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It seems like I NEVER see any of the other residents at Mom's Memory Care Home have anger or outbursts. She's been on and off raging, yelling, cursing now for a month and half, and we finally get to see the neurologist tomorrow. The Memory Care Home has been giving Mom Ativan as needed to help keep her rages to a dull roar, but I am hoping to have a better solution. The fine line is that we hope to manage the anger, but not dope her into a stupor. I don't want her to get kicked out. BUT if anger is so common, why don't I see the other residents (there are roughly 60 total) ever having an outburst. Are they all doped up? Grrr...frustrated.

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I would astonished if none of the other residents ever had these issues. Next time you're hanging around in the unit twiddling your thumbs while you wait to speak to the DoN or for your mother's clothes to be changed, see if you can catch the eye of fellow family members. Pound to a penny at least *some* of them feel exactly the same as you.

And, not to be cynical, but it could be that some of them aren't quite so punctilious about that fine line any more.

Remember those happy teenage years when you had a massive zit on your nose and you were sure the entire world was pointing and laughing? In reality, they were far more concerned about the spots on their own noses that you didn't even notice.
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Countrymouse, that is so true, I tell my teenagers that all the time!
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Make sure your mom is tested for a UTI.
Perhaps you could also ask for a consult with a geriatric physiatrist to adjust her meds.
Come back and tell us what the neurologist has to say.
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Mom has tested negative for the UTI and in addition to the neurologist, we are going to get a second opinion from another trusted doctor in the dementia community. I'll keep the geriatric physiatrist as an option as well.
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Just because something is normal doesn't mean everyone with dementia experiences all the symptoms all the time and to the same degree. To run with Countrymouse's teenager analogy: it may be "normal" for the average teen to have pimples but not every teen has them every day, and unfortunately there are some who have such ferocious acne that before the days of modern treatments they were left with permanent scars.
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So here is the update from the neurologist appointment: Mom's disease is progressing, she scored lower on one of the cognitive tests and showed that more areas in her brain are suffering the effects of the brain damage.

The Ativan has only been given six times, so the doped up state I have been seeing is most likely Mom's body adjusting to the increase in her other meds (the mood medicines were increased) and they changed the form from Depakote to Depakene, so another adjustment. Apparently Depakene is faster acting.

If the sedation affect doesn't even out, we are to consider lowering those mood medicine's a tiny bit, and if her anger and rage continue on or get worse, we can then try a different medicine called Seroquel. (at least we have options)

I notice a huge improvement in her mood and her mind function after her work out sessions at the gym, so I have added a 3rd one to her week. Unfortunately, she's beyond the whole reasoning thing it seems. I used to be able to reassure her that she worked out twice a week, and it would satisfy her somewhat, but now if the answer isn't an IMMEDIATE yes, work out is today, she kind of goes off the deep end.

We will see if added that 3rd work out helps overall or just helps in the moment.

I also spoke with the head nurse at her Memory Care home and asked if Mom was close to being given an ejection notice, and she laughed and said, not at all, they would let me know if their concerns started being that serious.

I guess it's good Mom hasn't actually hit anyone, and apparently the staff is fair game, other residents are not.

Other residents apparently do yell, got a story today from the staff: (and I find this humorous) One of the other residents was apparently yelling about having to use a walker (try getting someone with no short term memory to remember they now have to use a walker) and Mom came out of her room to tell that resident that they didn't have to yell about it, and apparently they both started yelling at each other.

I don't know how anyone can keep a straight face at that point. The whole scenario just tickles me. Of course, that's because I didn't have to calm anyone down, but still. Mom (who's been having yelling/screaming outbursts) telling someone else not to yell!
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Hee! Oh my....
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Definitely have her seen by the geriatric psychiatrist. I know how you feel. I came to pick my mom up to take her out for the day at the nursing home. She told me that a woman had gotten arrested for killing a baby in her room! When I told her that couldn't possibly be true and even showed her that the lady in question was still in her room, she dismissed it. When i got to my mom's room, she had packed up everything and told me she didn't care where she went, but she wasn't staying there. I was at a loss. I couldn't take her out like that because I doubt she would willingly go back. She started screaming at me and her roomate, told me the nurse was having sex at night with the sides and then spit at me. The nurse told me to just leave and not worry about it. They are used to handling these things and that my mom was worse once I got there. I left, had the nurse speak to the phlsychiatirst and eventually her meds got straightened out and my mom settled down. There were a bunch of times where she smashed her rollator into the elevator or away from her and fell. She also accused her roommate of having her blood drawn in the middle of the night at a residents council meeting. You are definitely not alone.

The extra therapy is great. Try watching some Teepa Snow videos if you haven't already. She can help with how to handle when your mom gets mad it isn't therapy day.
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jj and staaar, these stories are humbling, amusing, and touching. jj, it’s interesting to note that these happen when the family person is there... so at least you know that.
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Listening to your stories makes me feel not alone! My mom was just taken out of NH for swinging at the staff and cursing up a storm and taken to the geriatric psych unit. I do hope some type of medication will work for my mom as the NH she is in doesn’t seem to tolerate her well. Although another resident at her place as I walked by him told me “f you, drop dead” but I guess because my mom is continually doing it they aren’t able to handle her. I don’t want her kicked out! I hope everyone’s loved ones get calmed down!
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One of the pluses of having my mother in AL is I knew she would behave herself when people outside the family are around. She’s always set great store in behaving like a ‘lady’ and ladies don’t curse and hit.

And yet, before she went to Geri Psych and got proper medication that’s what she was doing at home. I’m so glad she’s calm now, she’s happier.
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Starr, I just found out that our area is seriously lacking in quality psychiatric care for the elderly. The closest unit that the head nurse trusts is about 3 hours away by drive. She also says we don't really have a decent geriatric psychiatrist in the area, but I'm glad she recommended the other doctor who is really good with medicine and the elderly even if his title is MD. His background is pharmacology, so that gives him an edge.

Last night we had a new, and hopefully fleeting new development. My Mom, who by the way had a lovely day out with her caregiver and gym training session, started spam calling me for about an hour before dinner. I spoke to her at the beginning of the hour, sure that since she had had such a lovely day, it would be a nice call.

NOPE

And then she proceeded to call me 15 more times and leave 12 voicemails. I finally answered the phone an hour later just before dinner, and it was surreal, it was like she had no recollection that the last hour she had spent calling me and talking to my voice mail. She was even in a decent mood?!? (she had only disowned me on one voice mail)

After Dinner, there was a repeat, she spam called me 12 more times, but this time left no voice mails (probably because my voice mail was full) and stopped after about 30 minutes.

UGH. I hope this pattern doesn't stick.

EricaMagoo, we can do this!
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Not to make light of the situation, as I know how upsetting it is to see the decline with the awful outbursts. But I was accused of going # 2 in my mother's depends, while she was wearing them mind you, which happened before I even arrived that day. I was torn between a giggle and tears of sadness. Didn't show either expression though, that would have been like throwing gas into a fire.
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There are as many manifestations of anger as there are personalities. Some people tend to have outbursts, just as they did before their illness; others hold back the outbursts thus becoming confused and bothered. My Mom is like that. She was always a quiet and very private person, never expressing anger outward. Always careful about social standing. Now, she gets angry within and expresses it by going into her shell and feeling bad about loosing her memory...she is in the mid-to-advanced stages.
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JJ I HOPE I CAN DO THIS! I live in Canada while mom is in NJ and i am the only child and i can tell you right now I’m emotionally and mentally drained. I do understand the disowning because as soon as I don’t give my mom what she wants such as taking her home, I’m the most awful person and she should of never had kids, every name in the book & disowned to only get a call the next day with no recollection and the process starts again. I’m learning and reading up on how to deal with a person with dementia and that is to never tell them “they can’t or they are wrong” because I’m just asking for her to get nasty! My mom was always someone who got nasty when she didn’t get what she wanted and a very vocal person however with dementia it’s over the top! I hope they actually get her up to the Geri Psych if the hospital and things can get evened out
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I'd like to share this resource:
alzheimersreadingroom.com
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I have heard and read that most outbursts are only in front of family.

This could explain why you only see your Mom having outbursts. I'm guessing that others go through it when they visit their LO's too.

I'm sorry - it has to be hard on you. You make time to visit and probably get yelled at the entire visit.
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It is not unusual for people with dementia to have angry outbursts. I worked in memory care units for years ,both as a nurse ,and then as an activity coordinator. I think sometimes the dementia clients just get very frustrated, scared and confused by changes in themselves. Their dementia alters their perception of their environment and they often feel threatened by the strangeness of their world!
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Some of these comments remind me of a woman in my mother's nursing home. I've been told his woman, who is probably only about 50 y/o but is in a wheelchair, has some form of schizophrenia that makes her believe some person or monster is hiding under the furniture so she often yells "Die!" at random times, and makes strange and insulting comments, including racial slurs, to visitors, residents and staff. One day she said "You're ugly!" as I walked by, so I said "Thanks; that's the only compliment I've had all day!" A staff member told me this woman has a problem and I shouldn't be offended by her comments, so I answered that I've seen her there for 4 years so I know about her and don't take anything personally. She never attacks anyone physically, so all one can do is wait to hear how "creative" a comment she can come up with. I think most people simply ignore her.
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I also would like to refer you back to this aging care discussion about namenda causing aggression if it applies to you...
https://www.agingcare.com/questions/namenda-causing-aggression-168721.htm
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Thanks, Dianelisa, My mom is on Namenda aka memantine, however her anger started a long time before they added that med.
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Tiffany, you have to make light, or rather, try to find the humor, it's either that or plummet into depression, and I would rather search for the humor. Thank you for that story...I haven't been accused of anything quite like that yet, but it's good to know it might be on the horizon. ha ha
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My wife, who is in an assisted living/memory care facility, has anger outbursts and will not listen to reason on some days, while she is easy going and happy on other days. I was thinking exactly as you, in that I saw no other resident ever having an outburst. I had intended to ask the nurses about this, but your post let me know I'm not the only one.
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JJ, you are where I was about two years ago. I was knee deep in end of year bookwork for my husband's business when I got the repetitive phone calls. Mom alternately called my cell phone and my landline. I answered the first couple of calls and then let them go to voicemail. The messages were angry. I decided to check her phone log (her cellphone was on my plan) and found that she was making lots of calls, some to random numbers at all hours of the day. I talked to staff and it was decided that her phone needed to go. I told her that I had tried to call her (a therapeutic fib) and got an error message so I needed to take her phone in for repair. The staff kept reminding her when she said she couldn't find her phone. The following month she was moved to the memory care wing and I told her that phones weren't allowed there because other residents might take them (easy for her to believe because she thought people were stealing her things whenever she misplaced something). We told her that she could use the phone at the staff desk whenever she needed to make a call. For a while she would demand to call me. Sometimes the staff would let her call, but most of the time they would pretend to call me and when I didn't answer they pretended to leave a message. It was hard to take her phone away, but it was contributing to her angry outbursts so it had to be done.

Like you, I rarely saw angry outbursts from the other residents. Some residents' personalities were not as volatile as others', and some were just at a different place in the dementia journey. Much of my mother's anger was directed at me, so I learned to keep my visits short, and when I couldn't keep the conversation from veering off to something that would trigger her anger I made an excuse and left. Now that she is gone, I have some guilt that I didn't spend more time with her, but triggering an angry outburst was not in her best interest, either.

She was taking medications and was seen by a geriatric psychiatrist, but I was never able to determine how much they helped. As her confusion increased, her anger decreased, so I believe that fear and frustration with her diminishing abilities was the main cause of the anger This is not something that you can fix.
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Thank you akdaughter, I appreciate you sharing your experience. I believe that the anger is like you say, a direct result of fear and frustration, and medicine can only help so much, and as her disease progresses, her ability to reason diminishes, and coping mechanisms go out the window. I can see it happening.

As for the short visits causing you guilt, I feel guilt on a regular basis about pretty much all of it, and then I realize it's not productive and I try to reason with myself. Some days I'm better at it, some days not so much, but really, the guilt has no place. If I were doing something wrong, then yes, but I'm not and neither did you, you had your Mom's best interests at heart, and so do I.

She's safe, she gets to do the things she enjoys, I see her way more often now that we are in the same state, like 1000x more, she is surrounded by people who care.
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Oftentimes, something is not as it seems, e.g. these other residents could be acting out during times that you're not there or it could be that they're showtiming because they see you there.
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JJGood19, you may find that you will have to take your Mom’s phone away. There will be a limit to your sanity, people can’t call if she is tying up your line, and it is not healthy for her to get that worked up anyway. Deep breathes and best wishes!
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JJ I’m still with ya in this. Went to visit my mother at the hospital nd she’s screaming at the top of her lungs and combative with the nurses! You can hear her down the hall! I’m the most awful person and callous and a bitch! A very unproductive visit. At one point she looked at me and asked if she could see her daughter! I feel hopeless right now but please know your mom is not the only one with angry outbursts, right now my mom is impossible! I hope the geriatric psych will do wonders otherwise I’m afraid the NH won’t take her back. I’m still in the middle of trying to get the Medicaid application done & spend down her money! Everything is just up in the air & I feel like I’m losing my own mind
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I use to work on an Alzheimer's wing at a nursing home. My guess is that you just haven't been there at the right time. Eventually as the disease progresses, there will be fear and angry outbursts. For many, it comes after the sky starts dimming towards nightfall. Others are that way because they also have other dementia issues, like vascular problems, or even glucose levels that are easy to fluctuate high and low. Some might get more aggressive and defensive as they find that they haven't seen loved ones in a while, and for some, one particular memory or realization that their memory is false is enough to do it. The thing with dementia is that it's not predictable as to when there's going to be a massive breakdown in mind to body communication, and nothing seems right.

As for doping up...unfortunately, if the doctor prescribes it for their safety and the safety of the other residents, then it does happen. However, they start low and slow for most issues. Also, in some places, not everyone there has dementia. They are there for other health reasons that mean they just can't care for themselves anymore and they somehow ended up there. But anti-anxiety meds are useful. I have seen some break through that med fog and attack other residents under the false view that the person was horribly insulting or about to hurt them. I've seen people who were considered to be very docile in nature cause real harm to others. No matter how many staff you have, the residents can suddenly act quickly and without warning. I doubt any staff member of a facility is one that has never been attacked themselves. I was attacked twice. Also, residents get hurt trying to do things under anger and upset. They fall forgetting they can't walk, and break things, which can lead to a major spiral towards death.

Speak to the faculty about the meds and ask them to always update you when she seems more aggressive than usual.
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My mom is still living at home with my dad, and goes from being totally normal to super angry and abusive without warning. She was always kind of strong willed, and that has now drifted into being completely focused on herself and how badly everyone around her has wrong her and what awful people we all are. Except the dog, whom she's going to run away with and live somewhere else. She thinks he can talk and narrates his dialogue for us constantly. The poor dog tries to hide from her as often as possible. (And no, she can't drive anymore, thank goodness!) Unfortunately her anger is becoming more and more aggressive over time. Tonight only a few minutes after conversing with her about dinner on the phone, I arrived at their house, but the moment I walked in she began screaming "why are you here? Why are you here?" She had no memory of the phone call, and proceeded to scream at me and my father for a good hour and a half. Many of her delusions are focused on money, and vague resentments of people she knew 50 and 60 years ago have blown up into gigantic delusions of how she was taken advantage of. She accuses me of having secret boyfriends who I spend all my money on (nope!) and that I bought teeth for some man in California (I can't figure that one out) and she used to make $500 an hour (nope) but none of the rest of us ever made a penny, and so on. She no longer remembers anything happy or fun or enjoyable from our lives; all those memories have vanished (I'm so thankful we have photos, or my daughter would think she was always like this!) and been replaced by anger and aggression and delusions. So it's impossible to get her to the doctor because we can't have a rational conversation with her, and can't physically carry her out to the car. I'd love to hear how some of you were able to get a parent in need of care actually into care!
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