Dad is getting combative, kicking and punching. Before this, I might have said at times he was agitated and couldn't sleep but now?

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marydys Asked June 2021

Dad is getting combative, kicking and punching. Before this, I might have said at times he was agitated and couldn't sleep but now?

So I guess this is maybe a new stage. Dad (93, on hospice) had another fall with no obvious injuries.. however he could have had another brain bleed. Since then he has been combative and aggressive and they are now giving him .5 Klonopin twice a day and he's asleep all the time. I obviously don't want him hurting his caregivers but I also don't like that he's asleep all the time.

To complicate things, dad has an undiagnosed adrenal insufficiency (possibly Addisons disease?) and is getting steroids to keep his electrolytes in order and keep his blood pressure up. When he's not on his steroid med, he's an absolute zombie, completely weak and sleepy. May as well be comatose. But with the right meds, he has had some quality of life.

So now he's taking steroid meds to get his BP up and make him alert and other meds (currently Klonopin) to make him sleep all the time. Makes no sense. I don't want him to have an adrenal crisis which could cause death, but on the other hand, if they intend to keep him asleep all the time, that's not much quality.

Has anyone faced a decision similar to this before? Any suggestions how to get things in the right balance?

End of Life Medications Violent Behavior

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score 0 · Answer 1

It’s true that my lines are ambiguous. Dads living will wants everything done short of resuscitation. (No CPR or ventilation). If he was sleeping because he was tired, it would feel differently to me. Being drugged to sleep when he is not in pain feels wrong but well I guess he’s agitated so there is mental anguish although (for all I know) it maybe because he doesn’t want to be drugged and asleep all the time. He’s not been exhibiting any end of life behaviors like not wanting to eat or different breathing. The last time I saw him awake he was in PT joking and walking up and down the hall quite well.

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score 1 · Answer 2

Wow.... Sounds like a very difficult situation! Instead of Klonopin, is there another medicine that would keep him calm like valium or something! I'm not a doctor, but you could have a conversation with his doctor! It may be that they are trying to keep him as comfortable as possible given his situation!

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score 4 · Answer 3

I walked through the home hospice experience with my dad. Even though he chose it for himself there were still times of doubt and worry. It’s a hard road. Please think about how scary it may likely be for your dad to feel things so out of control that he reacts by being aggressive and combative. The meds to calm this are a kindness to him. If he was his “former self” he might well tell you that life now isn’t worth the living. My dad certainly reached that point. Have a talk with his hospice nurse about the best plan for comfort, it’s what is important now

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score 6 · Answer 4

I've been following you for a while and I'm sorry to be so blunt but I'm just going to come right out and say it - why are you fighting so hard to keep him alive?
I would have liked my mother to live forever but at the same time I recognized she had zero quality of life and I just wanted her suffering to end. When I got a call that she had aspiration pneumonia I only hesitated for a split second before I said no to the hospital, and I was grateful they gave her enough meds to keep her zonked out of her mind for her final days.

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So basically you are saying I should have him taken off the steroids which is what I’m wondering as well. I’m not trying to “keep him alive,” but if he’s living I wanted him to have these steroids to give him some quality. Which they did. But not for very long. While it may sound easy to take him off these, I will feel that I’ve caused his death.

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Dad is getting combative, kicking and punching. Before this, I might have said at times he was agitated and couldn't sleep but now?

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