My Mom (93) had a stroke 6 weeks ago and is getting violent. Has anyone encountered this behavior?

My dad was in a facility when he went on hospice and the instructions were that he was to have Ativan PRN. And like what you've experienced, the nursing home was reluctant to give it at all. I tried to handle it myself with no success. I finally told hospice and they amended the orders to Ativan every 2 hours. No "as needed" attached. They bypassed the nursing home and had their own Dr. rewrite the orders.

Thank you all for your suggestions. We do not have hospice "facilities" per se in this area. Hospice is an overlay service added to SNF. At this point, she is now quiet and comfortable and in the "active phase" of dying. We don't expect her to last more than a few days.

I am right there with pamstegman...better advice you could not find.

Well, that leaves a couple things - something does hurt and she won't admit it or can't pin it down, OR she is angry and frustrated about being unable to communicate. My mo would say "no" to anything hurting, because at that very moment with her not moving or doing anything it didn't, but of ocourse it was why she could not move or do anything. They finally put her on regular, not PRN Tylenol and that worked pretty well. Speech therapy helped my mom a bunch with that - it did not make the aphasia go away, but it made it a little better, gave her a little awareness of it and allowed her to compensate, though inconsistently. Her vision was too bad for a picture board to work. There could be something she wants that she can't ask for - maybe going outside? maybe a different food? The guessing games are really hard, and when we had to guess what my mom wanted (she'd often say one thing but get very angry when we did that, and it wasn't what she really meant) it could be very stressful because her limited insight made her think we were all just a bunch of dolts for not understanding her and we;d be getting yelled at the whole time...not a happy memory to bring back. This really is a tough situation, and I hope something works for it!

Oy, thanks Pam. I should not email at red lights. Consult with a geriatric psychiatrist if you can!

babalou means ATIVAN, I think auto spell got her again.

In some elders, African can cause agitation

She has had UTIs, and is currently on antibiotics for a recent one about a week ago but we have seen no improvement in her mental state now, as it has cleared up.
She does not appear to be in pain and has said no when ask in the past. Yes, it was 2 large (bilateral) strokes, that have severely affected her verbal abilities and cognition. We understand her confusion & problems communicating but are having a tough time experiencing these violent out bursts. They are now giving her the Ativan twice a day but we have not seen any improvement in the lat 2 days. Time to go back to hospice and ask them to re-evaluate her dosage.

Yeah, this does not sound right. Something hurts her and/or she's got an infection and I take it the stroke was a bad one and she can't communicate verbally?

Would it be possible she has a UTI? I remember reading here that a UTI in an elderly person can cause all types of different and strange behavior, even violence.

PRN is for pro re nata, which means as needed. Just looked it up.

There is more than just Ativan I hope. She needs something for delirium. This is beyond the SNF capabilities. Move her to a Hospice Facility.

Sorry to have used jargon! But the doc needs to know that her behavior is deteriorating. Something stronger may be needed. Hospice is supposed to be about comfort care and she doesn't sound comfortable. so make sure the Hospice folks know what is going on.

Cdeh61 "PRN" means "as needed", instead of another option, which would be BID or twice a day, usually 12 hours apart. So the PRN is more general and not specific as to when it should be given, giving the skilled nursing facility the option of giving it or not giving it, depending on what they think is best. If the doctor thinks she should have it 2X a day, he needs to write the prescription for BID.

What is PRN? The most recent order was to give it to her routinely, twice a day. It was explained to me that California is very strict about giving drugs like Ativan and that with input from family - in essence requesting the drug - they would then give it to her? She is not terminal from anything else. She refuses to eat and will only take sips of water & Ensure. She is slowly dying.

Any change in mental status like this should be reported to the doctor. Is she on Hospice because she's terminal from something other than the stroke and/or Alzheimer's?

Diane; The SNF is reluctant to give the Ativan? Was the order written PRN? If so, get the doc to change it to scheduled, as in, they give it to her. Call the Hospice doc right away and report what is happening.