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My 92-year-old mother has Alzheimer's and has recently begun waking in the middle of the night warning other residents of a fire within the facility. She runs down the hall yelling fire while turning on their lights. The primary care physician prescribed Seroquel, but the psychiatric PA overrode the order and has prescribed Risperdal. The Seroquel put her in a stupor, and so far the Risperdal hasn't had much affect. Hoping we can find a middle ground in her alertness while decreasing the bad behavior.

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If you have the authority, go with what her pcp says. At least the seroquel is quelling behaviors.
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I think your Mom is ready for Memory care or LTC if MC is not affordable. I am surprised the Administrator has not recommended this. IMO ur Mom is passed what an AL is able to cope with. Really, her crying fire is not fair to the cognitive residents living there and probably does a number those with Dementia. Residents pay big bucks to live there. They deserve to sleep in peace.
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Sounds like time for a more appropriate living setting, like memory care. And a better review of meds to find what works.
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Personally if my mom had a fellow resident {or my mom doing that} I would expect them to move her…My mom saw fires when first diagnosed with Lewy Body Dementia. Her hallucinations were short lived. She never disrupted others. I expect my mom to get peace and reasonable quiet for the high priced rent we pay in our assisted living facility. Our facility prides its self on a calm peaceful environment. Mom has thrived there. There are memory care units in her facility for behavior issues. I would expect residents with that behavior to move into one of them. Mom and I have agreed she would be moved when her behavior gets disruptive to others. Good luck…such sad issues…
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My wife is in a facility and her roommate would not shut up. And another Down the hall was constantly screaming to let him out. These things do go on in these places and there is really nothing you can do except to get your loved one out. It is sad that this situation. Is what our medical care system has created.
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Is there a recent infection that could be behind this behaviour change?
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Yes, I went through that. She even took a swing at one of her (formerly) best friends. That earned her a trip to the local ER.
Long story short, after seven trips to the ER in ten days (yes, the family gets to pay for the ambulance ride back to the LTCF), she was sent to a Geriatric Psych unit. This place was excellent. They really got her stabilized. They also recommended permanent Memory Care and some lifestyle changes for both of us.

Was it perfect? Absolutely not. She thought she had been kidnaped by terrorists and flown to Germany (she was the daughter of an Army General, so she believed she was a valuable hostage). She wound up seeing the staff at MC as benevolent despots.

I would begin looking for Geriatric Psych hospitals in your area. They are not common, but a good one is worth whatever you pay for it.
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My niece would get called by staff about her FIL. She'd go over (leave work, a kid's softball game, etc.) and calm him down, get him to take his meds. (She's a dementia whisperer.)
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MHHE1967 Apr 2022
What is a dementia whisperer?
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Putting someone in a home at their age is unthinkable to me. Trying to change someone's rituals they have been doing all their life. If they have had a mind set of going from the get go and know what is going on is one thing but someone confused already,, I can understand them being hard to handle. Keep them where they know their surroundings. I would get an in home caregiver before even considering it. I do know, no matter what, some elderly just looses their minds and it is what it is but try to do whatever it is with compassion.
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PeggySue2020 Mar 2022
If this elder was at home they could well be wandering their neighborhood knocking on door and screaming fire. That’s why the only place for them is a facility. To say nothing of that the home she wants to go to is gone, both in place and time.
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Stilwtrs003: Perhaps your mother requires a higher level of care, e.g. Memory Care.
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Is this regular Assisted Living your mom resides in, or Memory Care Assisted living? While you can't have her in a stupor, you also can't have her running down the halls screaming FIRE and disrupting all the other residents & scaring them silly while they're trying to sleep. You do have to find a middle ground with the meds, but I would insist on a geriatric psychiatrist rather than a PA to see her. PAs are all fine and well, but they do not replace a DOCTOR who's also a psychiatrist when it comes to treating an elder with this level of Alzheimer's going on. Plus, you have a conflict between the PCP and and the PA, disagreeing on the course of meds, which is wreaking havoc within your mom's body. She's experiencing a high level of agitation ie: running down the halls screaming, so she needs to be treated for acute symptoms with a med that will have a fast effect, like Ativan for instance. That will help her right away, whereas the other meds take time to build up in the bloodstream.

I sincerely hope the doctors can find an answer for your mom and get her to where SHE is calm and relaxed and can sleep through the night. I wouldn't question the fact that you placed her; just which meds she needs to calm her, that's all. Placement for an elder with advanced ALZ is often the only viable answer that makes sense for ALL concerned.

Wishing you the best of luck finding a solution.
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Get PCP to write several orders - for anxiety, for sleep, and for pain. She may need any one of them at various times throughout the day or night.
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My husband who is 70 years old has been in a MC since January. He was displaying occasional aggressive behaviors that appeared not to be triggered by any particular stimulus. He was sent to a senior behavioral unit for which I am thankful. They thoroughly evaluate the patients, tailor medications and consistently monitor blood and liver levels. I’d recommend a facility like this and wish I had sent my husband prior to MC placement. I was very opposed to medication. He had an absence seizures last June which spiraled his dementia decline. He is on Depakote, Serouquel and Lexipro. He has been there for a month and his being discharged on Monday. His pacing and behaviors have been significantly reduced and his responses to questions are appropriate. He appears alert, relaxed and happy which is all I want. Pray that his return will uneventful. Hired one/one aides for the transition period.
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How much Seroquel were they giving her?

Seroquel worked great for my mom! She started on 12.5 mg, half of one pill. Over the course of four years the dosage gradually increased to 75 mg. It was given once a day and continued to work well.
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Your mother is doing exactly what is expected from an advanced case of Alzheimer's. No medication will improve that. Psychotropic meds can either knock her out or kill her. She will have to be moved to a close unit where she can't cause too much disturbance. Her Alzheimer's is not likely to improve despite any attempts.
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