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She has begun to have negative rude outbursts in the dining room and then has no memory of incident at all, denies it happened, and accuses staff of lying! She has never been social, rude, cold, judgemental, but can charm when necessary.  Neurological exam indicated only slight age related dementia so not cause of outbursts! I am at my wits end. I am called weekly and have asked that she be served in her room! Any help will be welcomed!!

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Whenever my mom showed signs of aggression my go to diagnosis was a UTI and I would say I was right about 90% of the time
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Nanajan;; Good Luck a low dose of some atavan , Lorzapam , xanex ,can do WONDERS but it can just be prescribed as needed PRN .....these things happen just talk to her Dr. They can prescribe a low dose that will help stop the sundowners HUGS TO YOU!!!!
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Tell them very simply YOU cannot fix it - that is their job. If they don't want her to have outbursts in the dining room, simple fix: HAVE HER EAT SEPARATELY. They do that here with these people and it solves endless problems.
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Dear NanaJan,

I understand how it feels to get the “does not play well with others” reports from the facility.

Personality aside, it seems that the episodes are dementia-related. It is good that they are tied to a specific activity, rather than generalized or unpredictable.

I agree that, if you can, you should be there during meals to observe for yourself. You will better understand what is happening. You know her well enough to see what might be causing her to be upset, or to see for yourself if it is random.

You might consider whether anything is going is going on with her physically that makes meals upsetting. My mom is slowly losing her word finding ability and cannot always tell me what is bothering her. Could it be a toothache or problem with dentures? Is she having difficulty sitting (a hemmeroid on a hard dining chair can be painful)? Is it becoming difficult for her to swallow or manage the fork? When these motor skills begin to decline, it can begin almost imperceptibly, but can cause distress and result in negative behaviors.

And, I agree with the recommendation to have a consult or other evaluation by a geriatrician or geriatric psychiatrist.

My own mom’s diagnostic tests did show some cognitive impairment and memory loss, very minimal shrinkage of brain mass, but no explanation for her extremely difficult behaviors.

The geriatric psychiatrist has been extremely good at connecting behaviors with what triggers them, and connecting her behaviors and symptoms to a diagnosis that finally makes sense. She does this through careful questions (of me, the caregiver and mom) and looking at mom’s medical history and neuro-psych evaluation)

And, if it is time to consider any medications to manage the behaviors, the geriatric psychiatrist is the best trained to do so with accuracy and appropriate cautions.

If this is the beginning of increased dementia and related behaviors, investing in this fact-finding now will better prepare you for her future needs which the facility may or may not be equipped to provide for.

Very best of of luck to you.
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Nanajan1234 Oct 2018
Thanks so much for your lengthy reply! I got the name of someone to take her to from My therapist last week! It makes perfect sense and could connect lots of dots and fill in many blanks. Thanks so much.
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Sadly, this is normal. She is no longer feeling constrained by inhibitions - we saw this with my "prim & proper" great aunt. Old "prim & proper" started swearing up a storm!
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My LO is TINY, and when she first entered her very well run AL, she was reported to have lost weight.
She herself always speaks very positively about the food, and we have provided nutritional supplements, so it was upsetting to me to try to understand why this was happening.
Yesterday I happened to make one of my frequent stops to visit, and for the first time in the few months since she’s lived there, I happened to stop just as lunch was being served.
When I entered the DR, my
The aromas in the dining room were delicious, her plate arrived, and it was beautifully arranged with small portions of very appetizing foods.
She picked up her fork and cleared the chicken and the broccoli, and ate at least some of the potato (“not cooked enough”).
At home, this tiny woman had the appetite of a stevedore!
The next time I see the diet manager, I’m going to mention that she might prefer a larger portion at her noon meal.
I also rely with confidence on staff observations and the recommendations of the very kind and capable psychiatric PA.
Amazingly, my LO sounds A LOT like some others mentioned here. Once a public figure in our community and a dearly loved but very self protective aunt, sister, Godmother and daughter, she also has hair done weekly and prefers privacy to group activity.
Sometimes dementia seems to me like a huge jig saw puzzle, and all I can hope (and pray) is that I can get the right pieces into the right
place as often as I find them.....
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Has she been checked for a UTI?

I would question the dx of " only mild age related dementia". Consider a consult with a geriatric psychiatrist.
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Babs75 Oct 2018
Yes, I would question that also. My 92 year old dad was officially diagnosed with dementia by his geriatric psychiatrist earlier this year. I have noticed his outbursts are happening more and more. The cab company called and 'politely' asked him if he could maybe talk to the cab drivers a little nicer (he takes a cab to the senior center and had an outburst with the cab driver the other day when he was going the wrong direction.) He had another one the day after that when the line at the store was moving too slow for him (not the first time). The caregiver had to try and calm him down. Seems to be happening more and more often. And he is checked for UTI's on a regular basis by the doctor.
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Maybe those other residents get on her last nerve.
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Ree111 Oct 2018
Yes I can relate! My mother can’t handle the sounds the other residents make so will yell “Shut Up!”
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A little memantine from the neurologist would help or something for anxiety from a psychiatrist.
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Babs75 Oct 2018
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Thanks everyone for replying and your helpful suggestions. My moms health is surprisingly good for her age. She has she a sitter several times a week, but bathes and dresses herself, and faithfully has her hair and nails done each week. She has very few interests outside of the beauty shop and watches Judge Judy! 😳. I have decided to arrange for a Meeting with the incharge people and come to an understanding as to what is acceptable and what they can do to help better deal with these issues. I agree, this is their responsibility too and I should be more of a reinforcement to their protocol. I visit at least 2-3 times each week and so does my brother. In light of this last DR uproar, I asked them to serve her meals in her room for a while until I can figure things out and decide what to do. All the old sayings that we’ve all heard about aging are becoming less and less funny! It is so true thatOld Age is NOT for Sissies! Old age is often time the ugliest part of the life cycle! I have 2 grown sons and I’m actually starting to get a little nervous! I’m definitely going to make plans/decisions well in advance for myself....Thanks again for a much appreciated and safe place to turn for information, support, and venting! 😍
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MargaretMcKen Oct 2018
Why do you want to have them serve her meals in her room? Surely you don't need to 'decide what to do'. You can't be there for every mealtime, and it is the job of the facility staff to work out how to manage her and how to protect the other residents. In view of the denial etc, it does sound as though she is further down the difficult track than 'mild'. Your frequent visits and your wish to 'help' (which they may see as 'control') might be making things harder for the staff, as well as very difficult for you. Your proposed Meeting is a good idea, but it would probably be better not to assume that you are able or obliged to make all the decisions.
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I agree. My mom was always negative, judgmental and as she slid further down the dementia slope, she got downright rude. You couldn’t put her in a (dining) room full of strangers and say, “Ok, Mom. Now make a lot of friends and be nice,” Your Mom is more than likely reacting to someone she tried to interact with who probably wasn’t very nice to her. Now, she is understandably afraid to reach out to anyone else.

Its my belief that Activity Directors and Assistants have a broader job description than blowing up balloons and having the residents play balloon volleyball with each other. They should be encouraging the residents to “at least try” a few meals in the dining room with the general population.

My mother’s facility never called me about anything other than an emergency or change in meds. How often do you visit? I’d go twice a week. Visit at lunch and see what’s going on.
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shad250 Oct 2018
Many of these places are seriously understaffed (with good reason) so they try to do the bare minimum so as not to burn out.
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How is her health otherwise? I might check for UTI, vitamin deficiency, medication issue, etc. Is she on Palliative or Hospice care? First, I'd might inquire about the details and make sure that the staff isn't lying. Do they have videos to show what happened? We assume it's the senior who is confused, but, maybe, she was justified. I'd just confirm it.

Lastly, you could get a second opinion on the dementia diagnosis. At her age, I'm not sure how many more tests you want to put her through though. I'd likely explore if they could treat her with a med for anxiety, if the outbursts continue or as Cwillie states, move her to a different area in the dining room.
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An AL dining room can be worse than the high school lunch room - gossip, snippy remarks, cliques and all. Frankly I would tell the staff to stop calling you, they are taking her money and it is their task to deal with it. Perhaps she could be moved to a different table or seated alone, or they could ensure she is served first (or last) so that her time with the others is limited.
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