rquellet Asked January 5, 2024

Ways to deal with a combative person with dementia?

My mother has severe dementia. We have the same routine every night. I will take her to the bathroom, get her ready for bed and she takes her meds. Every night when I go in her room to tell her that I need to help her up so I can help her to the bathroom, she gives me a mean look and just stares at me. She doesn't like to stand and walk because it hurts her back and knees. Once I get her up she's pretty good at walking, just slow. However, getting her to cooperate is horrible. She fights and struggles against the chair, refusing to help me. She pushes back with her feet and hits and kicks. She's very strong. I have to get her into the bathroom so she doesn't have an accident. What can I do? I get extremely anxiety filled every evening when I know that the battle is soon to begin. I try to be as nice and comforting as possible. She's fairly cooperative in the mornings and pleasant during the day. It's the evenings that are so horrible. Is there a way to overcome this? Is there something I could do different? She only uses the bathroom twice a day now because I can't get her to go. She says she doesn't have to when I ask. I know that she has to go in the evening. We barely get her on the toilet and she's going. I will take and suggestions. I am at my wits end and a stressed out wreck over this.

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First

I would recommend that you start to put your needs first, not hers.
If you get injured 'helping her' through these evening ordeals, who will be there for her? - and you? If you keep going, you will burn out and not be able to care for her - or yourself. You are at your wits end so it is time to stop and find an/other way. Even if it means placing her in a facility. And see below.

Medication?
Get a strong/er caregiver in at night to do this.
Don't argue.

There is nothing you could do different wherein she will be 'nice' and agreeable to what you are doing. She hurts physically. Mentally/psychologically she may believe that you are (wanting to) hurting her so she is rebelling. And, she may 'just' be so confused that she is angry and/or in a self-protection mood.

The one behavior you do not do is 'push against' / argue.
This makes everything worse.

Get a caregiver in there asap for the evening needs, including showers.
Do not ask. She cannot make these decisions. Introduce her to your NEW FRIEND.

Gena / Touch Matters

Helpful Answer (17)

My mother’s behavior changed dramatically after going on Ativan and Seroquel. She was finally able to get some rest at night.

Mom wore Depends at night. I did put a bedside commode next to her.

Helpful Answer (12)

Consider putting a commode next to her bed so she only has a minimum distance to travel to relieve herself, or get rid of all her cloth undies and replace them with disposable briefs (maybe the kind with velcro tabs for easier on and off).

Agree regarding meds.

She is no longer able to bring her broken mind to a place of cooperation and acceptance because she isn't able to figure out how to communicate her feelings and needs, so it is merciful to help her with this. It may not be a perfect solution and it may require trying several different drugs at different dosages before you find a good fit.

You will need to readjust your expectations and pick your battles so you don't burn out.

I also agree to maybe tour some facilities and figure out the financing of such so that you never have to do it in a crisis.

Helpful Answer (11)

I did that for my mom. I put a bedside commode next to her bed. It did help.

(5)

Sounds like Mom is sundowning and I think for some that suffer from Dementia it can last for a few hours.

Yes, ask the Dr for something to calm her.

Helpful Answer (10)

I agree with Lea that it's time to discuss medications with the MD. Sometimes you don't even need sedative type things. For some, a low dose anti-depressant improves overall mood, and may be worth a try.

I know that you already likely know that you may be looking at a time when this isn't doable by one person in-home, so I will surely spare you that whole talk until you come to us wanting to discuss it.

I surely do wish you the best of luck but the only recommend I have for you, being you are pretty much a pro at this, is to discuss with the Doc. I hope you'll update us.

Helpful Answer (8)

This became a problem with my mother in the last 8 months of her life. She was prescribed Seroquel. It made all the difference. Good luck. This is a very difficult situation.

Helpful Answer (8)

My mom has had the same issue. The Seroquel seemed to have helped (something did) but it took a week or so to work. Also, a uti can cause some of these same issues. We put her on an antibiotic for that at about the same time as starting the Seroquel so that's why I say "something" worked. She is off the antibiotic and is still no longer combative...knock on wood.

(1)

Is she on a calming medication like Ativan which can help? You can consider putting her in disposable briefs for the night and do away with the toileting entirely. The vast majority of elders with advanced dementia do wear disposable briefs due to incontinence.

Best of luck to you.

Helpful Answer (7)

We have had a very similar problem, mostly surrounding the bathroom and Mom now takes 1/2 a 5mg Lorazepam in the morning and the other 1/2 in the afternoon which makes the bathroom trips (she is incontinent) and night time routine so much better for all of us.

Helpful Answer (7)

My mother also gets Lorazepam. She gets the liquid and I squirt it into her mouth with an oral syringe. It's been a life saver.

At night, I also use a bedside commode so she doesn't have to walk to the bathroom. Easier for both of us. I use commode liners with pads that I buy on Amazon or Walmart which make cleanup a breeze. Here's a link:

https://www.amazon.com/OUMEE-Commode-Absorbent-Portable-Disposable/dp/B0BQWLVGBW/ref=sr_1_1_sspa?crid=36LY34X7OEQKI&keywords=commode+liners+and+pads&qid=1705072160&sprefix=commode+liners+and+pa%2Caps%2C590&sr=8-1-spons&sp_csd=d2lkZ2V0TmFtZT1zcF9hdGY&psc=1

(10)

I agree that the judicious use of meds can make a world of difference in managing elders who are combative.

DO NOT worry about addiction or what 'the neighbors might think--we're drugging mom to keep her manageable'.

Do what you HAVE to to get her to be cooperative. My MIL takes Ativan in the day and Xanax at bedtime. (Why the combo, IDK). Without the Xanax at night, she is completely incapable of cooperating with her kids who are her CG's.

I joke with DH as he tries to make her 'understand' b/c he can't. I said "Give a Xanax to Mom and you take one too". I'm joking, of course, but the point is, they BOTH get agitated and upset when she's not cooperative. And once she gets to raging--well, forget it, she is impossible.

She does toilet herself, but wears Depends all day. They are pretty well soaked, but she can change herself.

There's no way in the world she would put up with a commode in her bedroom. I bet a lot of seniors feel that way. (I would.)

Helpful Answer (6)

I get that the idea seems unsanitary. My 94-yr old Mom has one in her room on and off (her choice). As a retired RN she knows that many senior falls happen at night on the way to the bathroom. The OP's Mom has "severe dementia" so I doubt she may have an opinion about it.

(6)

This is so common with Alzheimers. My father was living in a memory care facility and he had a standing Rx for Ativan 30 minutes before showering. Sounds like she may need some meds to calm her and help you manage. Not sure if its fear, invasion of privacy or a bit of both, but very common. Also I suggest setting a reasonable goal for weekly showers, my father had 3 and this was a huge accomplishment!! You cant look at it with your standards so you just have to accept what is doable.

hope this helps!

Helpful Answer (6)