[Tucson]

After a wearing few months with my mother, I am frazzled. I need respite care for a vacation during my daughters fall break from school. I had everything set up despite the morons at the facility dropping the ball. Now they will not accept my mother for a stay because she was violent with them during her last time with them. This is now one week before the planned vacation. Oh boy!

I do not know what I am going to do. I have a prescription for Haldol for my mothers episodes of rage. But the pharmacy is out of the medication until Monday. Right now my mother has been yelling at the TV. She is now talking into her hand as though it is a telephone. She is having an arguement with the "person" on the other end. Has anyone had this problem with a person who has dementia?

Tucson

[BeyondtheRainbow]

It sounds like an admission to a geriatric psychiatric unit (they specialize in dementia) may be in order. They may be able to get her stabilized on some meds that will help prevent agitated episodes. That may be an AP or something for anxiety. I'm not sure Haldol is considered a good med for the elderly; no AP is but I think that the atypicals are more preferred when one is needed. APs increase the risk of falls and confusion. Haldol was never used commonly with my patients and I worked in a number of places that specialized in agitated dementias.

Does the respite place have a dementia unit? Those are generally set up to be able to handle agitated people and not get too upset about it; agitation is a way of life there.

[Tucson]

There are other facilities that have a dementia unt. I will find out about them on Monday. Where can I find a geriatric psychiatric unit? This sounds like a good plan. Back a week ago she hammered on the front door out of control. I stopped her where then she ran to her bedroom. I have a camera there, so I watched her from the other room. She found a wrench and said she was going to kill me. So I locked her in her room. About 45 minutes later of out of control behavior she settled down. Since then I have to be careful in how I talk to her. A raised voice can set her off.

I hope to take care of her until the end of the year. Then I will decide on what I am going to do next. I do not want my daughter to suffer through this. I tell you when I meet people who thinks it is better to take care of a mother with dementia at home, despite the advanced psychotic behaviour and the inherent risk, they do not have a clue what it is like, how much of a hardship this is, and what is really best for the one with dementia. Not a clue. Completely clueless.

Now I feel a little better getting that last part out.

Tucson

[BeyondtheRainbow]

Here is what I found with a search:
Geropsych Tucson, Arizona (AZ) - Tucson Medical Center

Senior Behavioral Health | Oro Valley Hospital

There may be more; I don't know that area at all. I'm sure there are more units in Phoenix too.

It sounds like it is time to do this before something bad happens. And sometimes it is an infection (urinary infections are notorious for causing psychiatric symptoms with the elderly) or a medication. I once was at a patient's home while her mother (who was elderly) was threatening to kill her. We had to call the police and adult protective services and try to hide all this from the mother. They eventually found that it was a reaction to a common med she was taking and she was fine after it was taken away. But as you've seen it can become violent and that's no good for you or your daughter.

Honestly I spent a huge amount of my life taking care of people with dementia and a lot of it people with dementia and concurrent psych issues and I still can't understand what it is to do that at home with a loved one all the time. It takes great dedication to the patient and a lot of love. IT also takes being realistic with your abilities for your own sake.

Gero-psychs are usually pretty good experiences. They deal with nothing but agitated depression so that makes them very calm about it. They have simple activities, music, lots of snacks (the unit where I go is linked to gero by a common locked door and the staff always are stealing from the mood disorder fridge), and doctors who can make med adjustments while monitoring everything that goes with being elderly.

[Tucson]

For the past couple days she has been saying that she wants to be dead, and cries about it. She has said that she wants to kill herself. At other times she wants me to kill her. A suicide risk?

[BeyondtheRainbow]

It's possible and since you can't ask questions and find out (and it's always better to take that too seriously) I'd say yes. It sounds like taking her to an ER where they have gero-psych may be a good idea, especially since you don't have the Haldol if things got bad. Plus it's probably pretty miserable for her as well and prolonging that isn't good.

[bizi]

depending upon the size of your town/city there may be psych inpatient places that can admit geriatric patients to stablize their meds. It can take a couple of weeks inpatient to do this.
good luck and you can always call the 911 if it gets bad for your safety.
or hers for that matter.
sorry it is so hard right now.
you are a very good son to her.
bizi
((((HUGS)))))

[BeyondtheRainbow]

Also, make sure her meds are locked and somewhere she wouldn't think to look. It sounds like it is too risky to have them anywhere she might get near them.

[Tucson]

Yes, lock up the meds. She took several tabs of my Remeron and was drugged up. She slept it off. Yesterday she was banging on my bedroom door, the front door, and yelling in the early morning hours. What I find surprising is her attempt to eat shampoo. She then decided it was not for her. Somehow amusing to me.

She is over her sui ideation, and laying down in bed right now. I gave her a doughnut. If that episode happens again, I will go to the ER. Her POA permits me to admit her to a psychiatric unit on the approval of her doctor. I imagine the doctor there can admit her if necessary. But I imagine this is only for a hold period. My question is will I be able to have the ER admit her to the geriatric psych unit for a longer period of time, like a week, without the primary care physicians request? I hope I will not have to petition the court for guardianship.

I will need to start preparing for a permenent admit to a nursing facility with a dementia unit. I want to be ready for this if all else fails. Hopefully I will be able to keep her at least until the end of the year, if not longer.

Tucson

[BeyondtheRainbow]

does the POA specify which doctor has to approve the admission? I'm sure that you can get her admitted via ER on a hold kind of basis and then the doctors will discuss but if a psychiatrist is recommending she stay IP then I doubt any doctor is going to deny that. It seemed like gero-psych stays were usually a little longer because they are careful to not over-medicate and there are so many sensitivities to contend with. I seem to remember 10-14 days being pretty normal with some longer and of course some shorter.

It really sounds like this is a step you need to take before something out of control happens. I'm sure it is hard but it is for her benefit.

[Tucson]

I agree. The POA states it needs to be my mothers physician. I imagine this means primare care. I also have the ability to admit her to a level one psych unit, whatever that means. So it looks like that the ER can admit for a couple days, and then her physician can admit her for a longer period of time.

It has recently occured to me that my mother actually has a MI. I need to start treating her that way. I have been seeing my mother going through stages, with some scary times thrown in. I still thought of comparing her to her former self where she is just being crazy. You know, blaming her, trying to reason with her, treating her as a child as of late since she has been acting very much like a two year old, there is just her and I, and I just have to deal with her everyday. But this is an actual MI. This needs to be taken very seriously instead of seeing her going through just another "stage". Perhaps then I can have more compassion for her. Perhaps I can be more sensative to her needs. Her depression needs to be taken very seriously, not for my sake, but hers.

Tucson

[Tucson]

Here is an update. My mother has settled down. As long as I do not raise my voice, she is more tranquil. I took her out to the drive-in biggie burger place. She still tries the locked front door, but at least she is not screaming and banging on the door. I hope her normal regiment of meds, which include the AP Olanzapine, will help.

Thanks for your support, BeyondtheRainbow!

Tucson

[BeyondtheRainbow]

I'm glad things are better. But I think it is seriously concerning that she's been prescribed 2 APs. That is definitely not accepted medical practice because it increases fall risk and confusion. I think it can even increase agitation.

There are psychiatrists who specialize in gero-psych and maybe she needs to see one? I'd hate to have something bad happen to her because of medication.

[bizi]

You are a good son.
Why wait to place her?
bizi

[bioChE]

Originally Posted by BeyondtheRainbow

I'm glad things are better. But I think it is seriously concerning that she's been prescribed 2 APs. That is definitely not accepted medical practice because it increases fall risk and confusion. I think it can even increase agitation.

There are psychiatrists who specialize in gero-psych and maybe she needs to see one? I'd hate to have something bad happen to her because of medication.

Two APs are accepted medical practice at times. I've been prescribed two at the same time by three different psychiatrists. It's not ideal, but at times it's done.

[BeyondtheRainbow]

I mean for someone who is elderly. The rules change there.

[bioChE]

Originally Posted by BeyondtheRainbow

I mean for someone who is elderly. The rules change there.

Fair enough. I'm not at all familiar with geriatric care.

[Tucson]

I promised her that I will keep her until she no longer knows who I am. Also there is significant credit card debt on one of her credit cards. I am using her income to pay it off. However, if she becomes unmanageable with meds, I will place her in a facility. I need to think of my daughter too who lives with me.

Tucson