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My dad is mild to moderate stage dementia and is not dealing with it well psychologically. He already was a very volatile person at baseline, and he has really blown up at me the last few times we have visited with them - the last time locking me, my mom, and my family out of their house just as we were trying to leave (with him) for the day. My kids are now scared of him; I am worried about what he might do to my mom in a fit of rage



We have expressed all of this to his memory care team, who prescribed Lexapro for him. He has steadfastly refused to take it, and - other than mailing a follow up note - the mc team has not exactly pushed too hard. They basically said they didn't think he'd ever agree to take it.



He is mostly still capable of rational discussion, though he does not seem to understand that he has dementia. Is it worth trying to reason with him to start taking the medication? I know it's not a likely to be a silver bullet, but as I said I worry about this going down a very bad path and it may be our best hope.



Thank you!

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I’m so sorry that you are in this situation.

I cared for my mom who lived to be 95. She had Parkinson’s disease and didn’t have any dementia until later on in her life. She didn’t have a volatile personality like your dad has.

I didn’t experience what you are going through. We were never afraid of her.

It’s sad that your children are in this position with their grandfather. How old are they?

I don’t think that I would expose your children to his disturbing behavior if he doesn’t agree to try the meds. I would stress to them that their grandfather is having trouble and they aren’t in any way to blame for his behavior.

My dad had bladder cancer, heart disease and a stroke, no dementia. He died at age 85.

Stick around because many others on this forum have experience with dementia and can give you some insight on what to do in your situation.

Wishing you and your family all the best. Take care.
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comforteagle Dec 18, 2023
Yeah thanks for cutting to the chase - and for your empathy. The bottom line is: I'm just wondering how he'll respond to an ultimatum. If it's almost guaranteed to be counterproductive, I don't want to waste the energy on it. Our kids are not that young - both middle school age - but it's got to be unsettling to see your Dad get screamed at repeatedly by an unhinged person. It's hard to explain that it will be fine... it doesn't seem fine!
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Is your dad in a facility?

The next time he "blows up", call 911 and get him admitted to the psychiatric unit of the best teaching hospital in his area.

Alternatively, get your mom someplace safe and then call Adult Protective Services and report a vulnerable adult with no care.
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comforteagle Dec 18, 2023
No they still live at home. And we are not local with them, so the interaction is limited. My understanding from the memory care team is that the police won't really step in unless there is obvious sign of imminent harm. They are not going to cart someone off to a psych unit if they are just yelling at people.
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OP, what is the makeup of his “memory care team”?

Are they at all able to help you all manage his care?

Are they suggesting that he is “mostly capable of rational discussion”? “Moderate dementia”, if actually diagnosed, would suggest that that might not be the case.

It would seem that your mother’s welfare might be a more timely concern currently than his. Is anyone nearby watching out for her?
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comforteagle Dec 18, 2023
Good questions. The two primary MC people are a nurse practitioner who deals with the medical side of things and a social worker who's managing the "care plan". The NP seems stretched pretty thin. The social worker is generous with her time, but is more on the side of aiming for perfection in terms of providing an environment for him to thrive - rather than taking into account the practical constraints of our family's situation. She is definitely on my Mom's side, but she pushes things

That "rational discussion" is my take. You can have real conversations with him - he's scoring I think around 19 on the MoCA. So in the low mild range from what I understand. Rationality-wise he's in the low mild range. Emotionally he's in the high moderate range. That is my opinion.

And yeah they are active in their church and have friends in their neighborhood. So she is not isolated, but I know it's really hard on her - and I really wish the MC folks would be a little more assertive about him starting on these meds. Because it seems like this is careening towards a bad outcome.
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You mention a "memory care team"
BUT
You mention last time you visited he locked everyone out of their home.
Then you tell us in the responses that he is still at home.
That there can be no EMS intervention unless things are more severe.

My advice. LIE. Whomever is the POA needs to call EMS and have him involuntarily committed for assessment at the hospital or a neuro-psyc unit. Someone could get hurt here.
I am not clear who the POA is and I surely don't understand some MC "team" that lets this go on in this manner.
It is time for placement. And he will be a difficult placement.
This isn't depression; it is dementia with a violent and angry component and he needs treatment. Without a full workup there can be none.

So basically I am telling you that whatever lies you need to tell to get him assess then you need to tell them and get him assessed. It isn't OK that a family is held hostage to a man who may go on a rampage at any moment.
Catch words:
"We are not safe with this volatile acting out. My Mother is afraid."
"He has no awareness of what he is doing, has done. He has locked us out. We are afraid".

So try that memory care soon and let them know you are very close to the "ER DUMP" if that's what you must do to protect the family.
If medications are tried and work, then you can move on from there. But I have found they often don't work unless used in too large amount to have someone safely cared for in the home.

Good luck. I imagine you are dealing with this for some time before writing us and recognize it is worsening. It must be addressed and the MC team is just wanting to answer, ignore, and then deem this OK, all fixed. And you know it isn't.
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comforteagle Dec 18, 2023
Thank you for this. You feel bad in this situation watching someone descend into the condition, and it's natural to want to approach everything with a sense of compassion towards them. Nobody's perfect, and whatever their preexisting flaws, if you've made it this far you've accepted them to a degree. So with all of that, it's easy to inch along and get to a pretty scary point without realizing you are there. But yeah, thank you. It seems like the appropriate course of action is clear.
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