Vascular dementia and aggressive behaviour

[CeliaW]

I know there are limited pharmaceutical interventions with vascular dementia but would appreciate any thoughts on management of this in a hospital setting and possible return home.

Briefly, a friends father (late 80s - early 90's) had a fall at home, admitted to hospital and then transferred to the equivalent of the local cottage hospital as felt not manageable at home. Staff are saying move to CH is possible option which seems realistic and is accepted by family.

However, I was told last night that friends Dad is playing up the staff, ranting etc and presumably aggressive because the staff say they are "a bit afraid of him" . It seems this is a continuation and probably increase of the difficulties his Mum had with him at home.

Hopefully a move to a good care home will see better "management" in non pharmaceutical ways but there still is the possibility he could go home and obviously the aggression is not good for him or anyone.

Any thoughts or useful experience to share? Thanks.

 

[canary]

".....friends Dad is playing up the staff, ranting etc and presumably aggressive because the staff say they are "a bit afraid of him" "

If this is what his wife is coping with at home, then my feeling is that he should not go home until this is sorted (if at all). How does his wife feel about him coming home? Would he be self-funding, or would his family have to persuade SS that he should be in a CH? Have the hospital offered a reablement package and is this in a CH?

Just throwing out questions there.

 

[CeliaW]

Thanks Canary. Good questions and I can guess at some answers and have advised them what sort of things they should ask/ be aware of / should be offered. Also offered to check any info they are given, in particular about the oft misleading interpretation of parts of the new Care Act etc that we read about so often on here.

What worries me is the comments make me think that they are just not looking at any aggravating cause (other than increase of symptoms because of change of location) such as UTI for the sudden increase in previous agitation / aggression or any ways of trying to manage / ameliorate and just making it obvious that they can't cope, he is frightening people.

I do appreciate its not easy to manage but have suggested rather than the "general" doctor managing care, that they ask for him to be seen by someone with dementia / mental health knowledge.

Hopefully he will go into care as that seems far more suitable than him going home. But he could end up in somewhere miles from home if he is only accepted somewhere that deals with challenging behaviour. That obviously has knock on problems for elderly wife visiting etc.

 

[CJinUSA]

My father died of vascular dementia. On one of his rages in the home, he fell and crushed the disks and vertebrae in his back. He still tried to rage, even though he couldn't get up. My OH got him onto his knees and up, but my father was suffering so, and we took him to the hospital.

There, he continued to try to thrash about, so they put a straitjacket on him and gave him Haldol. Once they gave him Haldol, I knew it was over. He kept asking to be cut loose from the straitjacket, in his lucid moments. I tried to have him released to my home, but it was too late. He died the night before they would have taken him to a restraining unit in a care home. Thank goodness. This was back in 1993. I don't know what drugs are out there, but if the situation is like this, it's just not possible to have them at home.

I provided the details so that you can see how awful this can become for the partner. My mother tried her hardest with him, and she just couldn't take care of him. I went over to give her relief on weekends (I work full time), and I slept with him to keep him quiet so she could rest. She lost 25 pounds, and she aged considerably in the 3 months my father was like this. Two of my other three sisters also were there to try to help. We were beside ourselves with concern.

I can't imagine anyone in a home situation whose dementia has gone into rages. It is terrifying at times. This is a vulnerable adult at risk, and if he is like my dad was, no one can control him at home. My father, too, could be so sweet at times, gently saying "Go get the scissors and cut me out of this thing," but then he'd fall asleep and after a nap awaken saying we all were trying to kill him or he had to get up and go protect his mother.

I'm not sure my message helps, but I thought by providing some details, I might nudge your friend into insisting on a care home placement.

 

[canary]

Good call about the UTI - I hadnt realised that the aggression etc had increased.
And I agree - it would be a very good idea to have him checked by a dementia specialist.

CJ - that sounds horrific

 

[CJinUSA]

Good call about the UTI - I hadnt realised that the aggression etc had increased.
And I agree - it would be a very good idea to have him checked by a dementia specialist.

CJ - that sounds horrific

The difficult part was that this was *my* father. A kinder nor gentler man did not exist. He had had a difficult childhood, and some of his raging seemed to suggest he was visiting some of those old memories or something.

At one point, OH and I were touching his arms on either side of his bed, and he awoke and gently said, "You should go home. There's nothing you can do here." One time when I came in on a Friday for the weekend (he was still in hospital, where he died, alas), he was coherent and said, "Thank you for the apples." He was referring to the dozen red roses I had had sent to him on Weds that week. He could be so much like his old self, and then, sometimes, really really impossibly difficult.

If my mother had been more open and asked for our help sooner, he could have been in a home and not have broken his back, but really, we were beside ourselves, and there was really very little information available to families at the time.

I don't think a woman alone can manage care for a man who goes into rages. This is why I posted my story, because she could get hurt or simply go into a deep depression from it or stop eating or whatever. And then there might be two people needing help.

 

[Sue J]

Hi Celia

I still go in and out of bad phases and am trying to get a handle on what happens when. I am just coming out of a bad phase and my 'aggression mode' this always follows a very heavy sleepy time when I can't stay awake and leaves me vague, unable to communicate, unable to make decisions and anyone can get a 'mouthful' What does seem to help is regular paracetamol during this time - I must remember to take it 4 - 6 hrly during this time - this is in addition to making sure I eat at approximately the same intervals as well. I wonder if the Drs are trying this with this poor man?

Hope they find something that does help

Best wishes
Sue

 

[CeliaW]

Thank you all for your helpful comments, I am sorry I have only just got back to reply.

CJ, I really appreciate you taking the time to post about your Father. I only hope that it wasn't too distressing for you to recall and write about it all, although I am sure it is something always in the back of your mind. I will certainly copy the comments from here without identifying who from and use them as a basis when I talk to the son.

Sue, how valuable to have your insight and comments - thank you.

I think from further discussion that the aggression is triggered by frustration - at home often because his wife is hard of hearing and doesn't respond always. It seems there to have been reactive outbursts rather than random and "unprovoked" but the fact that it has increased since admission and moving to the smaller hospital made me wonder about a UTI.

Thanks all, it gives me some basis besides my own thoughts and will help me when I chat with the son.

Celia x

 

[Ellaroo]

My mother has vascular dementia and since being in hosptal has outbursts of anger , lashing out when personal care is given.
There were signs of it at home but managed a million times better, more, time , more patience, consistancy etc.
Hospital tonight told me they have dols in place to put lt wt boxing gloves on mum as she scratches and hits staff.
I understand why theyve done it but it is a step backwards, mum will be frantic and terrified .
At home, mum cannot be rushed and i take casual approach.
Cant wait for her tomcone home and be settled