How to help aggressive/spiteful dementia patient?

Realize that her world does not make sense and that makes her feel frustrated and angry. She probably is not a good candidate for anti-anxiety medication given the poor state of her liver. You can try distracting her to more pleasant activities and topics of conversation.

Give the facility she's in permission to drug her as they see fit. She's suffering that is true, but that doesn't mean all the other residents and staff have to suffer because of her.

When she starts up just ignore her. I know that's easier said than done but try to. If you're not able to, end the visit or phone call when she gets to be too much.

I am very sorry for your situation but there's really nothing you can do for her.

Hi Memory50! It sounds like you have been a wonderful & loving daughter to a challenging personality but it's your mom. Yes. The hospice people are usually very good at their jobs. They know about meds & when to stop them usually. Shocking mom's not in the memory care (locked) unit. They deal with hitting and combative types. Yes the liver disease can also cause psychosis & confusion too. And the meds that are metabolized in the liver will be harder for MD to manage. Those were the hardest patients to care for. But hey! Memory50 only you know what you can handle with your mom. However as for her settling in- is there a social worker there to give ideas? The staff should have ideas. But for the most part, it sounds like you have done everything you could. Just know that this is not in your control. Pray. Be sure to care for yourself and have some support of friends/family and this community. Hopefully you can talk to your brother to help him along. If you pray and read the Bible that is the biggest comfort & support. Pray for guidance from God. That is best answer from me after you have done everything you can already. You are the best!

The agitation is caused by the multi infarcts. She has brain damage. My father & step father both had these problems. Depending on the part of the brain, you will see different problems. The frontal lobe hit causes most compulsive behavior. They aren't usually allowed to stay in general care when they are hitting staff. They could start hitting other patients. Seroquel used to be given to calm these behaviors. It's very very challenging to care for these patients. You need lots of patience, experience & knowledge. I think you also need help.

She needs medication to control agitation caused by dementia asap

Memory50: Your mother requires a higher level of managed care. She also needs a hospice evaluation stat.

Your empathy (and maybe a little guilt?) is showing. Your mother sees it, and it allows an opening for her to try and manipulate.
Every time she sees you, she gets to rant and complain and tell you how miserable she is and is probably hoping you will give in to her demands if she continues.
Think of a child who has a temper tantrum when they don't get their way, and yells their dissatisfaction, and repeats their "want" 100 times, hoping it will wear you down.

I think in this case, making yourself scarce, visiting less frequently will give her no audience for her complaints, and will give her time to try and settle in to her new routine. She has a competent staff to see to her needs, and opportunities to socialize with others in her living community. You can ask a staff member to check on her often, and to encourage her to participate in outings and activities.

When you do visit or call, don't let her see your sympathy. Keep an upbeat attitude, focus on the positives, and don't engage in any argument with her.
You will not be able to reason with her in her mental state.
If she continues to be difficult and causes harm to staff, other residents, or to herself, she will likely be kicked out. It's probably not worth telling her this, as it will only sound threatening and negative in the moment, and in the long run, she probably won't remember or it won't really compute.

While well intentioned, 'we put up her pictures to make her feel at home ..." - no this isn't going to work with all the variables / mental-cognitive issues you outline.

* Once you understand that you cannot appease her ... nothing will ... you can start to - not only - make decisions in her best interest, but in your best interest, too. .

* While empathizing is understandable, she is 'beyond' you empathizing in terms of directly addressing her "see what I am doing / done for you ... to feel more at home here?" when she is cognitively UNABLE to process this and changes that have been made and need to be made. She is FRIGHTENED, MAD/ANGRY (I don't need to tell you that), and she doesn't know what is happening nor what will happen.

* You need to take control of the situation in understanding her limitations due to her having lost brain functioning/brain cells. She is doing what she can - scream / express her fear and confusion.

* Consider medication; talk to the facility medical staff / administrator.

* The best one can do in these situations is 'self-protect' (do not take her behavior personally as it isn't (I know... not easy to do). As you can, let her rant to 'get it out' and then leave when you need to, saying "I am going to talk to the Director here and see what I can do for you." She may or may not get that, but saying it may get through ... although DO be aware of what is important:
- make eye contact
- hold her hand for reassurance (if you can)
- talk with a quiet / even tone of voice
+ These non-verbal behaviors will get through. And, the key is often non-verbal communication / interactions that make a difference to her (she feels safer, more ease due to feeling more relaxed [possibly] ) - verbal communication won't do it.

Yes, you 'hate seeing her like this.' This is understandable. However, the trick to improving attitude - is actually changing your attitude, not hers. The 'trick' part, which isn't a trick is mentioned above in how you communicate with her (eye contact, calm voice, reassurance --- and MEDICATION management.)

Yes, there is a negative loop - the brain 'does that' to the best of us with full brain capacity. (Read Rick Hanson's Buddha Brain). Check out TEEPA SNOW - her website, webinars, books, You Tubes. She is one of the country's best experts in dementia and how to work with / support people where they are.

And lastly, take care of yourself. Meditate, take walks in nature or knit - whatever relaxes you and shifts your feelings - mindset. This is a very difficult, heart wrenching situation. Be kind to yourself realizing you are doing your best to figure it all out. Often, for the best of us ... working with this population (i.e. dementia) in this field are perplexed and have to figure how communication and the best way to proceed ... the way I ... have proceeded is with educating myself with how the brain changes, knowing what I can do and can't do, developing compassion, not arguing or trying to convince (it doesn't work; they cannot comprehend due to the lack of brain cells / brain functioning). What a person with dementia GETS is ... kindness through actions as presented above. Be present with her as you can. Perhaps try massage / gentle touch. Stop 'thinking' you can talk to her to change her - you cannot. Educating yourself on dementia will help you learn how best to proceed / interact with her.

And, do know you are grieving a major loss, even while she is still here. Get therapy / counseling / support as you can / need to - to get your feelings out. Honor how you feel. It is a major loss. And, you do not want to see your mother like this - it hurts. She hurts. "If" it might help her, get volunteers or caregivers in to be with her.

Gena / Touch Matters

It is wonderful that your brother is managing her care. You know he's doing it at a distance from your mother so he does not have to deal with the verbal abuse. That is very healthy coping for him. You do not need to let her vent to you. She's most likely venting to everyone she can corner at the facility. I agree with those responders who have said not to take her calls daily, and to politely but firmly hang up when she starts her negative tyraid. So sorry you and your brother are dealing with this.

I agree with everyone. She needs to be in hospice. She has several terminal illnesses. No sense on being on any meds for any of them. Make her comfortable and maybe she can enjoy some time she has left.

Your mother is terminally ill with cirrhosis. No meds are going to cure it, only a liver transplant does that, and I'm sure she's not a candidate. That said, mom needs a hospice evaluation where she will be given calming medications not normally prescribed outside of hospice. If you want her to stay in managed care, her behavior must be brought to a manageable level where she's not making others miserable or trying to elope. I'd have her in Memory Care Assisted Living personally, with hospice on board, and meds to control her outbursts. For her sake and everyone else's. Sometimes there's no great answer, especially where dementia is concerned, so we take the least of the bad choices available.

Best of luck to you.

Put her in a locked memory care ward for her own good, and stop being so available to her. It’s only a matter of time before the facility she is in kicks her out.

Why are you disregarding her cluster B mental illnesses?

Your Mom should be in a Memory Care. Your brother should take her phone away and she should not be allowed to use the facility phone at all. Maybe you can get an Alexa where you can drop in to see how she is doing. Calling 911 is very serious.

Is Mom considered terminal? Are these meds just prolonging the inevitable? If so, why not get Hospice involved. All the life sustaining meds will be stopped. Only those for comfort will remain. No more doctors or poking and prodding.

@Memory50 - what I wanted to say to you is rather long and detailed - having a similar experience with a FIL with dementia and NPD. So I sent you a private message.

If you click on your initials in the top right corner and click Profile, it will take you to your messages.

Long and short - there is little you can do to help her settle. Cluster B personality disorders almost always exacerbate dementia.

Best of luck - and I'm happy to chat in messages if you like.

I didn't read what others said, so this may be repetitive.

There comes a time in are aging parents life that we just have to let go, or it will destroy are mental and physical health, we will ruin are healthy relationships, friends, job , the list goes on...

This sounds to me like , it's time, past time to do that. When your talking to mom , your not talking to the mom that raised you your talking to a very sick person.

There really is nothing more you can do for her. On top of the dementia, the liver and all the health issues cause more brain issues on top of it.

I feel your pain, unlike your mom my mom is aging at home, to make a long story short , I have no control, brother has it all. I visited yesterday and moms cold, her body can't control the heat anymore. She has the heat on 68, because that's where my brother wants it. My brother will have a fit if she turns the heat up.

So should when I leave feel sad,depressed have debilitating anxiety? I have no control, mom won't care what I say only what my brother says. So I can't bring this home and let it distory me. I have to move on, I have to make my own life, no matter how much it hurts, and stuff that inside me.

I have no control, which at this point you do not either.

Read the serenity prayer, a person of faith or not, that pray says it all.

There is very little you can do to help mom right now, and keep your sanity at the same time.

Very sorry for this

How long has it been since she was transitioned into the facility? Often it is suggested by admins to not visit or even call for about 2 weeks so that they can get acclimated.

If she's not on meds for her agitation/anxiety, why not? Even if she refuses to take them she can be held in a psych wing until she does. My cousin was held for about a month and then she finally relented. It is merciful to get meds into her. She can no longer bring her own self to a mental/emotional state of acceptance, so the meds are necessary.

I also wonder why she still has a phone? She's only using it to cause chaos. Take it away, at least until she calms down.

Dementia robs people of their reasoning and logic skills, so it is pointless to try to convince or impress anything upon her — you will wear yourself out trying. Dementia also robs people of their ability to empathize with others. Time and meds is what most likely will help her settle in.

This is her "fun"

It isn't anything you can do with a personality disordered case with dementia layered on top of it.

Most of us who grew up with dysfunctional parents learned early on how to be people pleasers to keep the peace.

My reaction to adult tantrums and threats is to ignore them. When she starts on her tirades, hang up. As a nurse told me once when I was on a case, don't accept disrespect.

Realize your mother is in a safe place getting three hots and a cot. If she is hitting and abusing staff, the next step would be a psych ward for medications to calm down this behavior. What more can you ask for. She had round the clock service with aides and other professionals. There is nothing you can do to make things better for her. Sorry to tell you, this is good as it gets for her.

I've reached a point that I can keep a person comfortable in bed and provide care to a certain extent, but when the abuse starts, I'm out. I'm not going to stick around to be slapped, bitten or kicked. This is when I detach emotionally and just make sure this person is not going to harm themselves, and I refuse to let them harm me in the process.

She won’t be there long if she keeps assaulting staff. She needs psych drugs that will make assault impossible.

It is truly an exercise in futility to argue with dementia. Stir in a few spices as in disorders and you have truly a nasty little mix. Ignore it. Visit infrequently and do not speak on the phone at all ever; in fact it is likely best that phones are now removed. If not you simply reply to complaints with "I am so sorry Mom. Love you. We will talk tomorrow". THAT IS IT.
There's nothing you an convince her about. A nice room? Nope. I don't think so.
I would watch a whole lot of Teepa Snow Videos to get an idea how to attempt to communicate best with the very demented.
You aren't responsible for happiness, and in fact, happiness for her is now a thing of the past. It won't return. And peace will come only with death. Those are the difficult truths.

Stop thinking of this in terms of "normal life". That is done where she is concerned. I am so very sorry. It is difficult to stand witness to.