew they could not cope but were hopeful of some improvement with more antipsychotics. This improvement didn't happen though. In retrospect I think the extra medication has a paradoxical effect and made her worse. I also think she maybe had an undiagnosed UTI, as this seems to have happened since (really aggressive and confused) and anti biotics have helped.

 

[alanalan]

It really sounds like she needs admitted to an NHS psychiatric assessment unit, though there may be some resistance to this as she is supposed to be in a place of safety.This happened to my Mum but she was served notice of eviction first as the home knew they could not cope but were hopeful of some improvement with more antipsychotics. This improvement didn't happen though. In retrospect I think the extra medication has a paradoxical effect and made her worse. I also think she maybe had an undiagnosed UTI, as this seems to have happened since (really aggressive and confused) and anti biotics have helped.

I agree, what concerns me is that the NH may decide they can't deal with her, and ask us to move her, though I'm of the opinion the main reason they are unable to handle her outbursts is down to lack of staff.
Though she is extremely difficult, needing one to one interaction most of the time. Some of the staff are brilliant with her, but the demands on what few staff seem to be available begs the question why are there not more.
I'm raising this question with the home's management, but need to be careful as we can't move her again.

 

[Karjo]

I agree, what concerns me is that the NH may decide they can't deal with her, and ask us to move her, though I'm of the opinion the main reason they are unable to handle her outbursts is down to lack of staff.
Though she is extremely difficult, needing one to one interaction most of the time. Some of the staff are brilliant with her, but the demands on what few staff seem to be available begs the question why are there not more.
I'm raising this question with the home's management, but need to be careful as we can't move her again.

Before my Mum was evicted from her first nursing home the social worker and the nursing home manager called a CHC meeting. I think the plan was that she might have been eligible for CHC due to her unpredicatable aggression and this would then pay to meet her needs over and above the councils's "EPR" rate which was not sufficient to meet her needs . As you say staffing always seems to be an issue even if they do not have disuptive clients. The home were hoping that CHC would fund for some one to one care, and then along with increased meds she could remain there. The meeting was a farce however, and the NHS CHC teAm literally walked out as soon as they realised she was on section 117 aftercare and said she was the councils responsibility. That is when she was served a months notice of eviction. Anyway that's another story but is your mum on CHC funding? if not it may be her needs are such that she should be and maybe this could fund for the extra attention she may need to get her through this bad time, rather than admitting her for assessment.

 

[henfenywfach]

I agree, what concerns me is that the NH may decide they can't deal with her, and ask us to move her, though I'm of the opinion the main reason they are unable to handle her outbursts is down to lack of staff.
Though she is extremely difficult, needing one to one interaction most of the time. Some of the staff are brilliant with her, but the demands on what few staff seem to be available begs the question why are there not more.
I'm raising this question with the home's management, but need to be careful as we can't move her again.

Hi alanalan

You must be so concerned about her.
Aggression is a form of communication..and im not saying its always the reason for aggressive behaviour but if we look at the behaviour from her perspective. When damage to the brain occurs the part of the brain that deals with facts and names etc is damaged first all things are judged by the side that deals with emotions ..and can you imagine trying to communicate with people through your emotions.

I have heard of people banging their heads because of a constant buzzing feeling or strange feeling in their heads. And also tapping.

If a persons memory has been damaged and is where they were younger (have a look at the bookcase senario ). They might be during childhood throwing food ...or even if in a different memory era...living 2015 through that era would be frightening...
For example if they think theyre 30 and in a care home...how can someone with communication problems and a brain disease understand or communicate that?

If you can see things through their eyes...sometimes you can see somethings differently.

Sending you best wishes .

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[ASH74]

Thanks for that, what do you mean by 'Local Service' rather than the Community Mental Heath Team.

As someone has said admission to the local assessment unit......may seem a drastic step but they have the expertise in dealing with those who are in a crisis and stabilising them. For my FIL the assessment unit and community team work closely together. I hope things are sorted soon.


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[alanalan]

Hi karjo
No she's not got CHC funding, not that I'm aware. She is Self-Funding regarding the fees etc. She also gets nursing care allowance.

 

[alanalan]

Hi alanalan

You must be so concerned about her.
Aggression is a form of communication..and im not saying its always the reason for aggressive behaviour but if we look at the behaviour from her perspective. When damage to the brain occurs the part of the brain that deals with facts and names etc is damaged first all things are judged by the side that deals with emotions ..and can you imagine trying to communicate with people through your emotions.

I have heard of people banging their heads because of a constant buzzing feeling or strange feeling in their heads. And also tapping.

If a persons memory has been damaged and is where they were younger (have a look at the bookcase senario ). They might be during childhood throwing food ...or even if in a different memory era...living 2015 through that era would be frightening...
For example if they think theyre 30 and in a care home...how can someone with communication problems and a brain disease understand or communicate that?

If you can see things through their eyes...sometimes you can see somethings differently.

Sending you best wishes .

Sent from my GT-I9505 using Talking Point mobile app

I see your point about the memory era thing, She dose seem to be living mainly in the past but even that varies from moment to moment. She certainly has no idea of where she is, who we are, where the bathroom is, wanders right past the one in her room.
Its very upsetting to see a once proud woman reduced to, and in such a state.

 

[Karjo]

I agree, what concerns me is that the NH may decide they can't deal with her, and ask us to move her, though I'm of the opinion the main reason they are unable to handle her outbursts is down to lack of staff.
Though she is extremely difficult, needing one to one interaction most of the time. Some of the staff are brilliant with her, but the demands on what few staff seem to be available begs the question why are there not more.
I'm raising this question with the home's management, but need to be careful as we can't move her again.

You are right to discuss this with the home manager, but the reality is no home can provide one to one interaction with any of their clients without charging for it. it is so frustrating I know only too well as sometimes these poor souls are trying to tell us something and just don't know how, and it takes so long to do anything. All too often as well the carers are just too young and not adequately trained in dementia, so a lot of "bad" behaviour depends on who is on duty.
i would listen to what the manager has to say and see how you can work with them to keep your mum from getting too distressed. ask them to make sure she definately does not have a chest or urine infection as these can bring on extreme behaviour symptoms and are more likley if they are having difficulty in keeping her properly clean after personal care.Ask if they feel she would benefit from admitting to an assessment unit, and also ask if you/they should be applying for CHC funding. Be aware though that the home will receive more from your mum at the moment as a self funder and therefore feel they can give her more attention. if the rate is reduced if she goes onto CHC this may affect the level of attention but I really have no idea if this is the case in practice.

 

[alanalan]

Thanks for that Karjo
Contacted CMHT regarding mums medication, and the fact its not working. Also mentioned the 'assessment unit' route.
They would rather try changing her medication to see what effect that will have first, but have not ruled it out.
The CMHT, will contact the NH direct to see what can be done their end.
Awaiting a meeting with the home manager.