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CARENOTES | Past Carenotes | Let's Talk


Welcome to CareNotes. In this special section we will feature a reader's letter and provide an opportunity for an interactive exchange that will help find some answers and possible solutions to concerns. If you wish to respond to this letter, simple follow the link provided at the end of the letter and add your comments and thoughts to our CareNotes Board.

This Week's Carenote - 1/14/14


I receive your newsletter and have gotten valuable information from it. We are currently experiencing an extremely difficult time with my father who is in assisted living along with my mother. He has better abilities than she, though his eyesight and mobility are issues. Even if it were not for her limitations, which are growing more and more, he would no longer be able to live alone.

Since we made the change to assisted living, he has felt "trapped." He has never aged "gracefully" and doesn’t accept his limitations; thus he gets hurt, makes bad decisions, and gets very grumpy. He is not just belligerent, but almost violent when he does not get his way. We fear that the facility will have to make a decision to move him out if he keeps this up. He has been violent at times, taking it out on my defenseless mom, my sister, and sometimes the nursing staff. We all know that there are no other options than for him to be where he is, and he knows this, too. But he hates where he is and we don’t know what to do with his mood. He is on anti-depressants and we have been juggling those for several months. This has helped, but nothing can "fix" things the way he wants them to be.

My sister and I are still very involved in their care; nothing like we moved them in and left them there. There is just no reasoning with him when he gets this way, and we know it is out of frustration of not being in his own home, not driving, and not having the freedom of coming and going as he pleases.

Caregivers Reply

Shared by: Gloria

when my dad was alive and rushed to the hospital for pneumonia, he didn't do anything they said to do. He was honory, stubborn, he was right and everyone else was wrong. This lasted for 7 days because they thought he was not a nice patient! So for 7 days they put the Hadol drug in his system. It is a drug they give to older people to calm them down. It's a drug mainly for schizoprhrenia, but found it useful in older people. It turned him into a psycho of a man. I never ever would see that my dad's hands and feet would be chained. I took matters in my own hands, got his records and even after my request of stopping the Haldol they kept injecting it. My dad was a good guy prior to pneumonia and yes stubborn and obstinent, would do things when he wants to, but after 14 days on Haldol, MY DAD DIED, overdose. Come to find out along the way my dad had lost his hearing and wouldn't acknowledge it to anyone, so they though that he was this and that, instead they killed him. Watch out for the entire medical field. I hope you find home care for your parents. I've been a full-time caregiver for my mom (5 years past stroke) she's home and couldn't be happier. God's blessings to you and sister.

Shared by: Kelly Sheets

As you described your father's situation I can feel his panic and fear. Fear is the foundation of anger. Fear of losing control, fear of declining, fear of being around all those other "old people", fear of losing his wife, his mind and his life. Fear of losing his freedom. And right back around to fear of losing control.

I have worked with seniors for over 15 years in some amazing assisted living communities - but the beauty and comforts do not alleviate that feeling of being trapped. Ask the staff and they will tell you how much they value their freedom to leave at the end of the shift.

Our senior care model has moved increasingly towards a medical model that prescribes drugs to "deal with the issue". But drugs don't get to the source. Using drugs may be helpful along the way as a tool, but I also agree that having someone to speak with that can offer support - without the threat of losing more control - may help your father acknowledge his fears. I sadly see that often in senior care we (families and staff) all tend to pretend that "everything will be ok" or tell stories to ourselves and others that actually just avoid the emotional pain involved in the reality of moving into senior communities. Many times I have simply spoken of the fear and what I might feel if I was in their situation and without trying to fix anything, a conversation evolves that helps them begin to process their current situation. Fear and anger are feelings that get bottled up so perhaps also increasing movement or ways to verbally express himself can diffuse o r burn up some of his held tension.

Shared by: Norma
Orlando FL

I can understand his frustration. Did you consider having in home services for your Mom & Dad instead of putting them in an Assisted Living?

Shared by: Kate Kunk, R.N.
Indianapolis, IN

Many of us who have been caregivers can relate to this issue. Given the dramatic lifestyle losses represented, perhaps even you and I would respond similarly in the same circumstances. In other words, depression and bad behavior are somewhat common responses, at least initially. However, since they are unacceptable for optimal quality of life, it is important to look beyond circumstances in case there are other contributing factors.

For example, how long have your parents been at this facility? Older people often require substantially more time to adapt to changes. Did the driving and other independent activities end at the same time they moved? Multiple losses all at the same time would be overwhelming for most of us, as I'm sure you can imagine. With time, perhaps the “strangeness” will wear off. Hopefully, he will develop an interest in some activities there and will have an opportunity to establish some friendships that give new meaning to his days.

In the meantime, PLEASE NOTE that it is extremely important to try to consider what things could be going on organically and have him checked out physically by a geriatrician as soon as possible. Is there a history of vascular problems? Is he eating well? Is he consistently well hydrated? Does he get sufficient exercise for good circulation (essential for mood)? There are many, many conditions that can exacerbate behavioral symptoms—and, for that matter, it can be very confusing to the body to experiment with medications, especially those that affect mood. You mention that you have been “juggling” with antidepressants for several months and, although this therapy has helped, the behaviors continue. Again, I would say—have everything checked (i.e. labs) if you haven’t done so, because there may be some underlying issue. I read an interesting article yesterday at about studies conducted and reported in the December 15, 2013 edition of Biological Psychiatry (medical journal) with regard to zinc levels and depression in older adults, just as one example. Imagine that! A simple zinc deficiency is known to be related to depression in older persons. Does that mean we start stuffing zinc? No, of course not—but it certainly supports the urgency of having a geriatrician look for and consider all possible variables influencing behavior.

In summary—give your father time socially, have him checked comprehensively, try not to worry—and give yourself and your sister a big ol' pat on the back for being good daughters.

Shared by: Sandi
Fargo ND

Have you thought about talking with his doctor, (who should then be the one to tell him) and getting a referral to a geriatric counselor/psychologist?? Instead of dosing with drugs, lets get someone talking with him about his feelings also. How did your dad manage changes before? Aging is hard work. It is hard to adjust to multiple changes. How about a Faith Community Nurse to visit with him? Or a pastor/priest? Gracious acceptance of becoming 'old' and needing more help is one of the steps in our journey. Maybe he is doing it the best he can. Maybe you and your sister need to verbalize to him that you see how hard it is, but you feel hurt when he is so angry. Ask him what may make things better. Use examples of his parents (if you are able) and their aging, use this is a remembering story form. Some of his frustration may be due to LOSS and he isn't able to express it. Good luck!!

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