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 Combativeness 
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Combativeness
Derek's evening nurse just phoned and said he has a small skin tear on his hand. The aide told her it happened when he was being combative and was trying to hit her. The combativeness isn't new but isn't getting any better. Do any of your LOs have ongoing combative behavior? Have any solutions been found? With Derek it usually occurs when his caregiver is trying to do hands-on care, like changing his briefs, cleaning him, changing clothes or putting him in the lift to get him into bed. These are the same situations in which he was combative with me when he was home. Obviously, you can't just leave him in dirty pants or not transfer him from the w/c to the bed. I hate to ask the doctor to increase his evening Seroquel [he is currently taking 50mg] but I'm not sure what other steps to take.

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Sat Jul 09, 2011 12:49 am
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Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: Combativeness
My heart goes out to you, Pat. What a difficult struggle this disease is!!

Why don't you want to increase the Seroquel?

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Sat Jul 09, 2011 1:08 am
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Combativeness
I'm always afraid of adverse effects, especially with neuroleptics. But I think it's probably indicated.

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Sat Jul 09, 2011 1:17 am
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Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: Combativeness
I would say that combativeness is pretty adverse, wouldn't you? Dang! There are so many trade-offs that involve the lesser of the evils. I hate this!

I know this isn't much comfort, because each person is absolutely unique in his drug reactions, but Coy has been on 100 mg of Seroquel for about 8 years. The fact that Derek already tolerates the drug seems encouraging to me.

Good luck.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Sat Jul 09, 2011 1:40 am
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Joined: Sun Oct 21, 2007 4:18 pm
Posts: 835
Location: Acton, MA
Post Re: Combativeness
Pat, Frank is very resistant, he will make a threat with his fist but there is never any power when he makes contact, he seems to know better. I know it's frustration and I try to back off but as you said, you have to keep them clean. He has a dr's appointment at the end of the month and I was thinking of asking if there was something that would help. I just get very nervous when it comes to adding or changing meds so I'll mention it and see what he says.

Do you worry that they may want you to move Derrick? I always thought it was wrong to sedate the patience in NH's but after taking care of Frank, and that's only ONE, I can understand why it might be necessary.

I hope you get an answer, it's hard enough having our loved ones suffer with this disease, you don't need calls that stress you out even more.

Take Care,
Gerry

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Gerry 67, cared for Frank 71, married 49 yrs; dx 2004, passed away October 26, 2011.


Sat Jul 09, 2011 7:03 am
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Combativeness
Jeanne, Derek takes 50mg Seroquel in the AM and 50mg in the evening. I'm guessing it needs to be increased at night although he does sometimes get combative in the AM, too. These girls are so kind and patient with him and I know he would not really want to hurt them but he sometimes does. Who knows what delusions are directing his actions?

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Sat Jul 09, 2011 10:30 am
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Joined: Tue Feb 23, 2010 10:32 am
Posts: 215
Location: Kalispell, MT
Post Re: Combativeness
For those with LOs in a facility, I suggest discussing a change of meds with the RN who best knows the patient and then conveying that info to the doctor. My husband was put on seroquel at home mostly because of the sleep interruptions, for my benefit. The RN in the facility said it made him a bit agitated and to ask the doctor if it could be discontinued, or given as needed. Doctor agreed. As we know, the physicians don't know the daily life of their patients like their caregivers do.

This was a case where seroquel was a benefit at home with me as 24/7 caretaker, and not a benefit at the memory care facility. So, in some instances, factors other than just the patient factor in. As if we need more complexity.


Sat Jul 09, 2011 12:42 pm
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Joined: Fri Nov 05, 2010 11:30 pm
Posts: 317
Location: southern cali
Post Re: Combativeness
reading this with interest as the doc suggested starting seroquel when we get back from our trip... hubby has never hit me but has sure wanted to, at times hes in the middle of a hallucination... and im the bad guy!! so will be interested to see how you decide to handle this and what the doc says...
thinking of you!!
cindi

_________________
sole CG for hubby.1st symptoms, 2000, at 55. Diag with AD at 62, LB at 64.. vietnam vet..100% ptsd disability,sprayed with agent orange, which doubled chances for dementia. ER visit 11-13,released to memory care..


Sat Jul 09, 2011 1:13 pm
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Joined: Mon Feb 21, 2011 9:55 pm
Posts: 355
Post Re: Combativeness
Pat, I know we are all different, but I found when Dad was like this, the extra seroquel was a lifesaver. It really helped calm him down. He started on 25mg of seroquel and at his worst, was on 100mg a day. It had started at just one 25mg in morning and eventually we had to give him 50mg during the day, when he was very bad, and then 25mg at night. The doctor was very hesitant to up his dose because he was so frail and thin, but we had no choice. We saw no side effects, and Dad was very weak and thin at this point. I wish you luck - it is a difficult decision.
Ger x

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cared for Dad who passed away on January 28th 2013 R.I.P.


Sat Jul 09, 2011 1:44 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Combativeness
Certainly I will discuss this with the staff. But it should be noted that I am an RN and that I spend more actual time with him at the SNF than do any of the caregivers so I am in a pretty good position to assess the results. After Derek's birthday [today is the party! :P ] I'm going to be getting ready for a short trip to the other side of the state with my brother to visit my mother on her birthday. So I don't want to change anything until I get back. But I will, after consultation with the caregivers, possibly fax his neuro about increasing his Seroquel. In fact, he has already told me that he will increase it when necessary.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Sat Jul 09, 2011 2:50 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Combativeness
I'd go for the increase in Seroquel to see if that helps.


Sun Jul 10, 2011 1:13 am
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Joined: Fri Nov 05, 2010 11:30 pm
Posts: 317
Location: southern cali
Post Re: Combativeness
happy birthday derek!!
pat... enjoy your well deserved trip!!
cindi

_________________
sole CG for hubby.1st symptoms, 2000, at 55. Diag with AD at 62, LB at 64.. vietnam vet..100% ptsd disability,sprayed with agent orange, which doubled chances for dementia. ER visit 11-13,released to memory care..


Sun Jul 10, 2011 11:31 am
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Joined: Sat Jan 03, 2009 2:59 pm
Posts: 1978
Post Re: Combativeness
Pat,
50 mg really isn't that high a dose if it were me I would try and small increase to see if it helps with these issues, I think my husband was 100mg at night and a total of 175 mg per day!

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Irene Selak


Sun Jul 10, 2011 12:46 pm
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Joined: Tue Dec 29, 2009 2:28 pm
Posts: 464
Location: Minnesota
Post Re: Combativeness
Pat, I agree that 50mg isn't as high as some people need. And there's nothing saying that you can't lower the dosage back down if the effect is too dramatic.

I don't know why the pros keep doing their jobs, but God bless them for taking care of our LO. I see things in Mom's NH. At least one, more often 2 or 3 residents get combative and abuse the staff either verbally or physically. One day a resident I'm actually very fond of got so bad, kicking the staff hard, that I suggested they ask the family to provide soft shoes, rather then shoes with the thick, hard, soles she was wearing that day. There was so much kicking that it's a wonder there wasn't serious damage to a staff member.

I'm guessing that being combative with staff isn't such a huge deal and that they would warn you if it got too bad. They certainly take a lot at Mom's place.

But maybe this trip could be a good time to try a different dose. Not seeing Derek for a couple of days and then coming back after it has been in his system for a bit might give you a clearer before and after picture.

I know that you know these things, Pat. But when it is someone we love so much, it is hard to step back and view things objectively. Know, though, that because you love him, only you can truly understand what he would want.

I hope Derek's birthday went well.

Best wishes,

Kate

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Kate [i](Cared for Mom for years before anyone else noticed the symptoms, but the last year of her life was rough and we needed to place her in an SNF, where she passed in February 2012)[/i]


Mon Jul 11, 2011 1:20 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Combativeness
Actually, the trip is postponed. My brother, who was going with me, is sick so we're going to wait a week or two. :cry:

PS: The birthday party went very well. His younger son and his family were able to come and, though Derek didn't know who they were, he appreciated that they were somehow related and that everyone had come for his birthday. My aunt and uncle plus my daughter and husband were there. We had nine family members plus the staff. He was exhausted afterward but I think he enjoyed it as well as he was able.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Mon Jul 11, 2011 3:27 pm
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